http://repository.usmf.md:80/xmlui/handle/20.500.12710/10713 Thu, 21 May 2026 18:01:55 GMT 2026-05-21T18:01:55Z 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/20.500.12710/28439 Anatomo clinical argumentation of reflexogenic zones Zaharco, Daniela Introduction. A reflexogenic zone can be defined as a specific region of the human body that, through stimulation or pressure, can influence or trigger responses in other parts of the organism. These can be considered true "mirrors" of internal organs or systems, reflecting their condition, whether it is one of health or imbalance. Aim of study. Determining the importance of reflexogenic zones in the medical and therapeutic context, including their role in diagnosis, as well as illustrating how these areas can influence the health of the human body. Methods and materials. The presented work was created through a literature review using articles published in databases such as PubMed, NCBI, and Science Direct, as well as anatomy textbooks and international literature on alternative medicine. Results. The state of internal organs can influence the appearance of external projection areas, for example, the appearance of moles, papillomas, keratomas, and condylomas, the emergence of vascular patterns on the facial skin, reddening or cyanosis of the lips and nails in the case of chronic pathology. Also, it can manifest with pain in the skin, muscles, periosteum, blood vessels, and fascia, which represents its projection. It was proven that a chronic kidney disease can lead to shoulder elevation on the same side of the body. Chronic lung diseases are often accompanied by kyphosis in the thoracic region of the spine. These aspects are based on visceral sensitivity, viscero-visceral, somato-visceral and viscero-somatic connections. For visceral sensitivity are responsible afferent visceral fibers that transmit information about the internal state of the body to the central nervous system (CNS). This information is processed unconsciously and contributes to the automatic regulation of vital functions, such as blood pressure, blood chemical composition, heart rate, respiratory rate, and vascular resistance. Viscero-visceral connections describe the interactions where one viscus can influence the functioning of another. Somato-visceral and viscero-somatic connections illustrate the interaction between internal organs and somatic structures. Stimulation of a somatic area can have effects on the functioning of a visceral organ. Conversely, dysfunctions of visceral organs can lead to manifestations in somatic areas, such as referred pain, a phenomenon in which pain from a visceral organ is felt in a superficial area of the body. It is explained by the dermatomal law, according to which visceral pain radiates to the cutaneous zones, also known as Zaharin-Head zones. Dermatomes correspond to the spinal segment at which the respective organ developed during embryonic development. An illustrative example is cardiac pain, which can be felt in the dermatomes C8-T1, also renal, ureteral, or testicular pain is referred to the dermatomes L1-L2. In the case of angina pectoris pain appears in the left shoulder and arm, in the case of gastric ulcer disease – in the interscapular region, and in the case of appendicitis – in the right inguinal region. Conclusion. Knowing and studying reflexogenic areas is important to understanding the human body's complexity and developing effective therapies such as reflexology, acupuncture, acupressure, physiotherapy, kinesiotherapy, hirudotherapy, cupping therapy, and others, which are components of traditional medicine, and as alternative treatment methods are proven to be effective and with fewer side effects. stimulation or pressure, can influence or trigger responses in other parts of the organism. These can be considered true "mirrors" of internal organs or systems, reflecting their condition, whether it is one of health or imbalance. Aim of study. Determining the importance of reflexogenic zones in the medi cal and therapeutic context, including their role in diagnosis, as well as illustrating how these areas can influence the health of the human body. Methods and materials. The presented work was created through a literature re view using articles published in databases such as PubMed, NCBI, and Science Direct, as well as anatomy textbooks and international literature on alternative medicine. Results. The state of internal organs can influence the appearance of external projection areas, for example, the appearance of moles, papillomas, keratomas, and condylomas, the e mergence of vascular patterns on the facial skin, reddening or cyanosis of the lips and nails in the case of chronic pathology. Also, it can manifest with pain in the skin, muscles, periosteum, blood vessels, and fascia, which represents its projection. It was proven that a chronic kidney disease can lead to shoulder elevation on the same side of the body. Chronic lung diseases are often accompanied by kyphosi s in the thoracic region of the spine. These aspects are based on visceral sensitivity, viscero-vi sceral, somato-visceral and viscero-somatic connections. For visceral sensitivity are responsible afferent visceral fibers that transmit information about the internal state of the body to the central nervous system (CNS). This information is processed unconsciously and contributes to the automatic regulation of vital f unctions, such as blood pressure, blood chemical composition, heart rate, respiratory rate, and va scular resistance. Viscero-visceral connections describe the interactions where one viscus can influence the func tioning of another. Somato-visceral and viscero-somatic connections illustrate the interaction between int ernal organs and somatic structures. Stimulation of a somatic area can have effects on the functioni ng of a visceral organ. Conversely, dysfunctions of visceral organs can lead to manifestations in somatic areas, such as referred pain, a phenomenon in which pain from a visceral organ is felt in a supe rficial area of the body. It is explained by the dermatomal law, according to which visceral pain radia tes to the cutaneous zones, also known as Zaharin-Head zones. Dermatomes correspond to the spinal segment at which the respective organ developed during embryonic development. An illustrative example is c ardiac pain, which can be felt in the dermatomes C8-T1, also renal, ureteral, or testicular pain is referred to the dermatomes L1-L2. In the case of angina pectoris pain appears in the left shoulder and arm, in the case of gastric ulcer disease – in the interscapular region, and in the case of appendicitis – in the right inguinal region. Conclusion. Knowing and studying reflexogenic areas is important to understandi ng the human body's complexity and developing effective therapies such as reflexology, acupuncture, acupressure, physiotherapy, kinesiotherapy, hirudotherapy, cupping therapy, and ot hers, which are components of traditional medicine, and as alternative treatment methods are proven to be effective and with fewer side effects. 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/20.500.12710/28439 2024-01-01T00:00:00Z http://repository.usmf.md:80/xmlui/handle/20.500.12710/28578 Risk factors for pulmonary tuberculosis defined according to the drug-resistance profile Savenco, Doina; Hujeirat, Shaher Mahmoud Introduction. Tuberculosis (TB) represents a major health problem, listed among 30 countries with the highest burden of the drug-resistant tuberculosis (MDR-TB) and its prevalence is correlated with the risk factors such as socioeconomic conditions, healthcare infrastructure, and public health measures. The MDR-TB is caused by Mycobacterium resistant to isoniazid and rifampicin The most effective anti-TB treatment for drug susceptible TB is standardized, consisting of isoniazid, rifampicin, pyrazinamide, and ethambutol. Lack of the direct observed treatment (DOT) leads to acquisition of the MDR-TB, which reduces the treatment effectiveness and increases the risk for low treatment outcomes, complications and death. Aim of study. The guidelines and treatment recommendations are updated regularly, and the new drugs are proposed. Therefore, the risk factors for MDR-TB should be continuously monitored. The aim of the study was the assessment of risk factors (RF) for pulmonary TB defined according to the results of the drug-susceptibility tests (DST). Methods and materials. It was realised a prospective case-control study which included 97 patients with pulmonary TB registered in R Moldova during 2022. Including criteria were adult age, TB with pulmonary localization and signed informed consent. The patients were distributed in the 1st group (1st SG) in which were enrolled 30 patients with DST showing MDR-TB, in the 2nd group (2nd G) – 56 with drug-susceptible TB and 3rd group (3rd G) – 11 which acquired (ac.) MDR-TB during the anti-TB treatment. Results. Distributing patients by sex was estbalished that the male sex was a low RF for MDR-TB OR=1,35 (CI 95%: 1,09-1, 51), medium RF for ac. MDR-TB, OR=1,4 (CI 95%: 1,22-2,67), urban residence – medium RF for MDR-TB OR=1,8 (CI 95%: 1,51-1,99), and rural residence-high risk factor for ac. MDR-TB, OR=2,5 (CI 95%: 1,92-3.13). The average age in 1st SG was 42.4 y., in the 2nd G=38.2 and 3rd G=49.1. Economicaly disadvantaged state was a neutral peculiarity for MDR-TB, OR=1,09 (CI 95%: 0.87-3.1) and high RF for ac. MDR-TB OR=4.41 (CI 95%: 2.765.81). Tobacco smoking was neutral for MDR-TB OR=1,18(CI 95%: 0,98-3.1) and high RF for ac. MDR-TB OR=5.01 (CI 95%: 3.32-6.92), alcohol abuse was high RF for developing drugsusceptible TB OR=4.21 (95%CI:1.41-12.54) and neutral for ac. MDR-TB 1,01 (CI 95%: 8.012.3) and comorbid state was a high RF for ac. MDR-TB OR=8,91 (95%CI: 6.8-14.19), HIVInfection was a high RF for drug-susceptible TB OR=3,9 (95%CI: 2.6-5.1). Economic migration and recent returning from abroad was a high RF Conclusion. The study demonstrated that high risk on developing of the drug-susceptible TB was caused by the alcohol abuse, HIV-infection and economic migration, but for ac. MDR-TB the economically-disadvantaged state, rural residence, tobacco-smoking, and commodities. with the highest burden of the drug-resistant tuberculosis (MDR-TB) and its prevalence is correlated with the risk factors such as socioeconomic c onditions, healthcare infrastructure, and public health measures. The MDR-TB is caused by Mycobacte rium resistant to isoniazid and rifampicin The most effective anti-TB treatment for dr ug susceptible TB is standardized, consisting of isoniazid, rifampicin, pyrazinamide, and etha mbutol. Lack of the direct observed treatment (DOT) leads to acquisition of the MDR-TB, which r educes the treatment effectiveness and increases the risk for low treatment outcomes, compli cations and death. Aim of study. The guidelines and treatment recommendations are updated regul arly, and the new drugs are proposed. Therefore, the risk factors for MDR-TB should be continuously monitored. The aim of the study was the assessment of risk factors (RF) for pulmonary TB defined according to the results of the drug-susceptibility tests (DST). Methods and materials. It was realised a prospective case-control study which incl uded 97 patients with pulmonary TB registered in R Moldova durin g 2022. Including criteria were adult age, TB with pulmonary localization and signed informed con sent. The patients were distributed in the 1st group (1st SG) in which were enrolled 30 patients wit h DST showing MDR-TB, in the 2nd group (2nd G) – 56 with drug-susceptible TB and 3rd group (3rd G) – 11 whi ch acquired (ac.) MDR-TB during the anti-TB treatment. Results. Distributing patients by sex was estbalished that the mal e sex was a low RF for MDR-TB OR=1,35 (CI 95%: 1,09-1, 51), medium RF for ac. MDR-TB, OR=1,4 (CI 95%: 1,22-2,67), urban residence – medium RF for MDR-TB OR=1,8 (CI 95%: 1,51-1,99), an d rural residence-high risk factor for ac. MDR-TB, OR=2,5 (CI 95%: 1,92-3.13). The avera ge age in 1st SG was 42.4 y., in the 2nd G=38.2 and 3rd G=49.1. Economicaly disadvantaged state was a neutral peculiarity for MDR-TB, OR=1,09 (CI 95%: 0.87-3.1) and high RF for ac. MDR-TB OR= 4.41 (CI 95%: 2.765.81). Tobacco smoking was neutral for MDR-TB OR=1,18(CI 95%: 0,98- 3.1) and high RF for ac. MDR-TB OR=5.01 (CI 95%: 3.32-6.92), alcohol abuse was high R F for developing drugsusceptible TB OR=4.21 (95%CI:1.41-12.54) and neutral for ac. MDR-T B 1,01 (CI 95%: 8.012.3) and comorbid state was a high RF for ac. MDR-TB OR=8,91 (95% CI: 6.8-14.19), HIVInfection was a high RF for drug-susceptible TB OR=3,9 (95%CI: 2. 6-5.1). Economic migration and recent returning from abroad was a high RF Conclusion. The study demonstrated that high risk on developing of th e drug-susceptible TB was caused by the alcohol abuse, HIV-infection and economic mi gration, but for ac. MDR-TB the economically-disadvantaged state, rural residence, tobac co-smoking, and commodities. 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/20.500.12710/28578 2024-01-01T00:00:00Z http://repository.usmf.md:80/xmlui/handle/20.500.12710/28571 Hereditary angioedema with C1 inhibitor deficiency Butucel, Ana Introduction. Hereditary angioedema (HAE) is a rare autosomal dominant disease with deficiency or/and dysfunction of C1 inhibitor, caused by mutations in the C1-INH gene. HAE is characterized by potentially life-threatening episodes of subcutaneous and/or submucosal edema without urticaria, prevalence 1:50,000 individuals. The primary mediator of swelling in HAE is bradykinin. The symptoms vary in severity, location, and duration, but the organs involved include the upper airways, skin, and gastrointestinal tract. Case statement. A 19 y.o. man was admitted in the ICU with severe dyspnoea, bronchospasm, oedema of face and extremities, acute respiratory failure. Patient was diagnosed in 2018 with hereditary angioedema with C1Inh deficiency. Symptoms of severe angioedema (upper and lower limbs lasting for 2-3 days, abdominal attacks, nausea and vomiting, facial edema associated with difficult swallowing) started at age 2 years. The patient has frequent episodes of angioedema every month (predominantly limbs, face) caused by various triggers: stress, low/high temperatures, trauma and other factors. Sometimes marginal erythema may be present as a prodromal symptom. Investigations: C1 inhibitor 0,0411 g/l (N 0,21-0,4), C1 inhibitor function 0,0411% (N 70-130%), C3 0,86 g/l (N 0.9-1.8), C4 0.08 (N 0.1-0.4), d-Dimers 8,24 (0-0.55 mg FEU/l), qualitative troponin positive, CK-MB 96 (N 0 - 25 U/L ), CRP 26 (0-5 mg/l). EKG, Echocardiography were normal. Treatment of choice: A plasma-derived C1 Esterase Inhibitor, fresh frozen plasma and tracheal intubation in severe cases (laryngeal angioedema). Patient was discharged on the 10th day with improvement of general condition with recommendation on management and prevention of further HAE attacks. Discussions. Because the disease is very rare, it is not uncommon for patients to remain undiagnosed for many years. Diagnostic delays impact the accuracy of management. Treatment is different from histamine-associated angioedema, antihistamines, corticosteroids, and epinephrine have no effect. Acute treatment of HAE can include IV infusions of C1-INH, receptor antagonists, and kallikrein inhibitors. Short- and long-term prophylaxis can also be administered to patients with HAE. Conclusion. In patients with early onset of repetitive angioedema episodes, not responding to antihistamines, corticosteroids therapy the diagnosis of HAE should be considered. or/and dysfunction of C1 inhibitor, caused by mutations in the C1-INH gene. HAE is characterized by potentially life-threatening episodes of subcutaneous and/or submucosal edema without urticaria, prevalence 1:50,000 individuals. The primary mediato r of swelling in HAE is bradykinin. The symptoms vary in severity, location, and duration, but the organs involved include the upper airways, skin, and gastrointestinal tract. Case statement. A 19 y.o. man was admitted in the ICU with severe dyspnoe a, bronchospasm, oedema of face and extremities, acute respiratory failure . Patient was diagnosed in 2018 with hereditary angioedema with C1Inh deficiency. Symptoms of severe angioedema (upper and lower limbs lasting for 2-3 days, abdominal attacks, nausea and vom iting, facial edema associated with difficult swallowing) started at age 2 years. The patient ha s frequent episodes of angioedema every month (predominantly limbs, face) caused by various triggers: s tress, low/high temperatures, trauma and other factors. Sometimes marginal erythema m ay be present as a prodromal symptom. Investigations: C1 inhibitor 0,0411 g/l (N 0,21-0,4), C1 inhibitor fu nction 0,0411% (N 70-130%), C3 0,86 g/l (N 0.9-1.8), C4 0.08 (N 0.1-0.4), d-Dimers 8,24 (0-0 .55 mg FEU/l), qualitative troponin positive, CK-MB 96 (N 0 - 25 U/L ), CRP 26 (0-5 mg/l) . EKG, Echocardiography were normal. Treatment of choice: A plasma-derived C1 Esteras e Inhibitor, fresh frozen plasma and tracheal intubation in severe cases (laryngeal angio edema). Patient was discharged on the 10th day with improvement of general condition with recommendati on on management and prevention of further HAE attacks. Discussions. Because the disease is very rare, it is not uncommon f or patients to remain undiagnosed for many years. Diagnostic delays impact the a ccuracy of management. Treatment is different from histamine-associated angioedema, antihist amines, corticosteroids, and epinephrine have no effect. Acute treatment of HAE can include IV infusions of C1-INH, receptor antagonists, and kallikrein inhibitors. Short- and long-term prophylaxis c an also be administered to patients with HAE. Conclusion. In patients with early onset of repetitive angioedema ep isodes, not responding to antihistamines, corticosteroids therapy the diagnosis of HAE should be considered. 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/20.500.12710/28571 2024-01-01T00:00:00Z