http://repository.usmf.md:80/xmlui/handle/20.500.12710/10713 2026-09-03T17:22:39Z http://repository.usmf.md:80/xmlui/handle/20.500.12710/29004 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 http://repository.usmf.md:80/xmlui/handle/20.500.12710/28452 Exploring the role of N-terminal pro-brain natriuretic peptide as a diagnostic biomarker in Kawasaki disease Duca, Alexandra Introduction. Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute febrile illness of unknown cause that stands out as a unique and challenging pediatric vasculitis, characterized by acute systemic inflammation and the potential for developing coronary artery complications. The most serious challenge is the development of coronary artery aneurysms, which are the predominant cause of morbidity and mortality among pediatric patients. Presently, the identification of KD relies on the manifestation of clinical features and lacks a distinct diagnostic biomarker. Aim of study. Exploring the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) blood concentrations and patients with acute and hyper-acute phases of KD. Methods and materials. Were analyzed articles available on online medical platforms such as PubMed Databases, Medscape and other scientific documents provided on Google Scholar. The most relevant 20 articles were selected and investigated, including case studies, which were published between 2014 and 2023. Results. The primary pathogenic occurrence in KD involves the activation of the innate immune system, leading to elevated secretion of interleukins (IL) 1, 4, 6, 10, and tumor necrosis factor (TNF). Given the significant evidence of myocardial engagement (often as myocarditis) in KD, new investigations have concentrated on exploring cardiac biomarkers, including serum NTproBNP - a biomarker, as well as a prohormone, released from the heart's ventricles in response to enhanced pressure and volume. It reflects cardiac stress and its significantly elevated levels may indicate myocardial dysfunction in children and infants with KD in acute and hyper-acute (≤4 days of fever, an insufficient duration for a conclusive diagnosis solely based on clinical criteria) phases of disease. In the acute phase of KD, NT-proBNP elevation primarily results from a combination of hemodynamic factors (myocardial stress due to pressure or volume overload and ventricular dysfunction) and non hemodynamic factors (myocardial inflammation, ischemia, and hypoxia). Higher NT-proBNP levels in the hyperacute phase are associated with an increased likelihood of coronary artery dilatation (CAD), which is a notable concern in KD. Furthermore, the lack of response to intravenous immunoglobulin (IVIG) therapy and the presence of coronary artery aneurysms (CAA) prove the elevated NT-proBNP levels, suggesting its prognostic utility. Conclusion. NT-proBNP levels could serve as an alternative indicator for distinguishing Kawasaki Disease from other febrile and infectious conditions. Additionally, it may forecast the engagement of coronary arteries, enhancing diagnostic precision, especially in instances with incomplete diagnostic criteria. an acute febrile illness of unknown cause that stands out as a unique and challenging pediatric vasculitis, characterized by acute systemic inflammation and the potential for developing coronary artery complications. The most serious challenge is the development of coronary artery aneurysms, which are the predominant cause of morbidity and mortality among pediatric patients. Presently, the identification of KD relies on the manifestation o f clinical features and lacks a distinct diagnostic biomarker. Aim of study. Exploring the relationship between serum N-terminal pro-b rain natriuretic peptide (NT-proBNP) blood concentrations and patients with acute an d hyper-acute phases of KD. Methods and materials. Were analyzed articles available on online medical platfo rms such as PubMed Databases, Medscape and other scientific documents provided on Google Scholar. The most relevant 20 articles were selected and investigated, i ncluding case studies, which were published between 2014 and 2023. Results. The primary pathogenic occurrence in KD involves the act ivation of the innate immune system, leading to elevated secretion of interleukins (IL) 1, 4, 6, 10, and tumor necrosis factor (TNF). Given the significant evidence of myocardial engag ement (often as myocarditis) in KD, new investigations have concentrated on exploring cardia c biomarkers, including serum NTproBNP - a biomarker, as well as a prohormone, released fr om the heart's ventricles in response to enhanced pressure and volume. It reflects cardiac stress a nd its significantly elevated levels may indicate myocardial dysfunction in children and infants w ith KD in acute and hyper-acute (≤4 days of fever, an insufficient duration for a conclusive dia gnosis solely based on clinical criteria) phases of disease. In the acute phase of KD, NT-proBNP elevation primarily results from a combination of hemodynamic factors (myocardial stress due to pressure o r volume overload and ventricular dysfunction) and non hemodynamic factors (myocardial in flammation, ischemia, and hypoxia). Higher NT-proBNP levels in the hyperacute phase are associa ted with an increased likelihood of coronary artery dilatation (CAD), which is a notable conc ern in KD. Furthermore, the lack of response to intravenous immunoglobulin (IVIG) therapy and t he presence of coronary artery aneurysms (CAA) prove the elevated NT-proBNP levels, suggesti ng its prognostic utility. Conclusion. NT-proBNP levels could serve as an alternative indicator fo r distinguishing Kawasaki Disease from other febrile and infectious co nditions. Additionally, it may forecast the engagement of coronary arteries, enhancing diagnostic prec ision, especially in instances with incomplete diagnostic criteria. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z http://repository.usmf.md:80/xmlui/handle/20.500.12710/28460 Metabolic peculiarities of immunotherapeutic medicines (chimeric antigen receptor t cells) used in cancer treatment (b-cell acute lymphoblastic leukemia) Sluchin, Andrei Introduction. In the dynamic realm of cancer therapeutics, many studies explore the metabolic nuances of Chimeric Antigen Receptor (CAR) T-cell therapy in treating B-cell acute lymphoblastic leukemia (B-ALL). Understanding these metabolic intricacies is pivotal for refining therapeutic strategies and improving patient outcomes. Advanced techniques and protocols guide this investigation-based review. Aim of study. to explore the most recent dates about the metabolic intricacies in Chimeric Antigen Receptor (CAR) T-cell therapy for B-cell acute lymphoblastic leukemia (B-ALL), which are guiding treatment optimization and enhancing patient outcomes. Methods and materials. This involved conducting an analytical literature review based on scientific articles using specific keywords: Chimeric Antigen Receptor (CAR) T-cell therapy and B-cell acute lymphoblastic leukemia (B-ALL). Through a comprehensive search on PubMed with the filters: clinical-trial, meta-analysis, in the last 5 years; 34 scientific articles were selected for the research topic.  Results. Scientific articles based on information unveiled significant metabolic alterations in Chimeric Antigen Receptor (CAR) T-cell therapy for B-cell acute lymphoblastic leukemia (BALL). CAR-T cells targeting CD-19, a key antigen expressed in B-cell malignancies- are the most commonly used combination to achieve the optimal therapeutic effect. There are distinct metabolic alterations induced by CAR-T cell therapy, revealing a pronounced shift towards glycolysis with concurrent suppression of oxidative phosphorylation. Notably, CD-28 and CD-3 coreceptor engagement played a crucial role in shaping the metabolic profile, influencing the magnitude of glycolytic flux and subsequent effector functions. Results of many studies highlight the intricate interplay between CD-19 targeting and coreceptor signaling in modulating CAR-T cell metabolism. Additionally, dynamic changes in amino acid metabolism and lipid biosynthesis took place, underscoring the multifaceted impact of immunotherapeutic interventions on cellular metabolic pathways. These findings provide valuable insights for optimizing CAR-T cell therapy efficacy and managing potential adverse effects.  Conclusion. The action of Chimeric antigen receptor (CAR) T-cell therapy for B-cell acute lymphoblastic leukemia (B-ALL) is based on complex mechanisms, including at the metabolic level. Deep knowledge of these modifications will allow optimization of therapeutic management and patient outcomes. nuances of Chimeric Antigen Receptor (CAR) T-cell therapy in treating B-cell acute lymphoblastic leukemia (B-ALL). Understanding these metaboli c intricacies is pivotal for refining therapeutic strategies and improving patient outcomes. Advance d techniques and protocols guide this investigation-based review. Aim of study. to explore the most recent dates about the metabolic in tricacies in Chimeric Antigen Receptor (CAR) T-cell therapy for B-cell acute lymphoblasti c leukemia (B-ALL), which are guiding treatment optimization and enhancing patient outcom es. Methods and materials. This involved conducting an analytical literature review based o n scientific articles using specific keywords: Chimeric Antigen R eceptor (CAR) T-cell therapy and B-cell acute lymphoblastic leukemia (B-ALL). Through a compre hensive search on PubMed with the filters: clinical-trial, meta-analysis, in the last 5 years; 34 scientific articles were selected for the research topic. Results. Scientific articles based on information unveiled signific ant metabolic alterations in Chimeric Antigen Receptor (CAR) T-cell therapy for B-cell acute lymphoblastic leukemia (BALL). CAR-T cells targeting CD-19, a key antigen expressed in B-cell malignancies- are the most commonly used combination to achieve the optimal therapeutic e ffect. There are distinct metabolic alterations induced by CAR-T cell therapy, revealing a prono unced shift towards glycolysis with concurrent suppression of oxidative phosphorylation. Notably, CD-28 and CD-3 coreceptor engagement played a crucial role in shaping the metabolic profile, influencing the magnitude of glycolytic flux and subsequent effector functions. Results of many studies highlight the intricate interplay between CD-19 targeting and coreceptor signaling in m odulating CAR-T cell metabolism. Additionally, dynamic changes in amino acid met abolism and lipid biosynthesis took place, underscoring the multifaceted impact of immunother apeutic interventions on cellular metabolic pathways. These findings provide valuable insigh ts for optimizing CAR-T cell therapy efficacy and managing potential adverse effects. Conclusion. The action of Chimeric antigen receptor (CAR) T-cell th erapy for B-cell acute lymphoblastic leukemia (B-ALL) is based on complex mechanism s, including at the metabolic level. Deep knowledge of these modifications will allow op timization of therapeutic management and patient outcomes. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z http://repository.usmf.md:80/xmlui/handle/20.500.12710/28464 The interplay of growth hormone, insulin-like growth factors, and cancer susceptibility: a medical perspective Briceag, Maria Introduction. GH and IGF-I, known for promoting growth, are under scrutiny for their potential involvement in cancer progression. While we understand their normal effects, the disruption caused by these factors and their role in cancer initiation remain mostly unknown. Studies on transgenic mice and cancer cell lines indicate their contribution to tumor development. Aim of study. To elucidate the intricate signaling pathways of growth hormone (GH) and insulinlike growth factors (IGFs) in cancer, providing foundational insights for targeted therapeutic interventions and advancing precision in cancer management. Methods and materials. This scientific review is founded on a meticulous examination of 20 specialized articles retrieved from reputable databases such as: PubMed, Bioscientifica, and ScienceDirect over the last five years. Conducted with precision, it aligns with key words like: growth hormone, insulin-like growth factors, and cancer. Results. GH and IGFs activate signaling pathways like Ras/MAPK and PI3K/Akt, fostering cell cycle progression and inhibiting apoptosis, which are critical in cancer development and progression. Abnormal activation of these pathways, often due to mutations in key elements like IGF-1R, can lead to uncontrolled cell division and oncogenesis. GH and IGFs also significantly contribute to angiogenesis, the formation of new blood vessels, crucial for tumor growth. They interact synergistically with factors like Vascular Endothelial Growth Factor (VEGF), amplifying angiogenesis and aiding in tissue repair and growth. In cancer, these hormones help tumor cells evade apoptosis and immune system detection, with IGFs exhibiting strong anti-apoptotic properties. Moreover, chronic hyperinsulinemia, a consequence of insulin resistance and metabolic disorders, characterized by elevated IGF-1 levels, is known to intensify the tumor-favorable environment in cancer. The tissue-specific effects of GH and IGFs vary across different cancer. Conclusion. Ongoing research unravels the intricate role of GH and IGF-1 as a critical nexus in oncology, highlighting their significant impact on cell proliferation, survival, and apoptosis. Innovative multidisciplinary strategies like IGF-trap molecules and GH receptor inhibitors offer promising avenues in disrupting pivotal signaling pathways. Comprehensive knowledge of the intricate hormonal balance of cancer paves the way for innovative therapeutic strategies in the combat against the disease. involvement in cancer progression. While we understand their normal effects, the disruption caused by these factors and their role in cancer initiat ion remain mostly unknown. Studies on transgenic mice and cancer cell lines indicate their contr ibution to tumor development. Aim of study. To elucidate the intricate signaling pathways of growth hor mone (GH) and insulinlike growth factors (IGFs) in cancer, providing foundational i nsights for targeted therapeutic interventions and advancing precision in cancer managemen t. Methods and materials. This scientific review is founded on a meticulous examinatio n of 20 specialized articles retrieved from reputable databases such as: PubMed, Bioscientifica, and ScienceDirect over the last five years. Conducted with precision, it aligns with key words like: growth hormone, insulin-like growth factors, and cancer . Results. GH and IGFs activate signaling pathways like Ras/MAPK and PI3K /Akt, fostering cell cycle progression and inhibiting apoptosis, which are critical in cancer development and progression. Abnormal activation of these pathways, ofte n due to mutations in key elements like IGF-1R, can lead to uncontrolled cell division and oncogenesi s. GH and IGFs also significantly contribute to angiogenesis, the formation of new blood ve ssels, crucial for tumor growth. They interact synergistically with factors like Vascular Endot helial Growth Factor (VEGF), amplifying angiogenesis and aiding in tissue repair and growth. In can cer, these hormones help tumor cells evade apoptosis and immune system detection, with IGFs exhibi ting strong anti-apoptotic properties. Moreover, chronic hyperinsulinemia, a consequence of insulin resistance and metabolic disorders, characterized by elevated IGF-1 levels, is known to intensify the tumor-favorable environment in cancer. The tissue-specific effects of GH and IGFs vary across different cancer. Conclusion. Ongoing research unravels the intricate role of GH and IGF-1 as a critical nexus in oncology, highlighting their significant impact on cell pr oliferation, survival, and apoptosis. Innovative multidisciplinary strategies like IGF-trap molec ules and GH receptor inhibitors offer promising avenues in disrupting pivotal signaling pathways. Com prehensive knowledge of the intricate hormonal balance of cancer paves the way f or innovative therapeutic strategies in the combat against the disease. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z