Moldovan Medical Journal

3-8

Authors: Lesnic Evelina, Malic Alina, Kulcitkaia Stela, Niguleanu Radu, Jucov Artiom, Gutu-Grecu Mariana, Cula Eugenia, Tolmaciov Mihai

Background: One of the most important among risk factors for active tuberculosis development represents diabetes mellitus. The aim of the study was the assessment of the predictive factors for pulmonary tuberculosis in Xpert MBT/Rif resistant assay patients with diabetes mellitus. Material and methods: A retrospective, selective, descriptive and case-control study was performed. Were enrolled 119 pulmonary drug resistant tuberculosis patients, diagnosed and hospitalized in the Municipal Clinical Hospital of Phthysiopneumology of Chisinau city in the period of 01.01.2013- 01.01.2015. The patients were distributed in 2 groups: the 1st group – 34 MDR-TB patients with diabetes mellitus and the 2nd – 85 MDR-TB patients. Investigations were performed according to the National Clinical Protocol – 123. Results: The biological characteristics of the pulmonary MDR-TB patients with diabetes mellitus were old age with associated diseases, which contributed to a lower treatment outcome. For MDR-TB groups were common social-economic vulnerability, late detection as symptomatic cases and a high treatment success rate. Conclusions: Patients with MDR-TB and diabetes mellitus need an individualized approach for an early TB detection and prompt initiation of the adequate treatment regimen according of the susceptibility testing results.

17-20

Authors: Placinta Gheorghe

Background: Toxocariasis is a clinical notion that reflects human involvement with the Toxocara larvae in the second stage of development. Its typical syndromes are Larvae Migrans Visceralis, ocular toxocarosis , neurological form and occult form. The most common toxocariasis is asymptomatic, only eosinophilia and the positive serological result being the only manifestations of this helminth. The epidemiological examination and a detailed anamnesis of the patient can be helpful in establishing this diagnosis. Children are part of the risk group, especially because of the childhood habits, their undoubted attraction to puppies, and because of their low immune system. Material and methods: The elaborated prospective-descriptive study presents the evolution features in a group of 94 children with T.canis monoinvasion in which were examined the clinical signs, important laboratory indices, the applied treatment and its influence. Results: The study revealed the most common clinical signs and paraclinical changes in a group of 94 children with T.canis monoinvasion. Was examined the specific treatment by highlighting its influence on laboratory indices representative for this parasitosis. Conclusions: The most common clinical signs were headache, dry cough and abdominal pain. The specific therapy for vicerial chronic toxocariasis in children was far superior in clinical outcomes, this being reflected by maintaining ALT levels within the normal values demonstrating the direct involvement of larvae and toxocara toxins in the establishment and maintenance of hepatic cytolytic syndrome in children.

24-27

Authors: Ergeshov Atadjan, Punga Victor, Rusakova Larisa, Yakimova Marina, Izmailova Tamara

Background: The comparative assessment of the epidemiological indices and challenging issues of the tuberculosis control in the Russian Federation. Material and methods: In the study were used the analytical annual reports of the statistical indices registered and the electronic resources of the Federal Research Institute for Health Organization and Informatics of the Russian Ministry of Health. Results: The tuberculosis epidemiological situation in the Russian Federation is continuously improving. The achieved indices in disease control were 71.3% of the population annually screened and the rate of 51.5% patients with microbiological sputum conversion from positive to negative. During the period from 2000 till 2017, the incidence decreased from 90.4 to 48.3 per 100 000 population, the incidence in children aged between 0 and 14 years old decreased from 19.1 in 2001 to 9.7 in 2017 and in children aged between 15 and 17 reduced from 40.5 (the highest level) in 2005 to 21.6 in 2017 (the lowest level 16.6 in 1992). One of the contributing factors with an important impact on the epidemiological state represents the HIV-infection, the incidence of which went up from 6.5% in 2009 to 20.9% in 2017. In 2017, the effectiveness of treatment based on bacterial conversion was reported in 70.7% of new cases, and closure of cavitary lesions was reported in 62.9% of cases. Conclusions: Russia made certain progress in tuberculosis control, however, the vast territory, its heterogeneity, including climatic and social economic differences, affect the epidemiological situation. Big efforts were performed for solving the problems associated with the infection control. The epidemiological data determined an increasing rate of the MDR-TB and TB/HIV co-infected patients, which required the development of the new approaches in tuberculosis control.

38-42

Authors: Placinta Cheorghe, Pantea Victor, Cebotarescu Valentin, Cojuhari Lilia, Paveliuc Petru, Musteata Tatiana, Panasiuc Alexandru, Lungu Victoria, Simonov Ludmila

Background: Leishmaniasis is a disease caused by parasites of the Leishmania type. Cutaneous leishmaniasis is a neglected worldwide, zoonotic, vectorborne, tropical disease. The clinical spectrum of leishmaniasis ranges from a self-resolving cutaneous ulcer to a mutilating mucocutaneous disease and even to a lethal systemic illness. People who recover from cutaneous leishmaniasis are protected against future infections. The risk of infection is for people of all ages if they live or travel where leishmaniasis is found. Leishmaniasis usually is more common in rural than in urban areas, but it is found in the outskirts of some cities. The transmission risk is highest from dusk to dawn because this is when sand flies generally are the most active. Cutaneous leishmaniasis causes skin lesions, which can persist for months, sometimes years. The skin lesions usually develop within several weeks or months after the exposure but occasionally first appear years later. Presented here is a clinical case of leishmaniasis of the cutaneous form, diagnosed by the microscopic method. The patient was diagnosed, monitored and treated in Clinical Hospital of Infectious Diseases “Toma Ciorbă” from 10.01.2018-09.02.2018. The progression of the disease was favorable following the etiotropic treatment with antimony meglumine (Glucantime), requiring careful monitoring due to adverse reactions. Conclusions: Clinical symptomatology was characteristic for cutaneous leishmaniasis: skin lesions of various pink-cherry sizes, some with ulcers on the body. The first etiotropic treatment with antimony meglumine was effective. Antimonate Meglumine treatment at a dose of 15 ml resulted in adverse reactions: asthenia, fever, myalgia and arthralgia.

51-62

Authors: Sciuca Svetlana, Antonovici Natalia, Dolganiuc Angela

Background: The article reviews aims to promote the communication between scientists engaged in basic research and clinicians working with children, in order to better understand the mechanism and work together towards an optimal management of this prominent pediatric condition. We reviewed the recent advancements in regards to pediatric asthma related to pathogenesis, diagnostic criteria and differential diagnosis, and peer-reviewed evidence for efficiency of pharmacological and non- pharmacological/alternative/adjuvant treatment; we also emphasize the importance of education of all parties involved in care, outpatient management, age-appropriate involvement of children in their own care, and asthma prevention measures in children. Clinically asthma is characterized by recurrent episodes of wheezing, dyspnea, and cough; at the pathophysiological level the airway wall thickness is increased and involves both smooth muscle and collagen tissue, the mucous glands and mucus production are increased, and the vascularity of the airways is increased, all leading to chronic inflammatory remodeling of the airways and resulting in reduction of lung function. Conclusions: Asthma among children has been on the rise for decades. With an estimated prevalence of 10-30%, asthma is the most prevalent chronic disease of pediatric population worldwide and one with a large health care burden. The approach to diagnosis and treatment of asthma in children is distinct from adults; so is the management, prevention and the education of parties involved in care. Recently there has been a significant progress in mechanistic understanding of asthma; further, asthma management in children is becoming a top priority.