MedEspera 2024

Assessment of the cases of postpartum hemorrhage in multiparous women

Mon, 01 Jan 2024 00:00:00 GMT

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.

Immunohistochemical particularities as prognostic factors in diffuse large B-cell non-Hodgkin lymphoma

Mon, 01 Jan 2024 00:00:00 GMT

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

Genetic aspects of migraine

Mon, 01 Jan 2024 00:00:00 GMT

Genetic aspects of migraine Morari, Ecaterina Introduction. Migraine is a common neurological disorder which affects 15–20% of the population and usually begins at puberty, but has the greatest impact on people aged 35 to 45 years. Migraines present a severe headache with associated symptoms of nausea, vomiting, photo and phonophobia. The pain can localize on one side of the head. It can be aggravated by physical activity. There are migraines without aura (MO) and migraine with aura (MA) which include many other subtypes. Aim of study. To investigate the molecular and genetic mechanisms of migraine and their impact on the quality of human life. Methods and materials. From a variety of articles from PubMed, NCBI databases, Medlineplus.gov, Americanmigrainefoundation.org we selected and analyzed 25 sources describing the genetic manifestations of migraine in more detail Results. Familial hemiplegic migraine (FHM) is the only known autosomal dominant subtype of migraine with aura. There are mutations in the calcium-channel gene CACNA1A which is present on chromosome 19p13. Four missense mutations were detected in the conserved regions of this gene. This gene usually encodes the pore-forming α1 subunit of the neuronal voltage-gated Cav2.1 channel. The different migraine phenotypes are associated with deletion of the CACNA1A gene. Another involved in increasing the risk of migraines is MTHFR gene which is localized on chromosome 1p36.2 and encodes the enzyme methylenetetrahydrofolate reductase, normally involved in the metabolism of vitamin B9 (folic acid). The MTHFR enzyme catalyses the reduction of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate which is needed for the conversion of homocysteine to methionine. The C677T mutation of the MTHFR gene is quite widespread. For example, it occurs in 35-55% of representatives of the European (Caucasian) race. Missense mutations in this gene lead to protein deficiency or defective protein synthesis. This will lead to an increased level of homocysteine in plasma and a decrease in the amount of methionine. The clinical consequences of elevated plasma homocysteine levels include damage to endothelial cells, spontaneous activation of trigeminal nerve cells, and changes in blood coagulation properties. It is believed that spontaneous activation of trigeminal nerve cells, leading to inflammation of the meninges and blockage of cerebral vessels, is the cause of migraine-related pain. Thus, homocysteine dysfunction can clearly increase the patient's propensity to develop migraines. In this case, the patient is forced to be motionless, since any exposure to light or noise makes the headache unbearable Conclusion. Migraine is a complex brain disorder that occurs when homeostasis is lost, which leads to activation of the trigeminal vascular system and a cascade of events, the manifestation of which depends on mutations in the MTHFR and CACNA1A genes. population and usually begins at puberty, but has the greatest i mpact on people aged 35 to 45 years. Migraines present a severe headache with associated sympt oms of nausea, vomiting, photo and phonophobia. The pain can localize on one side of the he ad. It can be aggravated by physical activity. There are migraines without aura (MO) and migraine with aura (MA) which include many other subtypes. Aim of study. To investigate the molecular and genetic mechanisms of m igraine and their impact on the quality of human life. Methods and materials. From a variety of articles from PubMed, NCBI databases , Medlineplus.gov, Americanmigrainefoundation.org we selected an d analyzed 25 sources describing the genetic manifestations of migraine in more detai l Results. Familial hemiplegic migraine (FHM) is the only known autos omal dominant subtype of migraine with aura. There are mutations in the calcium-c hannel gene CACNA1A which is present on chromosome 19p13. Four missense mutations were detected in the conserved regions of this gene. This gene usually encodes the pore-forming α1 subunit of t he neuronal voltage-gated Cav2.1 channel. The different migraine phenotypes are associated with deletion of the CACNA1A gene. Another involved in increasing the risk of migraines is MTHFR gene which is localized on chromosome 1p36.2 and encodes the enzyme methylenetetrahydrofol ate reductase, normally involved in the metabolism of vitamin B9 (folic acid). The MTHFR enzyme catalyses the reduction of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate whi ch is needed for the conversion of homocysteine to methionine. The C677T mutation of the MT HFR gene is quite widespread. For example, it occurs in 35-55% of representatives of the E uropean (Caucasian) race. Missense mutations in this gene lead to protein deficiency or defectiv e protein synthesis. This will lead to an increased level of homocysteine in plasma and a decr ease in the amount of methionine. The clinical consequences of elevated plasma homocysteine l evels include damage to endothelial cells, spontaneous activation of trigeminal nerve cells, and cha nges in blood coagulation properties. It is believed that spontaneous activation of trigeminal nerve ce lls, leading to inflammation of the meninges and blockage of cerebral vessels, is the cause of migraine-related pain. Thus, homocysteine dysfunction can clearly increase the patie nt's propensity to develop migraines. In this case, the patient is forced to be motionless, since any exposure to light or noise makes the headache unbearable Conclusion. Migraine is a complex brain disorder that occurs when h omeostasis is lost, which leads to activation of the trigeminal vascular system and a cascade of events, the manifestation of which depends on mutations in the MTHFR and CACNA1A genes. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova

Incidence, risk factors, and complications of cardiovascular system in patient with Graves disease

Mon, 01 Jan 2024 00:00:00 GMT

Incidence, risk factors, and complications of cardiovascular system in patient with Graves disease Saravanane, Essaimathi Introduction. Graves' disease, a common autoimmune illness characterized by a rise in thyroid hormone production, has been widely researched in terms of its effects on the thyroid gland. However, a new study emphasizes the necessity of understanding the complex link between Graves' illness and cardiovascular health. While thyroid problems are the most common symptom of this disorder, there has been increasing recognition that the impact extends beyond the endocrine system. Aim of study. Literature review of PubMed citations of patients with GD from 2009 to 2019 was included in the research and Temporal Dynamics of Atrial Fibrillation in Graves' Disease: A Retrospective Analysis (2009–2019) and other related articles Methods and materials. Literature review of PubMed citation, patients with GD from 2009 to 2019 were included in the research. And Temporal Dynamics of Atrial Fibrillation in Graves' Disease: A Retrospective Analysis (2009–2019). Results. The review of the publications and article shows that Heart failure occurred in 74 out of 1371 GD patients, representing 5.4% of the total. Further breakdown: 31 (2.3%) had heart failure with reduced ejection fraction (HFrEF), and 43 (3.1%) had heart failure with preserved ejection fraction (HFpEF). Atrial fibrillation (AF) and thyroid-stimulating hormone receptor antibody (TRAb) levels were identified as independent risk variables for HFrEF. Hazard Ratio (HR) for AF: 10.5 (3.0-37.3), p<0. 001.HR for TRAb level: 1.05 (1.01-1.09) per unit, p=0.007. These findings suggest distinct risk factors and outcomes for HFrEF and HFpEF in GD patients. AF and TRAb levels were specifically associated with HFrEF, while factors such as COPD, aging, visible hyperthyroidism, higher BMI, and elevated blood pressure were linked to HFpEF. Both types of HF were associated with an increased risk of cardiovascular illness, but only HFrEF was linked to a higher risk of all-cause death. The overview of the report of an article state identified atrial fibrillation (AF) in 139 Graves' disease (GD) patients from 2009 to 2019, with 23.0% representing late-onset AF and half obtaining euthyroid. Early AF risk factors include age, overt hyperthyroidism, and male sex. Late AF is connected with aging, chronic obstructive pulmonary disease, and heart failure. Even after correcting for age, gender, and pre-existing AF, AF in GD was connected to increased mortality, acute coronary events, and cardiac hospitalizations. The findings underscore the necessity of cautious treatment and risk assessment in GD patients with AF. Conclusion. Graves' disease (GD) patients face a 5.4% incidence of heart failure, with distinct risks for heart failure subtypes. Atrial fibrillation (AF) and thyroid-stimulating hormone receptor antibody (TRAb) levels are notable risk factors, particularly for heart failure with reduced ejection fraction (HFrEF). AF in GD is associated with heightened mortality and cardiovascular events, emphasizing the need for precise management strategies. hormone production, has been widely researched in terms of its effects on the thyroid gland. However, a new study emphasizes the necessity of understanding the c omplex link between Graves' illness and cardiovascular health. While thyroid problems are the most comm on symptom of this disorder, there has been increasing recognition that the impact extends beyond the endocri ne system. Aim of study. Literature review of PubMed citations of patients with GD from 2009 to 2019 was included in the research and Temporal Dynamics of Atrial Fibr illation in Graves' Disease: A Retrospective Analysis (2009–2019) and other related articles Methods and materials. Literature review of PubMed citation, patients with GD from 2009 to 2019 were included in the research. And Temporal Dynamics of Atria l Fibrillation in Graves' Disease: A Retrospective Analysis (2009–2019). Results. The review of the publications and article shows that Heart fai lure occurred in 74 out of 1371 GD patients, representing 5.4% of the total. Further breakdown: 31 (2.3%) had hea rt failure with reduced ejection fraction (HFrEF), and 43 (3.1%) had heart failure with preserve d ejection fraction (HFpEF). Atrial fibrillation (AF) and thyroid-stimulating hormone re ceptor antibody (TRAb) levels were identified as independent risk variables for HFrEF. Hazard Ratio (HR) for AF: 10.5 (3.0-37.3), p<0. 001.HR for TRAb level: 1.05 (1.01-1.09) per unit, p=0.007. These findings suggest distinc t risk factors and outcomes for HFrEF and HFpEF in GD patients. AF and TRAb levels were specifically associated with HFrEF, while factors such as COPD, aging, visible hype rthyroidism, higher BMI, and elevated blood pressure were linked to HFpEF. Both types of HF were associated with an increased risk of cardiovascular illness, but only HFrEF was linked to a high er risk of all-cause death. The overview of the report of an article state identified atrial fibrill ation (AF) in 139 Graves' disease (GD) patients from 2009 to 2019, with 23.0% representing late-onset AF and half o btaining euthyroid. Early AF risk factors include age, overt hyperthyroidism, and male s ex. Late AF is connected with aging, chronic obstructive pulmonary disease, and heart failure. Even a fter correcting for age, gender, and pre-existing AF, AF in GD was connected to increased mortalit y, acute coronary events, and cardiac hospitalizations. The findings underscore the necessity of c autious treatment and risk assessment in GD patients with AF. Conclusion. Graves' disease (GD) patients face a 5.4% incidence of heart f ailure, with distinct risks for heart failure subtypes. Atrial fibrillation (AF) and thyroid-stimu lating hormone receptor antibody (TRAb) levels are notable risk factors, particularly for heart failure with reduced ejection fraction (HFrEF). AF in GD is associated with heightened mortality a nd cardiovascular events, emphasizing the need for precise management strategies. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova