ARCHIVES OF THE BALKAN MEDICAL UNION

8-15

Authors: Anca EVSEI, Adelina BIRCEANU-COROBEA, Mihai GHITA, Narcis COPCA, Maria SAJIN

Introduction. Immunotherapy has emerged as a potent strategy for treating advanced cancer. This generated new and exciting research, especially regarding tumour microenvironment (TME), including the immune checkpoint system, to further stratify endometrial carcinoma (EC) patients and improve targeted therapy. The objective of the study was to evaluate the TME and PD-L1 impact on various molecular groups. Material and methods. 50 cases of formerly diagnosed ECs were tested for CD4, CD8, CD68 and PD-L1. Results. PD-L1 testing in our group revealed 60% of cases showing <1% cell positivity, 34% of cases showing 1-49% cell positivity, and 6% of cases showing ≥50% cell positivity. The statistical analysis revealed the following significant correlations with clinical and pathological parameters: pT (p=0.012), FIGO stage (p=0.028), myometrial invasion (p=0.037) and ESMO risk stratification (p=0.017). PD-L1 expression in the three different molecular subgroups showed significant correlation with the MSI-H subgroup (p=0.014). The analysis between TME and PD-L1 expression revealed significance with stromal CD4+ cells (p=0.037), tumour and stromal CD8+ cells (p=0.011, p=0.028), and stromal CD68+ cells (p=0.012). Conclusions. Molecular classification, TME evaluation and PD-L1 expression are key ancillary tools in elaborating comprehensive EC pathology reports. Combined evaluation of these features allows a more precise prognostic stratification of EC patients and provides significant implications for incorporating immunotherapy in current therapeutic strategies for EC.

24-32

Authors: Mariya MARUSHCHAK, Uliana HEVKO, Inna KRYNYTSKA, Yulia DANYLEVYCH, Svitlana DANCHAK, Lyudmyla MAZUR

Introduction. The complexity of the interaction between type 2 diabetes mellitus (T2DM), comorbidities, and emerging complications requires a clinical approach that manages risk while maintaining indicated therapeutic goals. The objective of the study was to analyse the frequency and effectiveness of mono- and combined glucose-lowering therapy in T2DM patients with obesity and chronic pancreatitis (CP). Material and methods. The retrospective study analysed 579 medical records of T2DM patients, who were divided in the following groups: group 1- patients with normal body weight and without CP (n=67); group 2 – patients with normal body weight and with CP (n=32); group 3- overweight patients without CP (n=126); group 4 – overweight patients with CP (n=33); group 5 – obese patients without CP (n=262); group 6 – obese patients with CP (n=59). When evaluating the effectiveness of the received therapy, the target value of HbA1c less than 7% was considered. Results. Most of the patients with T2DM+CP and T2DM with normal body weight received combined therapy. The presence of CP significantly influences the choice of treatment for T2DM, particularly, 81.5% of patients with T2DM and CP were prescribed combined therapy. There was no significant difference between serum glucose and HbA1c levels in patients with only T2DM and comorbid T2DM+CP+overweight/obesity regarding monotherapy vs combined glucose-lowering therapy. However, glucose and HbA1c levels in patients with only T2DM on monotherapy were significantly lower, respectively, by 41.72% and 25.64% vs patients with comorbid CP and overweight/obesity, who were also prescribed monotherapy. Conclusion. The presence of CP significantly influences the choice of treatment for T2DM, while overweight/obesity is not a criterion for choosing mono- or combined glucose-lowering therapy. The use of metformin as monotherapy and the use of combined therapy in most of patients with only T2DM and comorbid T2DM do not achieve the target levels of glucose and HbA1c.

43-50

Authors: Halyna PAVLYSHYN, Renata BOKINIEC, Maria K. BORSZEWSKA-KORNACKA, Iryna SARAPUK, Ivanna HORISHNA

Introduction. With the improvement in perinatal care management, the survival rate of very and extremely preterm infants increased, while the incidence of neonatal morbidity remained constant. The aim of the study was to analyse and compare two cohorts of Neonatal Intensive Care Unit-admitted preterm infants with gestational age <32 weeks (from Ukraine and Poland), and to identify the key problems of neonatal care, to improve the management of preterm infants. Material and methods. The comparative analysis included survival rates and neonatal outcomes as intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, late-onset sepsis, necrotizing enterocolitis (NEC), duration of parenteral feeding, breast-feeding rate and infants’ growth parameters. Mann-Whitney U-test and Chi-square test were used for statistical analysis. Results. The survival rate of preterm infants was lower in the cohort from Ukraine compared with Poland (p=0.0076). The late-onset infection rates were higher in extremely and very preterm newborns (p<0.05) and NEC prevailed in very preterm infants (p=0.000) among neonates of Ukraine; the duration of parenteral feeding was significantly higher in both age groups in this cohort. Postnatal growth failure was observed in 57.1% and 29.4% in extremely preterm infants of Ukraine and Poland, respectively (p=0.035). Conclusions. The comparative analysis of short-term outcomes of very and extremely preterm infants in different perinatal centers identified key problems in their management and the possible ways to improve the quality of care. Regular auditing of clinical outcomes and identification of main problems could facilitate quality improvement in preterm infants’ management and help to implement new interventions and approaches.

58-65

Authors: Alexei PLESACOV, Vitalii GHICAVII

Introduction. Thulium:YAG laser has been increasingly used in retrograde transurethral enucleation of the prostate as a new advanced surgical treatment in benign prostatic hyperplasia (BPH). The implementation of Thulium:YAG laser prostatic vapoenucleation (ThuVEP) will allow patients with large BPH, who have traditionally been treated via open adenomectomy or monopolar transurethral resection, to undergo minimally invasive endoscopic treatment by using laser energy. The objective of the study was to provide a comparative assessment of ThuVEP vs. standard transurethral resection (TURP) in the treatment of benign prostatic hyperplasia. Material and methods. The study was conducted on 81 patients with BPH, regarding the appropriate surgical treatment, including ThuVEP (40 patients) and TURP (41 patients), from May to December 2018. All patients were assessed before surgery and 3, 6 and 12 months after surgery. The obtained data were compared retrospectively. Results. ThuVEP has proven its long-expected surgical efficacy. The main urodynamic and ultrasonographic indices at 12 months postoperatively showed no statistically significant difference. Moreover, the incidence rate of surgical complications was lower in the ThuVEP group. Patients from the ThuVEP group did not require further blood transfusions. Conclusions. ThuVEP exhibited major efficacy and maximum efficiency in the treatment of BPH in our study. Thulium:YAG laser used in the surgical treatment of BPH is considered superior compared to the classic TURP endourological technique, as well as promising for clinical practice. Further long-term patients’ follow-up is necessary to assess the durability of the intervention.

72-79

Authors: Oksana BOYARCHUK, Tetyana HARIYAN, Nataliia YAREMA, Mariya KINASH

More than ten years of implementation of newborn screening for severe combined immunodeficiency (SCID) using a T-cell receptor excision circle (TREC) and in recent years the TREC/ kappa-deleting recombination excision circle (KREC) assay have shown a number of advantages, which are not only the proper detection of SCID, to achieve better treatment outcomes and survival of children, as well as expanded knowledge on the prevalence of SCID, other diseases associated with T- and B-lymphopenia, but also allowed to detect new mutations associated with PID. The challenges include the inability to diagnose SCID with T-cell dysfunction and normal levels of T-lymphocytes and other SCIDs using the TREC assay, cytomegalovirus infection, that significantly worsens hematopoietic stem-cell transplantation prognosis (HSCT), economic issues, especially in low- and middle-income countries, and certain ethical issues. Considering the good worldwide experience, there are many reasons for a wider implementation of the newborn screening program for SCID in the world, including the Eastern Europe.

88-93

Authors: Leonard SIMONI, Astrit CEKA, Ermir TAFAJ, Mirald GINA, Alban DIBRA, Artan GODA

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, a disease affecting mainly the respiratory system, has become the major cause of a worldwide crisis, imposing a real challenge for the healthcare systems. The underlying pathological mechanisms of coronavirus disease 19 (COVID-19), such as increased inflammatory and immune responses, endothelial damage, prothrombotic status, were expected to increase the incidence of acute coronary syndromes (ACS), but observational studies so far indicate an important reduction in ACS admissions and treatment, possibly because of the fear of contagion, reorganization of medical structures and reduction of physical activity. Further work is needed to identify the factors responsible for this situation.

101-105

Authors: Ruxandra OPRITA, Gabriel CONSTANTINESCU, Teodor BEREA, Diana DIACONESCU, Lidia STEFAN

Introduction. The tumours of the small intestine are rare findings. These tumours are more common in the duodenum than in the jejunum and ileum. The symptoms are vague and non-specific. A complete and thorough esophagogastroduodenoscopy plays a crucial role in the early diagnosis of small bowel tumours, especially those localized after the second part of the duodenum. Case presentations. The first case is of a 43-year-old man, who presented for important weight loss (19 kilograms in one year). The upper digestive endoscopy revealed a tumour in the third part of the duodenum, with a positive biopsy for non-Hodgkin’s lymphoma. The second case is of a 63-year-old male smoker patient, who presented to the emergency department for melena. While the emergency upper digestive endoscopy was non-diagnostic, a second evaluation highlighted a mass in the third part of the duodenum, that macroscopically and subsequently microscopically was confirmed to be a gastrointestinal stromal tumour. The third case is of a 59-year-old woman who presented for abdominal pain and in whom echo-endoscopy diagnosed a duodenal tumour. Conclusions. While many duodenal tumours become symptomatic when they are locally advanced, an incomplete upper digestive endoscopy may further delay the diagnosis and worsen the outcome. This highlights the importance of performing a complete esophagogastroduodenoscopy with the visualisation of the entire duodenum.

110-113

Authors: Nikoleta G. TABAKOVA, Emil G. KOVACHEV, Vilislava R. IVANOVA, Tsvetomir E. KACHOVSKI, Dimitar D. IVANOV

Introduction. Pelvic abscess rupture is a rare complication following in-vitro fertilization procedures. Case presentation. We describe an unusual case of ovarian abscess rupture following transvaginal oocyte retrieval in a 31-year-old female with a previous endometrioma. The patient presented 17 days after ultrasound-guided oocyte retrieval and 12 days after embryo transfer in our emergency room, with acute lower abdominal pain, septic fever and malaise. Laparoscopic surgery was considered after failure of triple intravenous antibiotic combination. Conclusions. Managing patients undergoing infertility treatment with this condition appears to be difficult due to the need of aggressive antibiotic and surgical treatment, which increases the risk of spontaneous abortion after embryo transfer.

121-129

Authors: Farah S. CONSTANTIN, Andrei E. CONSTANTIN, Bianca M. RADU

Introduction. Glaucoma is a bilateral progressive hereditary optic neuropathy which determines the slow and irreversible destruction of the optic nerve fibres. Cases presentation. We present two cases of primitive open-angle glaucoma developed following sustained stress. In both cases, the cause of glaucoma was the depressive disorder. Once glaucoma is installed, therapy will be continued long-life, to prevent irreversible vision damage and thus to increase the quality of life of these patients. Conclusions. Glaucoma, as a disease with blinding potential, determines an additional stress, besides the preexisting stress, which itself is the triggering cause of the disease. The relationship between stress and increased intraocular pressure is known into practice, but it is still insufficiently researched. The relationship between elevated intraocular pressure and worsening glaucoma during the life of these patients is known, and the existence of stress leads to increased intraocular pressure. This cascade of side effects of stress leads to the aggravation of glaucomatous disease.