Moldovan Medical Journal

3-6

Authors: Ciobanu Natalia, Ciobanu Sergiu

Background: Patients with stroke associate a lot of complications; one of the most serious is femoral neck fracture. Nearly 30% of patients who have suffered femoral neck fracture die during the first year, in the survivors persists pronounced pain syndrome and reduced motility in the affected limb, and they become dependent in their habitual activities. Material and methods: The notes of all patients with fractured neck of femur who were admitted to Clinical Hospital of Traumatology and Orthopedics, Chisinau, the Republic of Moldova, between January 2014 and December 2015 were scrutinized. Results: In a series of 67 hemiplegic patients who subsequently fractured their hips, it was found that hip fracture occurred significantly more often on the hemiplegic side. Hip fracture was equally common in right and left-sided hemiplegia, and often occurred within five years of the stroke. Conclusions: Hip fracture after stroke is an increasingly recognized problem. Measures to prevent bone loss and preserve bone architecture have not been part of stroke management thus far. Because rapid bone loss is a risk factor for fracture, we believe that kinesiotherapy in the early phase of stroke rehabilitation is indicated. If a successful prevention program could be worked out in stroke patients, there would be potential saving of lives, suffering, and resources.

13-17

Authors: Railean Silvia

Background: There is no information about cranio-facial asymmetry among school children and the influence of this pathology on the quality of life. Material and methods: The study presents a descriptive analysis of 3923 children ages 7 to 18 years. In this scientific work were involved three types of schools: 421 children from schools with severe neurological disorders; 2157 children from auxiliary schools with special educational needs; and 1345 children from pre-university schools. Buccal examination included the dento-maxillary analysis in three planes (sagittal, vertical, and horizontal) and cranial anatomical shape was examined for all children. Results: In total 3923 children were examined, of which 632 (16%) were determined with cranial asymmetry. Among 2157 children from auxiliary schools for children with special educational needs 18% were detected with cranial deformities. In schools for children with neurological disabilities cranial asymmetries were detected in 44.18%, and in pre-unuversity schools 4.76 % were found with cranial deformities. A high incidence (twice more) of dental alveolar anomalies were found in children with cranial deformities, compared to those without deformities in the sagittal plane, 15.5% of children with cranial deformities were found with dento-alveolars anomalies and 7.84% in children without cranial deformation was (P<0.001). Similar resultswere found in the determination of occlusion anomalies in the horizontal and vertical planes. Conclusions: The high incidence of cranial deformities was found among handicapped children and children from schools with special educationalneeds. A few children with cranial deformities were found among children from pre-university schools. It was proved that a high risk of dento-alveolaranomalies have children with cranial deformities.

22-25

Authors: Olaru Andrei

Background: Vertebral cement augmentation and external beam radiotherapy have become increasingly used techniques for treatment of vertebral compression fractures due to spinal metastatic lesions in the Republic of Moldova. Surgically, the goal of vertebral cement augmentation is to improve the strength and stability of the injured vertebrae, as well as local tumor control. External beam radiotherapy for suppressing tumor or inducing pain relief are performed immediately after vertebral cement augmentation. Usually, local tumor control is occurred by CT or MRI studies. We have studied through the infrared thermography the dynamics of temperature gradient of tumoral foci skin projection. Material and methods: The purpose of this study is to evaluate the local tumoral control, analyzing the infrared thermographic examinations in 33 patients with uncomplicated metastatic vertebral fractures, undergoing combined method of treatment (vertebral cement augmentation + external beam radiotherapy), before the treatment and at 12 months follow-up. Results: We observed an indirect tumor “thermographic field” decrease registered by temperature gradient decrease from an average of 2.03±0.24ºC in preoperatively to 1.28±0.33ºC at 12 months postoperatively follow-up. Conclusions: Combined method of stabilization (vertebral cement augmentation + external beam radiotherapy) in patients with uncomplicated metastatic vertebral fractures is effective in minimal invasive surgery and offering local tumor control.

31-34

Authors: Baltaga Ruslan, Tibirnac Petru

Background: Circulation insufficiency is one of the most common dysfunctions in the patients admitted to the intensive care units (ICU) [1]. These patients need an intravenous (IV) vasoactive drug administration to optimize or support cardiovascular system (CVS). Emergency situations, hard work conditions, difficult devices’ usage and a lot of other specific factors of complex environment of ICU create favorable conditions for the occurrence of medical errors (ME). Material and methods: Within this prospective study were examined the methods of administration and the types of the errors that were found during the administration of the following drugs: epinephrine, noradrenaline, dopamine and dobuthamine. In the period of time May – September 2016, were examined 50 patients from ICUs from 4 different hospitals. The age limits were between 31-100 years old. The data collection was accomplished on the base of a questionnaire prepared beforehand. Results: From all the number of examined patients, 33 (66%) were men and 17 (34%) – women. The body weight was indicated in the medical notes of 21 (42%) patients. To 15 (30%) of them was administrated the adrenaline, noradrenaline had the incidence in 15 patients (30%) and dopamine – 17 patients (34%). Conclusions: Tracked dosage errors in 20% of cases, 4% of them were found at dilution administration of the drugs. The inscription of administered drug in medical notes was lacking in 2 uses.

41-44

Authors: Grib Liviu, Cenusa Octavian, Varvariuc Viorica, Abras Marcel, Grib Andrei, Grajdieru Romeo

Background: Atrial fibrillation (AF) is associated with a 5-fold increase in the risk of stroke and a 3-fold increase in the incidence of heart failure. The increase in AF prevalence can be attributed both to better detection of silent AF, alongside increasing age and conditions predisposing to AF. Nonpharmacological measures aimed at «healing» AF were initially tested in open surgery. Searching for an approach with a greater chance of success led to the development of radiofrequency ablation (RFA). Only recently RFA technique began to be used extensively in people with AF, not being tested in large randomized studies, with establishment of remote results. Conclusions: Catheter ablation is used successfully in patients suffering from symptomatic paroxysmal atrial fibrillation, as an alternative to drug therapy. Performed correctly by a trained and experienced electrophysiolologist, RFA allows us to get remarkable results, being possible suspension of treatment with antiarrhythmic drugs and to avoid its so well known side’s effects. RFA with catheter is superior to antiarrhythmic drug therapy in preventing recurrence in both persistent AF and in the paroxysmal AF. The success rate of RFA in experienced centers for paroxysmal AF exceeds 70% a year. RFA reintervention is necessary in the approximately 9-20% of patients with more modest results. The frequency of major complications related to RFA is less than 5%. The restored sinus rhythm with RFA in patients with heart failure may be associated with significant improvement in left ventricular ejection fraction.