ARCHIVES OF THE BALKAN MEDICAL UNION

219-221

Authors: Camelia DIACONU

Oxidative stress is involved in the pathophysiology of many chronic diseases, including heart failure. Oxidative stress is an imbalance between the production of reactive oxygen species (ROS) and the antioxidant defense. The overproduction of ROS can lead to cellular damage and eventually cellular death. This applies also in patients with chronic heart failure, who present a dramatic increase of oxidative stress associated with a pronounced decrease of the antioxidant defense mechanisms. The components of the antioxidant defense mechanism of myocardial cells are superoxide dismutase (SOD), catalase, nicotinamide adenine dinucleotide (NAD+), glutathione peroxidase (GPx), and glutathione (GSH). Experimental animal studies have demonstrated the decrease of the activity of SOD, catalase and GPx in animal models with heart failure1,2. Furthermore, excessive ROS induce myocardial fibroblasts proliferation with cardiac remodeling. The promising results of experimental studies in animals with heart failure led to the hypothesis that oxidative stress may be a therapeutic target in patients with heart failure. Clinical trials have studied the effects of antioxidant treatments in humans with heart failure. Treatment of oxidative stress can have different approaches: inhibition of oxidative stress producers, increase of endogenous antioxidant capacity, and increase of antioxidant capacity by administration of exogenous antioxidants, such as vitamin C, vitamin A, vitamin E, folic acid. Inhibition of xanthine oxidase by the administration of allopurinol or oxypurinol in patients with chronic heart failure is the most studied treatment 3,4. Different trials have demonstrated that treatment with allopurinol or oxypurinol (inhibitors of oxidative stress) had beneficial effects on myocardial function, endothelial dysfunction, and led to the decreased levels of serum natriuretic peptides and improved left ventricle ejection fraction3,4. Other trials failed to demonstrate the beneficial effects of oxypurinol5. Other clinical studies focused on the effects of increasing the antioxidant capacity in patients with heart failure, by administration of vitamin A, vitamin C, vitamin E or folic acid. Despite the initial enthusiasm regarding the effects of these antioxidants, a recent meta-analysis of 50 randomized trials on their cardiovascular effects, including almost 300,000 patients, has demonstrated that supplementation with vitamins and other antioxidants failed to demonstrate a decrease of the cardiovascular risk. The third therapeutic approach, increase of endogenous antioxidant capacity, may be achieved by supplementation of cellular antioxidants GSH and NAD+6. This strategy has been studied only in a few trials, but their results until now seem to be promising. Supplementation with NAC, which is a precursor of GSH, in patients with chronic heart failure can be a potential approach in order to decrease the oxidative stress secondary to myocardial injury6. The improvement of the expression and activity of the gamma-glutamyl cycle and NAD+ producers is another option to increase the endogenous production of antioxidants in heart failure. Some studies have demonstrated that a few components of the gamma-glutamyl cycle (gamma-glutamyl-cysteine synthetase, GPx, OPLAH) are correlated with the risk of heart failure and its progression7. Therefore, the overexpression of these enzymes may have cardioprotective effects. OPLAH is a cytoplasmic enzyme of the GSH cycle, with a central function in the gamma-glutamyl cycle and also with an important antioxidant function; its expression is decreased in heart failure. Therefore, the stimulation of the expression and activity of OPLAH in patients with heart failure may play an important role for their prognosis. In conclusion, oxidative stress may play an important role in patients with chronic heart failure. Experimental studies have demonstrated the beneficial effects of therapies addressing the oxidative stress in animals. However, until now, these effects have not been fully demonstrated by clinical trials in humans. Further antioxidant strategies must be studied.

227-234

Authors: Olga AVILOVA, Victoria EROKHINA

Background. The burden of immunodeficiency and infectious diseases is rapidly increasing worldwide. Thus, it becomes necessary to find effective and affordable immunomodulatory drugs that may modify the response of the immune system. Objectives. To investigate ultramicroscopic changes that occur in parathyroid glands and thymus of male rats after administration of the immunomodulatory agent imunofan. Methods. Thirty-six WAG matured male rats were divided randomly into two groups. The first group received imunofan in a dosage of 0.7 mg/kg animal body weight by intramuscular injection. Rodents were sacrificed on the 3rd and 30th day after injection and specimens were dissected out and processed for electron microscopy. The second group served as control and was provided 0.9% soluble sodium chloride. Results. The results showed that imunofan exposure caused marked ultramicroscopic changes in parathyroid glands and thymus of rats. On the 3rd day after injection, the amount of the active chief cells significantly increases. A significantly increased number of secretory granules is recognized as the ultrastructural hallmark of chief cells change. Thymus in this term of imunofan administration showed no significant ultrastructural changes in comparison to control group. On the 30th day after the administration, the examination revealed that all the glands of the experimental rats have big amounts of active cells with well-developed secretory apparatus. Floccular оr particulate material was observed in the enlarged intercellular spaces surrounded by three or more chief cells. A significant amount of the secretory granules as the material might be excreted by exocytosis into the intercellular spaces. Electron microscopy of thymus revealed that imunofan injection causes changes in organ as a result of the activation of cell-mediated and antibody-mediated immunity on 30th day. Apparently, it also causes temporary delay of age-related thymic involution. Conclusion. The dynamics of changes in the electronic microscopic structure of rats’ parathyroid glands and thymus indicates a high degree of organs reactivity in response to immunotropic drug administration.

245-252

Authors: Olena P. BABKINA , Dmytro O. MATYUKHIN, Svitlana I. DANYLCHENKO, Igor. S. KOROBKO, Oleksiy O. GALMYZ, Andriy A. CHERNOZUB, Illia I. VAKO

Introduction. Liver injury is an important cause of death in patients with traumatic injuries. The objective of the study. To study the dynamics of changes in histological parameters of injured liver tissues in case of mechanical trauma, depending on the time of damages in the absence of alcohol intoxication. Materials and methods. We examined liver tissue of 52 individuals (38 men and 14 women) aged 20-60 years, who died at known and unknown time in the absence of alcohol in the blood in the Lugansk region of Ukraine. The cause of death was a mechanical trauma. The study was conducted by means of histological, histochemical methods, statistical analysis. Results. Regular histological changes were observed in the area of injured liver tissue. These changes directly depend on the time elapsed since the caused damage. Usage of the histological method was proved to be expedient for determining the time of injury, both in the isolated liver injury and in combined injuries of the abdominal organs. This method allows to increase the objectivity of the results determining the time of injury. Conclusions. The study determined changes of histological parameters of liver tissue depending on the time of injury, time of death, presence of traumatic illness, which can help in solving the question on the injury duration.

260-266

Authors: Oleksandra Yu. KUSHNIR, Iryna M. YAREMII, Inna G. KYSHKAN, Kyrylo A. PANTSIUK, Iryna D. VIZNIUK

Introduction. Melatonin, a potent antioxidant agent, is essential for glucose homeostasis. The objective of the study was to determine the influence of melatonin on basal levels of glucose in blood, activities of glucose-6-phosphatase in kidney and liver, pyruvate kinase in muscles and heart, content of glycogen in muscles and heart of rats with alloxan-induced diabetes. Materials and methods. Diabetes was induced in male Wistar rats by single intraperitoneal injection of alloxan monohydrates (170 mg/kg). Four days after diabetes induction, rats were divided into diabetic and melatonin-diabetic groups (10 mg/kg «Sigma» USA, daily and intraperitoneal for 14 days starting from the 5th day). Results. Melatonin injections caused normalization of the elevated serum glucose level in diabetic group of rats compared with basal glucose level before treatment. The activity of pyruvate kinase in muscle and heart tissue of diabetic animals was 45% and 63% less than in control groups, respectively. Regarding kidney and liver of diabetic rats, the activity of glucose-6-phosphatase was increased in average by 148% compared with control value. The glycogen content in the heart and skeleton muscles of diabetic animals was reduced in average by 20% compared with the control. Melatonin restored all these indexes back to normal level. Conclusions. These findings suggested that melatonin restored the events in Cori cycle by possible activation of glycolysis in skeletal and heart muscles and normalization of gluconeogenesis in liver and kidneys.

274-280

Authors: Olga S. SHEVCHENKO, Lilia D. TODORIKO , Iryna A. OVCHARENKO, Yevheniia B. RADZISHEVSKA, Olga M. SHVETS, Sergiy S. OVCHARENKO, Igor O. SEMIANIV, Volodymyr V. VIVSYANNUK

The objective of the study was to evaluate the dynamics of reorganization of connective tissue, aldosterone and glucose level as markers of favorable course of multidrug-resistant pulmonary tuberculosis. Materials and methods. The study was performed on 84 patients with firstly diagnosed multidrug-resistant pulmonary tuberculosis. Aldosterone, free and protein-bound hydroxyproline and glucose levels were measured in all patients. Results. It was found that in group I patients, free hydroxyproline levels are lower than in group II during the first two months of treatment for 60% at treatment onset and for 29.4% after 2 months of treatment. There was an increase in this index during the first 2 months of treatment in both groups. Protein-bound hydroxyproline level was higher in group I by 21.7%. The level of aldosterone at the treatment onset was almost identical in both groups. After 2 months of treatment, its level decreased in both groups. However, after 2 months of treatment in group I, its index was lower than in group II by 12.7%. Conclusions. Our results suggest that patients with a favorable course of multidrug-resistant tuberculosis have more pronounced decrease in aldosterone level, which may act as a pro-inflammatory agent and free hydroxyproline, which is a marker for the destruction of connective tissue. Inverse correlation between protein-bound hydroxyproline and glucose levels confirm the importance of normal glucose concentration for repair process.

288-292

Authors: Andreea D. IORDAN DUMITRU, Horia LAZARESCU, Andrei KOZMA , Agnes K. LACKNER, Doriana AGOP-FORNA

The objective of the study was to analyze a phenomenon that is more and more common in dental practice, i.e. the simultaneous presence on the arch of both the temporary tooth and the successor tooth. Material and method. The study has been conducted for over a year (1.01.2018-31.12.2018) by the authors practicing in Romania. From the total number of patients, we selected and studied those who had in the oral cavity both their temporary teeth and their successor teeth. In addition to their recording in the oral cavity, where appropriate, the temporary teeth extraction was used to place the definitive ones so that the functions of the dental-maxillary apparatus would not be altered. Results. 272 children with different pathologies at the oral cavity level were evaluated, of whom 102 children (37.5%) presented both temporary and definitive successor teeth. There were no significant differences between the two sexes. In the majority of cases, the temporary teeth and the definitive teeth were not in the same plane so that, on the arches line, the temporary ones and the permanent ones had an ectopic position; the temporary teeth had unreabsorbed roots and the final teeth had a defective position. Conclusions. Presence on the arches of both the definitive teeth and the temporal teeth leads to malocclusions that, if not corrected, the entire oral cavity will be damaged. If teeth with malposition do not return to their normal place on the arch, the patient will be directed to the orthodontic specialist.

300-306

Authors: Tamila V. SOROKMAN , Snizhana V. SOKOLNYK, Alexandra-Maria V. POPELYUK, Sergii O. SOKOLNYK, Olena V. MAKAROVA, Volodymyr V. BEZRUK

Introduction. A progressive increase of obesity prevalence, both among adults and children, is observed in many countries. Today, obesity is seen as a chronic systemic inflammation with low activity. Currently, new data are available about the biological and clinical significance of metal proteins in the inflammatory processes. The objective was to study the transferrin and ceruloplasmin indices in overweight and obese children. Material and methods. We have examined children with excess body weight (EBW, 30 children), obesity (40 children) and 30 healthy children aged 13-18 years. The evaluation included history, anthropometric data (height, body weight, body mass index, waist-to-thigh ratio – WTR), serum glucose, insulin, HOMA-IR calculation, transferrin (TF) and ceruloplasmin (CP). For statistical analysis of the results, statistic modules of Statistica v.6.0, MedStat and on-line SISA calculator were used. Results. In a total sample of 325 children, excess body weight was observed in 75 (23.1%) cases and obesity in 68 (13.6%) children. Boys prevailed, with 40 (53.3%) cases of EBW among those and 38 (55.8%) with obesity. The content of TF and CP in children aged 16-18 years was higher (28.1±0.8 mg/dL and 3.90±0.70 g/L, n = 22, p <0.05) than in children aged 13-15 years. The highest TF level (3.98±0.9 g/L, n = 16) and CP level (28.9±0.8 mg/dL, n = 16) were recorded in children with grade II obesity. There was no apparent difference either in the gender indices of TF and CP, nor in obese children combined with insulin resistance or obesity without insulin resistance. Less obvious changes in TF and CP were found in children with EBW. The weak relationships between the increase in BMI in children and the CP and TF (r = 0.28; p <0.001) level in the blood plasma of obese children (r = 0.23; p <0.0001) were detected, though they are highly statistically significant. Conclusions. Early identification of children with EBW and monitoring of their health, including the assessment of systemic inflammation markers, is an up-to-date and promising area for optimizing the obesity prophylaxis.

315-319

Authors: Tengiz VERULAVA, Tinatin ASATIANI, Beka DANGADZE, Revaz JORBENADZE

Introduction. In the past years, the role of social workers in the oncological disease treatment processes has significantly increased. The role implies supporting patient’s psycho-social conditions. The objective of the study was to study the psycho-social challenges of oncological children and their families and to define a role of social work in this area. Material and methods. As part of a qualitative study, five interviews were conducted with pediatric oncologists, also 15 in-depth interviews with family members of oncological patients and a focus group with 8 members. For the quantitative study, 62 beneficiaries and 12 medical specialists were interviewed. Results. The children with oncology conditions and their families faced psycho-social challenges and were in need of social workers’ support in overcoming those challenges. The study demonstrated a low level of public awareness. There is a lack of information among both doctors and beneficiaries. Both psychologists and social workers are involved in re-socialization of oncological children and they care for the improvement of children’s quality of life and support their families. However, there are only a few of such organizations. Therefore, many people who need their support have no chance to take such services. Conclusions. Implementing the social work in the pediatric oncology will be a major step toward the medical quality standards.

320-324

Authors: Simona BOBIC, Bogdan SOCEA , Ovidiu G. BRATU, Ana Maria A. STANESCU, Vlad D. BALEANU, Dragoș V. DAVITOIU, Mihai C.T. DIMITRIU, Dan DUMITRESCU, Dumitru C. BADIU, Vlad D. CONSTANTIN

Introduction. Cognitive impairment is a key symptom of schizophrenia and is known to be due to neurodevelopment changes. The aim of our study was to compare verbal fluency of patients with paranoid schizophrenia (PSch), first grade relatives (FGR) and healthy control subjects (HC) and to find additional risk factors for poor verbal fluency test performances in cases with PSch. Material and methods. 108 PSch (66 males, 44 females, mean age 38.86±10.02 y), 58 FGR (30 males, 28 females, mean age 36.71±11.74 y) and 60 HC (37 males, 23 females, mean age 35.68±11.36 y) were studied during the period 2015-2017 at the Department of Psychiatry and Medical Psychology, University Hospital Pleven, Bulgaria. After giving informed consent, they underwent full somatic and neurological examinations and fulfilled Isaac’s Set Test (IST) and K, A, M, E literal fluency test (LF). Results. PSch obtained lower scores on both LF and IST than other two groups. FGR had poor performance only on LF. Ageing, level of formal education, severity and duration of schizophrenia were associated with LF and IST performances. Conclusions. PSch show significant LF and semantic fluency difficulties. FGR have only LF changes. Verbal fluency is related to ageing, formal education, duration and severity of schizophrenia.

334-338

Authors: Nicolae BACALBASA , Irina BALESCU, Cristian BALALAU, Mihaela VILCU, Iulian BREZEAN

Pancreatic adenocarcinoma remains one of the most aggressive malignancies worldwide which is unfortunately associated with very poor long-term survival. However, it seems that the only option in order to improve the outcomes of these patients remains radical surgery consisting of in block resection of the tumor and the surrounding tissues. When it comes to the extent of the lymph node dissection, a permanent debate still exists between the eastern and the western countries; while the Western countries consider that an extended lymph node dissection increases the postoperative complication worthwhile, the Eastern countries consider that this should be the treatment of choice as long as these tumors usually disseminate on the lymphatic route. In order to establish what patients could benefit most from an extended lymph node dissection, certain authors proposed performing the sentinel lymph node biopsy technique. This is a literature review of the largest studies conducted on this theme.

345-350

Authors: Gina GHEORGHE, Madalina ILIE, Bogdan SOCEA, Ana Maria A. STANESCU, Ovidiu G. BRATU2,4, Mihaela A. IANCU2, Mihaela C. OLARIU, Gheorghe CIOBANU, Camelia C. DIACONU

Budd-Chiari syndrome (BCS) is a rare disease characterized by obstruction of the hepatic veins, regardless of mechanism and degree, in the absence of heart disease, pericardial disease or sinusoidal obstructive syndrome. In relation to etiology, BCS is classified in primary BCS, when it is caused by an intravascular thrombosis, and secondary BCS, when the obstruction is due to extrinsic compression or tumor invasion. The positive diagnosis is based on patient’s medical history, clinical examination, and paraclinical investigations. The clinical picture is polymorphous. The most common signs and symptoms include fever, abdominal pain and abdominal tenderness on palpation, hepatomegaly, ascites, edema of the lower limbs, gastrointestinal bleeding and hepatic encephalopathy. Laboratory tests can detect the degree of liver injury, with decreased serum albumin, altered coagulation, hepatic cytolysis and cholestasis, while imaging investigations may reveal the venous obstruction. Regarding treatment, all patients with BCS are recommended systemic anticoagulation to reduce the risk of thrombus extension and prevention of further thrombotic episodes. Depending on patient’s individual characteristics, angiography with or without stent, thrombolysis, trans-jugular intrahepatic portosystemic shunt and liver transplant are to be considered. The syndrome’s severity and prognosis are dictated by the underlying disease, ranging from a possible curability to quick death.

357-362

Authors: Raluca T. TATAR, Doina I. NACEA

Introduction. Skin and soft tissue defects in lower extremity are challenging clinical situations that have to be dealt with on an individual basis. Closure technique must be tailored to the wound size, location and etiology, and also to the patient’s characteristics (age, other comorbidities etc.). This paper aims at emphasizing the clinical particularities of lower extremity wound closure in children. Material and methods. We review the clinical data, surgical strategy and operative staging, and also the postoperative outcome of three cases of children (aged between 4 and 9 years old) with skin and soft tissue defect cause by trauma and infection, operated in our department in 2017. Results. The three patients presented with lower leg and anterior foot skin and soft tissue defects, ranging from 5 to 10 cm on the long axis, with deep involvement (including joint exposure in one of them). Etiology was traumatic in two cases, one complicated by infection due to inappropriate initial cure. In the third case, the skin defect was caused by foot cellulitis that was incised and debrided in another hospital, and was referred to us for closure of the remaining uncovered wound. The surgical approach was to use local flaps and skin grafts, alone or combined, after thorough debridement and removal of all infected and devitalized tissue, combined with systemic antibiotics. Postoperative assessment at 1-2 months showed very good graft take and convenient scar appearance, with no functional impairments and no other complications. Conclusions. Surgical protocol for closing lower extremity skin and soft tissue defects raises technical problems, even in the young patient. However, a careful planning of closure steps and preparation of good quality underlying tissues may ensure fast and satisfactory results for the patient and his/her family, as well as for the treating physician.

368-371

Authors: Andra M. IONESCU, Bogdan SOCEA, Mihai C.T. DIMITRIU, Vlad D. CONSTANTIN, Cringu A. IONESCU, Alexandra MATEI, Diana C. GHEORGHIU, Irina PACU, Teodora VLADESCU, Mihai B. NICULAE

Introduction. Struma ovarii represents a rare tumor, only 1% of the ovarian tumors, with an incidence of 0.3-0.7%. The positive diagnosis is obtained by microscopic examination; sometimes elevated serum levels of thyroid hormone, CA 125 and ultrasound aspects can suggest the preoperative diagnosis. Case presentation. We report the case of a 56-year-old woman with unilateral struma ovarii and no clinical or paraclinical evidence of the diagnosis to come. Transvaginal ultrasound revealed polyfibromatous uterus and apparently normal adnexa. Partial hysterectomy with bilateral salpingo-oophorectomy (considering the patients’ age) through laparotomy was performed under spinal anaesthesia. The histopathological result showed an endometrial polyp, multiple intrauterine leiomyomas, left ovary with thyroid follicles, which looked like normal thyroid tissue. The evolution of the patient was favorable, with no complications at the 6 months’ follow-up. Conclusions. In the literature, there are only a few cases of benign struma ovarium, and even less cases of malignant struma ovarium or bilateral presentation of the tumor. The particularity of the case consists in the diagnosis of struma ovarii only after surgery, in a patient without clinical or paraclinical evidence of this diagnosis.

375-378

Authors: Florin GROSEANU , Stefan CUCULICI, Radu VISAN, Bogdan SOCEA, Stefan CRISTEA

Introduction. Scaphoid non-union associated with avascular proximal pole necrosis represent a really challenging problem for orthopedic surgeons and its treatment is still in debate. Case presentation. We present the case of a 33-year-old patient, with scaphoid non-union, who was treated according to Zeidenberg’s technique using a vascularized radial bone graft. The primary objectives of treatment were to obtain union of the scaphoid, to improve the functional recovery of the wrist and to allow professional reimplantation of the patient. We were able to obtain a functional graft and after 9 months the results were very good. Conclusions. Vascularized bone grafts represent the optimal method of treatment of scaphoid non-union associated to avascular proximal pole. It is mandatory to be associated to rigid osteosynthesis such as Herbert compression screw. The technique of Zeidenberg offers good results in these cases, but it should not be performed without magnifying lens and tourniquet uses.

384-390

Authors: Oksana BOYARCHUK, Andrii CHORNOMYDZ , Iryna CHORNOMYDZ

Introduction. The Kasabach-Merritt syndrome is a rare and severe disease that occurs in children in the presence of a large-sized hemangioma, accompanied by coagulation disorders. This disease complicates the course of many somatic diseases in children, including community-acquired pneumonia, due to the clotting disorder. Case presentation. A case of a 4.5-month-old child with a combination of capillary hemangioma of the dextral chest surface, complicated by Kasabach-Merritt syndrome, and community-acquired right-sided focal pneumonia is presented. The possible effect of the Kasabach-Merritt syndrome on the course of community-acquired pneumonia has been analyzed. Additionally, the drugs’ effect on the coagulation disorder, the state of hemangioma, and the course of community-acquired pneumonia in children have been investigated. Conclusions. Severe coagulation disorders may occur in patients with Kasabach-Merritt syndrome and community-acquired pneumonia. Constant monitoring is essential during hospitalization. Such combination of diseases should be treated considering the ability of the drugs to influence both the hemostasis system and the progression of hemangioma’s growth.