Moldovan Medical Journal

3-9

Authors: Alina Malic

Background: The aim of the study was the assessment of the impact of the molecular genetic Xpert MTB/Rif assay on the diagnostic delay and the treatment effectiveness in pulmonary tuberculosis, according to the results of the microbiological and molecular-genetic methods, in order to optimize the management of the drug resistant tuberculosis. Material and methods: A retrospective selective study, which included 226 patients with multidrug-resistant pulmonary tuberculosis (study sample) and 78 patients with drug-susceptible pulmonary tuberculosis (control group), was performed. Patients were divided into 2 subgroups following the results of the molecular-genetic and bacteriological investigations. The study sample was divided in two groups: the 1st group included 85 patients enrolled in the treatment for drug resistant tuberculosis, according to the results of the Xpert MTB test and the 2nd group included 141 patients enrolled in the treatment DOTS plus, according to the results of the conventional cultures. Results: The impact of the molecular genetic GeneXpert MTB/Rif assay was demonstrated on early diagnosis, adequate treatment according to the drug susceptibility to rifampicin, shorter duration of the treatment, low rate of the side events, optimal treatment compliance and higher treatment effectiveness. The conventional microbiological methods contributed to the late diagnosis of the patients, high rate of the severe and complicated tuberculosis, long duration of the treatment which were reflected on the low treatment effectiveness. However the conventional culture methods allowed the treatment individualization according to the drug susceptibility tests. Conclusions: Target screening of the population with risks and compulsory investigation by GeneXpert MTB/Rif assay will diminish the rate of severe late detected forms of pulmonary tuberculosis and adapt the treatment according to the drug resistance to rifampicin.

15-23

Authors: Evelina Lesnic, Eugen Cotelea

Background: Drug injection is considered an important issue for the public health of the Republic of Moldova. In the RM the intravenous drug users (IVDU) are the key population for HIV infection, B and C hepatitis, TB and sexual transmitted diseases. The aim of the study was to assess the tuberculosis evolution and treatment outcome in intravenous drug addicted patients. Material and methods: A retrospective selective, descriptive study targeting socioeconomic, demographic, economic and epidemiological peculiarities, case-management, diagnosis of radiological aspects and microbiological characteristics of 233 patients with pulmonary tuberculosis registered in Chisinau city from 2012 to 2016 among them 48 IVDU was performed. The results were compared with a sample of 34 IVDU. Results: Men were predisposed for drug addiction and the age is younger in addicts with tuberculosis. Socioeconomic vulnerability is extended in the selected groups; however, the poverty deepness was more important in addicted patients with tuberculosis. Close contact with a sick patient predominated in addicts with tuberculosis, but nobody assessed the contact in addicts without tuberculosis. Associated diseases predominated in addicts with or without tuberculosis, more frequently were: HIV infected individuals, viral hepatitis and neurological disorders. Conclusions: Risk factors for tuberculosis in drug addicts were: unemployment and associated lack of health insurance, patient’s homeless state, middle adulthood and the immune suppressive condition – HIV infection. Major disease-related characteristic in IVDU patients was the presence of severe destructive forms of tuberculosis and "loss to follow-up" as outcome.

31-38

Authors: Оlexandr Koval, Volodimir Vasyuk

Background: The scientific papers deal with it reporting different treatment technologies for distal tibia metaepiphysis fractures; meanwhile the complication and failure rates remain high. Material and methods: 265 patients were examined. Their average age was 45.15±15.98 years (from 18 to 86). The patients were distributed into clinical groups according to the type of surgery performed. Clinical group I included patients who underwent mini-invasive osteosynthesis with K-wires and screws (113 patients, 42.64% from general group); Clinical group ІІ included patients with external fixation osteosynthesis (36 patients, 13.58%); and Clinical group ІІІ included patients who underwent osteosynthesis with plates (116 patients, 43.77%). Results: The technology of mini-invasive osteosynthesis of distal metaepiphysis fractures of the lower leg is improved. Reposition is performed under general or conduction anaesthesia under C-arm control. Ligamentotaxis principle is applied pulling fragments by means of distractor. In case separate bone fragments are not repositioned a pricker, single-toothed tenaculum are used through separate pricks of the skin. Every step is controlled by imagic intensifier. After subluxation is eliminated and reposition completed, trans-articular fixation of fragments is performed inserting 2-3 K-wires 2 mm in diameter from the sole in the direction of the tibia middle part. Conclusions: The analysis of implementation of the improved mini-invasive osteosynthesis technology for fractures of the distal lower limb compared with the traditional methods of surgical treatment of these injuries in 265 patients from the three clinical groups demonstrated that the use of closed reposition and improved technique results in improved results and considerable reduction of costs for treatment in comparison with traditional osteosynthesis.

47-52

Authors: Tatiana Timercan

Background: Interleukin-6 is a multifunctional cytokine with well-defined pro- and anti-inflammatory properties. Binding to the receptor complex composed of specific interleukin-6-receptor (IL-6R) and transmembrane glycoprotein gp130, it stimulates various signalling cascades. Intracellular signal transduction involves both STAT-dependent, and STAT-independent mechanisms. IL-6R exists in the soluble and the membrane-bound forms, thus were described the classical signalling and the trans-signalling pathways. The pro-inflammatory response occurs via trans-signalling, while the antiinflammatory effects are mediated by classical signalling pathway. IL-6 is produced by cardiovascular components. The high levels of IL-6 are identified in the inflammatory diseases. Conclusions: IL-6 expresses the well-defined pro- and anti-inflammatory properties. The experimental studies have revealed classic signalling pathway with regenerative and anti-inflammatory effects (via the membrane-bound IL-6R), and trans-signalling responsible for the pro-inflammatory response (via the soluble form sIL-6R). The intracellular signal transduction involves the activation of STATs, MAPK, and PI3K cascades. It has been proved that in the cardiovascular pathologies the serum levels of IL-6 correlate with the disease severity and the degree of myocardial damage, being the indicator of heart disease and a predictive factor of adverse outcomes.

57-62

Authors: Viorel Moraru, Petru Bujor, Galina Pavliuc, Sergiu Bujor

Background: Gallstone disease and chronic calculous cholecystitis are the most prevalent gastro-enterological diseases requiring a surgical treatment. This disease occupies a special place in the pathology of the hepato-bilio-pancreatic area, which is important for the etiological diagnosis as well as for the resonance and the complex impact on the function of the adjacent organs. Besides, gallstone disease can result in serious outcomes, such as acute gallstone pancreatitis and gallbladder cancer. This article analyzes the clinico- morphological characteristics of gallbladder stones. At the same time, the role of duodenal dysmotility in the ethiopathogenesis of cholestasis was reevaluated through the contemplation of the contemporary concepts of lithogenesis. Conclusions: The pathogenesis of gallstone disease is suggested to be multifactorial and probably develops from complex interactions between many genetic and environmental factors and the state of adjacent organs. Based on its anatomical and physiological features, the duodenum is a completely unique crossroads where the digestive pathways of the stomach, liver and pancreas meet. The sealing functionality of these organs allows them to be cataloged as an integral system, and the duodenum due to its specific role exerts ”the pituitary function” of the gastrointestinal tract. Therefore, any disruption of the duodenum activity may not be etiopathogenetically reflected on the hepatobiliary-pancreatic disease, and biliary cholelithiasis is no exception in this regard. The achievement in the study of the pathophysiology of bile stones formation and the pathogenesis of gallstone disease can help to improve the complex medico-surgical treatment of this category of patients.