MedEspera 2024

Assessment of the cases of postpartum hemorrhage in multiparous women

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.

Acute viral infection as a trigger for DSNMG: a case report

2024-01-01T00:00:00Z

Acute viral infection as a trigger for DSNMG: a case report Stafi, Vlada; Stavila, Iulia; Tofan, Lucian Introduction. Categorical evidence shows that patients with Acute Respiratory Viral Infections have a higher risk of concurrently developing autoimmune diseases, reflecting phenotypic heterogeneity in MG. The association between Double Seronegative Myasthenia Gravis and Interstitial Pneumonia has been rarely reported in the Republic of Moldova. The present case aims to report the coexistence of dSNMG and ARVI confirmed in patient. Case presentation. Patient F, 58 years old, presented symptoms of ARVI, including sore throat, general weakness, headache for 10 days. On the 10th day, she developed general weakness, numbness throughout the body, with emphasis on the left hand, speech disturbances and diplopia. She sought medical attention at the Neuroemergency department for investigation. On clinical examination, the patient scored GCS=15p., bilateral external ophthalmoplegia, hemihypoesthesia on the L, Romberg sign(+), palatal veil deviated to the L, dysphagia, dysphonia, dysarthria, without signs of oral automatism. CSF analysis showed the Pandi test(+). Presumptive diagnosis: Myasthenic crisis. Within 2 days, the patient's condition worsened, adding respiratory disorders and sialorrhea, and transferred to the ICU. Initiation of treatment with Prednisolone 5mg with a daily dose increase up to 11 tab. and Calimin 60 mg tab.—initially ½ twice a day, then 1 tab. twice a day—was decided. Chest CT showed bilateral interstitial pneumonia, involuted thymus, and ground-glass opacities in S3-S5 on the R and S4-S5 on the L. The Prozerin test led to a slight regression of eyelid ptosis. On the 4th day of hospitalization, she was intubated and connected to assisted ventilation, with variable oxygen levels. On the 5th day from onset, antibodies were collected, and the result was: Anti-AChR antibodies (<0.07), Anti-MuSK antibodies (<0.01). On the 6th day, plasmapheresis was initiated, followed by immunoglobulin treatment with positive reaction, to which the patient responded positively. She was extubated after 13 days, transitioning to an oxygen mask with FiO2 ~30%. Discussions. This report describes the case of a woman who initially presented ARVI signs, and eventually diagnosed with dSNMG for both AChR and MuSK antibodies. The disease evolved negatively which caused the transfer to ICU. This case suggests that acute viral infections should be qualified as a trigger for agressive dSNMG. Conclusion. The case highlights the complexity of the relationship between ARVI and MG, emphasizing the importance of careful monitoring and management. These observations align with reports of other infections inducing autoimmune disorders, as well as the growing evidence of other neurological conditions with presumed autoimmune mechanisms following the onset of ARVI. have a higher risk of concurrently developing autoimmune d iseases, reflecting phenotypic heterogeneity in MG. The association between Double Seron egative Myasthenia Gravis and Interstitial Pneumonia has been rarely reported in the Republic of Moldova. The present case aims to report the coexistence of dSNMG and ARVI confirmed in patient. Case presentation. Patient F, 58 years old, presented symptoms of ARVI, inc luding sore throat, general weakness, headache for 10 days. On the 10th day, she de veloped general weakness, numbness throughout the body, with emphasis on the left han d, speech disturbances and diplopia. She sought medical attention at the Neuroemergency departme nt for investigation. On clinical examination, the patient scored GCS=15p., bilateral externa l ophthalmoplegia, hemihypoesthesia on the L, Romberg sign(+), palatal veil deviated to the L, dysphagia, dysphonia, dysarthria, without signs of oral automatism. CSF analysis showed the Pandi t est(+). Presumptive diagnosis: Myasthenic crisis. Within 2 days, the patient's condition worsened, adding respiratory disorders and sialorrhea, and transferred to the ICU. Initiation of treatment with Prednisolone 5mg with a daily dose increase up to 11 tab. and Calimin 60 mg tab.—initiall y ½ twice a day, then 1 tab. twice a day—was decided. Chest CT showed bilateral interstitial pneumonia, involuted thymus, and ground-glass opacities in S3-S5 on the R and S4-S5 on the L. The Prozerin test led to a slight regression of eyelid ptosis. On the 4th day of hospitalizatio n, she was intubated and connected to assisted ventilation, with variable oxygen levels. On t he 5th day from onset, antibodies were collected, and the result was: Anti-AChR antibodies (<0.07), Anti-MuSK antibodies (<0.01). On the 6th day, plasmapheresis was initiated, followed by immuno globulin treatment with positive reaction, to which the patient responded positively. She was extubated after 13 days, transitioning to an oxygen mask with FiO2 ~30%. Discussions. This report describes the case of a woman who initially pre sented ARVI signs, and eventually diagnosed with dSNMG for both AChR and MuSK antibo dies. The disease evolved negatively which caused the transfer to ICU. This case suggests that acute viral infections should be qualified as a trigger for agressive dSNMG. Conclusion. The case highlights the complexity of the relationship betwe en ARVI and MG, emphasizing the importance of careful monitoring and mana gement. These observations align with reports of other infections inducing autoimmune disorders, as we ll as the growing evidence of other neurological conditions with presumed autoimmune me chanisms following the onset of ARVI. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova

Transcutaneous auricular vagus nerve stimulation efficacy in drug resistant epilepsy treatment

2024-01-01T00:00:00Z

Transcutaneous auricular vagus nerve stimulation efficacy in drug resistant epilepsy treatment Iurcu, Victoria; Olaru, Natalia Introduction. Transcutaneous auricular vagus stimulation (taVNS) modulates the locus coeruleus-norepinephrine (LC-NE) network through impulses delivered to the external ear via Aβ fibers using frequencies mostly between 10-30 Hz which could desynchronize ictal rythms and prevent seizure onset. taVNS might be a viable therapeutic adjunctive option in drug resistant epilepsy, with no response to 2 different medications (25% of all cases). Aim of study. Assessment of taVNS’s impact on neural oscillations via modulation of seizurefree period duration, seizure frequency, P3 event-related potential amplitude, tonic pupil size, salivary cortisol levels, and evaluate potential side effects. Methods and materials. Clinical trials, prospective studies, and meta-analyses published between 2018 and 2024, using PubMed and ILAE databases with 267 references in total. Results. Across 3 studies the results at 8, 16 and 24 weeks, displayed average seizure frequency reduction of 36.2%, 49.1%, and 55.6%, compared to the baseline. On average 24% of the participants were reported to be seizure free compared to the control group. In a different study, interictal EEG at 44 weeks displayed a reduction of abnormal findings during wakefulness. LCNE modulation research reveals heterogeneous outcomes, as taVNS does not induce changes in P3 amplitude and pupil size diameter (p = 0.3-0.4), yet a mitigated decrease in salivary cortisol was observed (p=0.4). Across 10 studies adverse effects amounted to 10%, most prevalent being headache, skin irritation and ear pain (8.9%, 7.1%, 4.6%). Conclusion. Research reveals an improved quality of life and seizure control in patients undergoing taVNS. The physiological markers did not seem to be modulated by taVNS, however hormonal responses that would indicate LC-NE network activation were attested. Gaining further insights into optimal adjustment of taVNS parameters which would impede ictal rhythm synchronization without adverse effects is crucial for enhancing effectiveness on a case-by-case basis. This is particularly significant for individuals with drug-resistant epilepsy, as it expands the range of available adjunctive therapeutic options. coeruleus-norepinephrine (LC-NE) network through impulses de livered to the external ear via Aβ fibers using frequencies mostly between 10-30 Hz which could desynch ronize ictal rythms and prevent seizure onset. taVNS might be a viable therapeutic adjunctive option in drug resistant epilepsy, with no response to 2 different medications (25% of all cases). Aim of study. Assessment of taVNS’s impact on neural oscillations via m odulation of seizurefree period duration, seizure frequency, P3 event-related pot ential amplitude, tonic pupil size, salivary cortisol levels, and evaluate potential side ef fects. Methods and materials. Clinical trials, prospective studies, and meta-analyses published between 2018 and 2024, using PubMed and ILAE databases with 267 references in total. Results. Across 3 studies the results at 8, 16 and 24 weeks, displayed a verage seizure frequency reduction of 36.2%, 49.1%, and 55.6%, compared to the baseline. On aver age 24% of the participants were reported to be seizure free compared to t he control group. In a different study, interictal EEG at 44 weeks displayed a reduction of abnormal findings during wakefulness. LCNE modulation research reveals heterogeneous outcomes, as taVNS does not induce changes in P3 amplitude and pupil size diameter (p = 0.3-0.4), yet a mitigated decrease in salivary cortisol was observed (p=0.4). Across 10 studies adverse effects amo unted to 10%, most prevalent being headache, skin irritation and ear pain (8.9%, 7.1%, 4.6%). Conclusion. Research reveals an improved quality of life and seizur e control in patients undergoing taVNS. The physiological markers did not seem to be modulated by taVNS, however hormonal responses that would indicate LC-NE network act ivation were attested. Gaining further insights into optimal adjustment of taVNS parameters whic h would impede ictal rhythm synchronization without adverse effects is crucial for enh ancing effectiveness on a case-by-case basis. This is particularly significant for individuals wit h drug-resistant epilepsy, as it expands the range of available adjunctive therapeutic options. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova

Herpes zoster in patients with HIV/AIDS. Epidemiological, clinical and treatment features

2024-01-01T00:00:00Z

Herpes zoster in patients with HIV/AIDS. Epidemiological, clinical and treatment features Josan, Maria Introduction. Herpes Zoster represents the phenotype, conditioned by the reactivation of the Varicella zoster virus from its latent phase. It manifests itself as viral ganglioneuritis with damage to the intervertebral ganglia, ganglia of the cranial nerves, skin, posterior and anterior horns of the gray matter. Herpes zoster is more common and more severe in HIV-infected patients because cellular immunity is reduced. Aim of study. Assessment of the clinical features, epidemiology and treatment of Herpes Zoster in people with diagnosed HIV/AIDS, hospitalized in the Dermatovenerology and Communicable Diseases Hospital, in the Republic of Moldova, during the 2018-2023 period. Methods and materials. Data from the observation sheets of 143 patients, with diagnosed HIV/AIDS, hospitalized in the Dermatovenerology and Communicable Diseases Hospital in Chișinău, Republic of Moldova, were investigated according to the National Clinical Protocol. The following aspects were analyzed: signs of Herpes Zoster in patients with HIV/AIDS which includes the presence of vesicular eruptions in the intercostal region, in the cervical region, in the back region or post-zoster neuralgia. The data in the study was collected using laboratory examinations and clinical-anamnestic data as investigative methods. Results. Among the investigated batch of patients, 50.3% (72) were men, 49.7% (71) - women, the average age being 43 years and 2 months. Post-zoster neuralgia was diagnosed in (107) 73.4% of the studied batch. Of those hospitalized with Herpes Zoster 26.6% (38) were in the active form, of which 57.9% (22) manifested vesicular eruptions in the intercostal region, 23.7% (9) manifested rashes in the back region and 18.4% (7) manifested rashes in the cervical region. The diagnosis of HIV was based on the following laboratory tests: anti-HIV antibodies, HIV DNA test and viral culture. More informative is the HIV DNA test (PCR). The diagnosis of Herpes Zoster is based on laboratory tests: VZV DNA test (PCR) and VZV viral culture. Conclusion. HIV/AIDS remains a major public health issue worldwide. The evolution of HIV infection is highly variable, thus it has a large number of potential complications. One such complication which is investigated in this study is Herpes Zoster. Following the study of the characteristics associated with Herpes Zoster in patients with HIV/AIDS, hospitalized in the Republic of Moldova some conclusions regarding which phenotype is more prevalent. The data collected in this study once again indicate the importance of timely detection of specific Herpes Zoster symptoms, in order to prevent irreversible consequences. Varicella zoster virus from its latent phase. It manifests itself as viral ganglioneuritis with damage to the intervertebral ganglia, ganglia of the cranial ner ves, skin, posterior and anterior horns of the gray matter. Herpes zoster is more common and more seve re in HIV-infected patients because cellular immunity is reduced. Aim of study. Assessment of the clinical features, epidemiology and t reatment of Herpes Zoster in people with diagnosed HIV/AIDS, hospitalized in the Derma tovenerology and Communicable Diseases Hospital, in the Republic of Moldova, during the 2018- 2023 period. Methods and materials. Data from the observation sheets of 143 patients, with d iagnosed HIV/AIDS, hospitalized in the Dermatovenerology and Communica ble Diseases Hospital in Chișinău, Republic of Moldova, were investigated according to th e National Clinical Protocol. The following aspects were analyzed: signs of Herpes Zoster in patients with HIV/AIDS which includes the presence of vesicular eruptions in the interco stal region, in the cervical region, in the back region or post-zoster neuralgia. The data in the study was collected using laboratory examinations and clinical-anamnestic data as investigative m ethods. Results. Among the investigated batch of patients, 50.3% (72) were me n, 49.7% (71) - women, the average age being 43 years and 2 months. Post-zoster ne uralgia was diagnosed in (107) 73.4% of the studied batch. Of those hospitalized with Herpes Z oster 26.6% (38) were in the active form, of which 57.9% (22) manifested vesicular eruptions in the inter costal region, 23.7% (9) manifested rashes in the back region and 18.4% (7) manifested rashes in the cervical region. The diagnosis of HIV was based on the following laboratory tests: anti-HIV an tibodies, HIV DNA test and viral culture. More informative is the HIV DNA test (PCR). The diagnosis of Herpes Zoster is based on laboratory tests: VZV DNA test (PCR) and VZV viral culture. Conclusion. HIV/AIDS remains a major public health issue worldwide. The evol ution of HIV infection is highly variable, thus it has a large number o f potential complications. One such complication which is investigated in this study is Herpes Z oster. Following the study of the characteristics associated with Herpes Zoster in patien ts with HIV/AIDS, hospitalized in the Republic of Moldova some conclusions regarding which phenoty pe is more prevalent. The data collected in this study once again indicate the importan ce of timely detection of specific Herpes Zoster symptoms, in order to prevent irreversible conseque nces. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova