http://repository.usmf.md:80/xmlui/handle/20.500.12710/10713 Fri, 04 Sep 2026 02:14:03 GMT 2026-09-04T02:14:03Z 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. Mon, 01 Jan 2024 00:00:00 GMT http://repository.usmf.md:80/xmlui/handle/20.500.12710/29004 2024-01-01T00:00:00Z http://repository.usmf.md:80/xmlui/handle/20.500.12710/28453 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 Mon, 01 Jan 2024 00:00:00 GMT http://repository.usmf.md:80/xmlui/handle/20.500.12710/28453 2024-01-01T00:00:00Z http://repository.usmf.md:80/xmlui/handle/20.500.12710/28554 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 Mon, 01 Jan 2024 00:00:00 GMT http://repository.usmf.md:80/xmlui/handle/20.500.12710/28554 2024-01-01T00:00:00Z http://repository.usmf.md:80/xmlui/handle/20.500.12710/28558 Treatment of Hodgkin’s lymphoma in advanced stages Marandici, Daniel; Musteață, Larisa; Musteață, Vasile Introduction. Hodgkin's lymphoma is a relatively frequent neoplasm of the lymphatic system representing one of the most common types of cancer in young adults. Hodgkin's lymphoma is an aggressive, clinico-pathologically heterogenous group of lymphomas arising from the germinal center B cells. The last decades have seen significant progress in the management of patients with Hodgkin Lymphoma; it is now curable in at least 80% of patients. The therapeutic approach to each patient depends on clinical prognostic factors, comorbidities, and toxicity profile. Therefore, finding ways to reduce treatment-related morbidity and mortality is now a major goal of scientific research and clinical trials. Aim of study. Studying the treatment options in the advanced stages of Hodgkin's lymphoma. Methods and materials. We studied the medical records of patients diagnosed and treated in the Oncological Institute with the confirmed diagnosis of Hodgkin's lymphoma in the advanced stages. Results. According to the results of the performed study, women comprised 62% of all cases with Hodgkin's lymphoma. The predominant age group was 40-50 years with a rate of 36%, followed by the age group of 50-60 years (23% of cases). The time elapsed from the first symptoms to a confirmed diagnosis of Hodgkin's lymphoma was 2-4 months in 43% of cases. There were 6% of cases diagnosed within one year after the appearance of the first symptoms. According to the histopathological results, most of the lymphoma cases were attributed to nodular sclerosis type (87%). The main symptoms were: an increase in the size of peripheral lymph nodes (100% of cases), cough and breath shortness (78% of cases with mediastinal involvement). The stage of the disease at diagnosis was IIIB in 68% of the patients. The patients were treated with combined chemotherapy according to the schemes: ABVD and BEACOPP. Complete remissions were obtained in 35% of cases, partial remissions - in 38% of cases. Treatment failure or relapse were registered in 27% of cases. 62% of patients obtained partial or complete remissions after 8 courses of combined chemotherapy. The following post-chemotherapy complications were recorded: agranulocytosis in 78% of cases, toxic liver disease in 42% of cases and gastrointestinal disturbances in 98% of cases. Conclusion. The patients with Hodgkin's lymphoma are treated in Moldova and abroad with combined chemotherapy schemes such as BEACOPP and ABVD. Radiotherapy is performed in cases with residual tumor masses and in bulky diseases. Current treatment options allow to achieve the complete and partial remission rate of 73% in the advanced stages of Hodgkin lymphoma. representing one of the most common types of cancer in young adults. Hodgkin's lymphoma is an aggressive, clinico-pathologically heterogenous group of lymp homas arising from the germinal center B cells. The last decades have seen significant pr ogress in the management of patients with Hodgkin Lymphoma; it is now curable in at least 80% of patien ts. The therapeutic approach to each patient depends on clinical prognostic factors, comor bidities, and toxicity profile. Therefore, finding ways to reduce treatment-related morbidity and mort ality is now a major goal of scientific research and clinical trials. Aim of study. Studying the treatment options in the advanced stages of Hodgk in's lymphoma. Methods and materials. We studied the medical records of patients diagnosed and tr eated in the Oncological Institute with the confirmed diagnosis of Hodgki n's lymphoma in the advanced stages. Results. According to the results of the performed study, women co mprised 62% of all cases with Hodgkin's lymphoma. The predominant age group was 40-50 years with a rate of 36%, followed by the age group of 50-60 years (23% of cases). The time elap sed from the first symptoms to a confirmed diagnosis of Hodgkin's lymphoma was 2-4 months in 43% of cases. There were 6% of cases diagnosed within one year after the appearance of the first symptoms. According to the histopathological results, most of the lymphoma cases were attributed to nodular sclerosis type (87%). The main symptoms were: an increase in the size of pe ripheral lymph nodes (100% of cases), cough and breath shortness (78% of cases with me diastinal involvement). The stage of the disease at diagnosis was IIIB in 68% of the patients. The patients were treated with combined chemotherapy according to the schemes: ABVD and BEACOPP. Co mplete remissions were obtained in 35% of cases, partial remissions - in 38% of c ases. Treatment failure or relapse were registered in 27% of cases. 62% of patients obtained parti al or complete remissions after 8 courses of combined chemotherapy. The following post-chemotherapy complications were recorded: agranulocytosis in 78% of cases, toxic liver disease in 42% of cases and gastrointestinal disturbances in 98% of cases. Conclusion. The patients with Hodgkin's lymphoma are treated in Moldova a nd abroad with combined chemotherapy schemes such as BEACOPP and ABVD. Radio therapy is performed in cases with residual tumor masses and in bulky diseases . Current treatment options allow to achieve the complete and partial remission rate of 73% in the adv anced stages of Hodgkin lymphoma. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova Mon, 01 Jan 2024 00:00:00 GMT http://repository.usmf.md:80/xmlui/handle/20.500.12710/28558 2024-01-01T00:00:00Z