Moldovan Medical Journal

5-9

Authors: Lilia Andronache, Valeriana Pantea, Aurelian Gulea, Inna Svet, Vasilii Graur, Valerii Matcovschi, Marina Gamaniuc, Valentin Gudumac

Background: Currently, there is a growing interest in new copper (Cu2+) heterocyclic coordination compounds (CC), isothiosemicarbazide derivates, which demonstrated multiple beneficial properties, but their effect on reactions with free radicals such as the superoxide radical has not been investigated. Material and methods: The action of new micromolecular complexes of copper (Cu2+) chloride and bromide with methyl n- (prop-2-en-1-yl) -2- (pyridin- 2-ylmethylidene) hydrazine carbimidothioate on capturing activity of the superoxide radical was determined by the spectrophotometric method in vitro experiments. Results: It was established that the micromolecular complexes of copper (II) chloride and bromide with methyl n-(prop-2-en-1-yl)-2-(pyridin-2- ylmethylidene) hydrazine carbimidothioate have been found to possess strong superoxide radical inhibitor properties when interacting with a superoxide radical. In addition to this, the IC50 of the studied compounds depends on the nature of the acid-ligand in the internal sphere of the complex and increases in the following sequence: Cl-–Br-. Conclusions: The established property of mentioned compounds is new, because their use as micromolecular inhibitors of superoxide radicals has not been described so far. The synthesized CC expand the arsenal of superoxide radical inhibitors with high biological activity. Their possible significance for the development of new treatment strategies for diseases associated with the overproduction of superoxide radicals is discussed.

13-19

Authors: Vitalie Cobzac, Liliana Verestiuc, Mariana Jian, Viorel Nacu

Background: Articular cartilage has poor regenerative capacities. Numerous cartilage repair techniques are known, including implantation of autologous chondrocytes. Material and methods: From 18 rabbits pieces of cartilage were harvested from femoral condyle. Minced cartilage was treated with 0.25% trypsin-EDTA. In the 1st group (n=9) the cartilage was digested with 0.6% collagenase in 15 ml tubes by shaking in incubator at 37°C, 5%CO2. In the 2nd group (n=9) digestion was performed in 25cm2 cell culture flasks placed on the lateral side, monitoring the process under a microscope after 120 minutes. The isolated cells were cultured to a 80-90% confluence. The chondrocytes were identified using histochemical staining after culturing for 16 days in overconfluence. Results: Chondrocytes isolation in the 1st group lasted a fixed 360 minutes, in the 2nd group – 140±10 minutes. In the 1stgroup were isolated 9.2x104±3.1x104 chondrocytes with a viability of 85.36±16.41%, but in the 2nd group – 1.6x105±3.4x104 chondrocytes with a viability of 98.09±3.85%. The mean period of cell culture in the 1st group was 15±2 days, in the 2nd group – 11±3 days. In first passage of the 1st group were obtained – 1.2x106 ±4.3x105 chondrocytes and in the 2nd group – 2.92x106 ±3.6x105 chondrocytes. The secreted extracellular matrix by chondrocytes was stained specifically for cartilaginous tissue. Conclusions: The method used for chondrocytes isolation has a direct impact on the number of isolated cells, their viability, but also upon the culture period and the number of cells obtained during the first passage.

26-32

Authors: Elena Pavlovschi, Alina Stoian, Grigore Verega, Viorel Nacu

Background: The use of bone graft has been a successful step in the treatment of a large number of diseases of the osteoarticular system. But a massive bone defect remains a dilemma for modern reconstructive surgery. Present methods used have a high level of morbidity and complication. Literature indicates the absence of an optimal solution in massive bone defects healing. The aim of this study: to perform an in vivo preliminary study of vascularization of the hind limb in the rabbit model, for obtaining a graft able for further inclusion in the host blood circulation, without immunosuppression by decellularization. Material and methods: The study was performed on the 12 laboratory rabbits. After euthanasia of the rabbit, the femoral and tibiofibular bone was collected without soft tissue, only with the vascular pedicle, and keeping the passage through the vessels. In the abdominal aorta was injected contrast material, with the subsequent preparation of the arterial vessels, succeeded by anatomical, morphological, radiography, and microangiography study of this vascularized bone segment. Results: The principal nutrient artery of the rabbit femur springs from the lateral circumflex femoral artery. The optimal segment for vascularized allografting (the rabbit model) was determined the upper third of the femur with the up to the level of the internal iliac artery. So, it could be used as a bone graft for further conservation and decellularization. Conclusions: The vascularized allogeneic bone without immunosuppression would be a perfect alternative in the treatment of the massive bone defects.

37-40

Authors: Victor Schiopu, Vasile Turcanu, Nicolai Ghidirim

Background: Timely diagnosis of primary retroperitoneal tumours is one of the current challenges of clinical oncology. This is due to the rarity, polymorphism and diagnostic difficulties of primitive retroperitoneal tumours. Material and methods: The study is cross-sectional, prospective and retrospective. The study group is represented by 118 patients with abdominal and retroperitoneal space tumours. Using the receiver operating characteristic (ROC) analysis curve and calculating the average quality of the diagnostic model, the informativeness of ultrasonography in the diagnosis of primary retroperitoneal tumours (PRT) was appreciated. Results: For tumour localization, the ultrasonography (USG) as a diagnostic model demonstrated an appropriate use criteria (AUC) of 0.641 (95% CI 0.541, 0.740, p <0.001), and the mean quality of the diagnostic model was 0.54. Following the statistical analysis, was found a partial correlation between the size of the tumour and the dimensions estimated at USG of 0.540 (95% CI 0.295, 0.737, p <0.001), which represents a high positive correlation. To determine the uni- or multicentric character of the tumour, the USG demonstrated an integrative value of sensitivity and specificity of 0.644 (95% CI 0.415, 0.873, p <0.001. In assessing the proximity ratio of retroperitoneal tumours, the highest AUC was recorded in the assessment of the ratio of tumour to pancreas – 0.838 (95% CI 0.705.0.971, p <0.001) and kidney – 0.861 (95% CI 0.699, 1.024, p <0.001). Conclusions: Ultrasonography is a fairly informative imaging diagnostic method in the diagnosis of retroperitoneal tumours. The characteristics of the tumours obtained after the ultrasound examination provide indirect information about the malignant or benign nature of the primitive tumour, which allows the assessment of the next stages of diagnosis and treatment.

49-52

Authors: Victoria Rusu

Background: Sevoflurane is the inhalational anesthetic agent that is used widely in operating room. It is currently the most commonly used inhalation anesthetic in operating rooms. A series of studies on animal and human model detected the association of intraoperative use of sevoflurane and postoperative cognitive dysfunction (POCD) manifestation. On the other hand other studies demonstrate the same POCD associated with intravenous agents. Relevant multicentric trials got the reasons to suspect other key factors in developing postoperative cognitive dysfunction. Conclusions: The intra-anesthetic use of sevoflurane has been associated for a long time with the higher incidence of POCD. The mechanism was not identified, and the theory of neuroinflammation remained the main key of pathophysiological reaction that leads to cognitive dysfunction. Recent multicentre trial gives reliable information that the use of intravenous anesthetic agents is associated with the same POCD. Neuroinflammation remains to be the mediator of cognitive disorders, and apparently IL-6 keeps a major role in them. Future studies are needed to be conducted to identify the role of anesthetic agents in determining the neuroinflammation.

5-10

Authors: Iana Coropceanu, Gheorghe Ciobanu

Background: Acute coronary syndrome (ACS) is associated with high costs of hospital care, frequent recurrences and high risks of sudden death and short-term mortality. Material and methods: The retrospective study was based on the evaluation of 140 patients who met the ACS criteria. Clinical and epidemiological data were obtained based on the analysis of statistical reports of the Ministry of Health during 2016-2020. Results: The mean age of the patients was 65.0 ± 27.7 years. Incidence of acute myocardial infarction (AMI) in the population increased from 4.7 to 5.2 cases per 1000 inhabitants. The study found the following occurrence of risk factors: history of cardiovascular disease – 42 (91.3 %) patients, hypertension in 35 (76.1%), obesity in 21 (45.6%), diabetes mellitus in 14 (30.4%) and smoking in 13 (28.3%). The share of risk factors in the male group was distributed as follows: history of cardiovascular disease – 82 (87.2%) patients, hypertension – 63 (67.1%) patients, smoking – 40 (42.5%) patients, diabetes mellitus – 27 (28.7%) patients and obesity was established in 24 (25.5%) of men. Conclusions: ACS affects men more frequently, compared to women, in a ratio of 2.04:1. People under the age of 65 years constitute 57.5%. The results of the study showed that compared to men, women with ACS were older and had significantly more comorbidities.

16-20

Authors: Alina Malic, Evelina Lesnic

Background: In the Republic of Moldova almost 5% of the cases with tuberculosis are diagnosed annually among diabetic patients. The aim of this study was to assess the impact of diabetes mellitus on the evolution and anti-tuberculosis treatment effectiveness in a prospective study. Material and methods: A prospective, longitudinal and case-control study, which included a total number of 252 patients diagnosed with pulmonary tuberculosis and distributed in a study group, consisting of 93 patients diagnosed with diabetes mellitus and a control group, consisting of 159 patients without glycemic disorders, was performed. Results: This study identified that one half of the group with diabetes was detected by active screening and one third received anti-tuberculous treatment before actual episode. A similar rate of diabetic and non-diabetic patients was microbiologically positive, as well confirmed with drug-resistance. The anti-tuberculous treatment effectiveness was lower in diabetic patients, the death rate and the low treatment outcome (lost to follow-up and failed) were higher than in non-diabetic patients. The main causes of unfavorable evolution were: glycemic disorders (hyperglycemia), diabetes complications and the history of the anti-tuberculous treatment in the anamnesis. Conclusions: The individualized approach and a tight follow-up should be performed regularly in all patients with glycemic disorders and tuberculosis for the improvement of the disease outcome.

27-32

Authors: Andrei Ungurean, Alina Malic, Tatiana Osipov, Evelina Lesnic

Background: The surge demand and decreased availability of the health workers determined the designation of the Clinical Municipal Hospital of Phthisiopneumology (CMHP) into a hospital for the case-management of COVID-19 patients during the period of December 2020 – April 2021 for the treatment of the mild cases. The aim of the study was to assess the main peculiarities of the patients with COVID-19 through a cross-sectional study developed during the period February-April 2021 in the CMHP. Material and methods: A cross-sectional, analytical and prospective study was realized, which included 145 patients with COVID-19 hospitalized in the CMHP during February-April 2021. The inclusion criteria were: patient older 18 years, COVID-19 infection diagnosed by the pulmonologist with the positive polymerase chain reaction result for SARS-CoV-2 (COVID-19) and signed informed consent. Results: The peculiarities of patients with COVID-19 were dominated by the female sex, age over 60 years, residence in the urban districts of Chisinau and the infection acquired in the Republic of Moldova. Common clinical manifestations were: high temperature, profuse sweats, asthenia and headaches, productive cough, dyspnea, loss of smell or taste, and sore throat. The typical radiological findings such ground-glass pattern or consolidation with bilateral multifocal involvement were most frequent. Were cured most of the patients and the death rate was low. Conclusions: Peculiarities and clinical manifestations of the patients admitted in CMHP were typical for the COVID-19 infection. These findings did not show the real outcome of the standard case-management of the COVID-19 due to the restricted admission criteria.

38-41

Authors: Anatolie Taran

Background: The purpose of this study was to explore the differences in prehospital care, admission characteristics, burn intensive care, surgery and outcomes in patients requiring admission to a burn intensive care unit. Material and methods: The study was conducted on a group of 31 patients, who were hospitalized within the Clinical Hospital of Orthopedics and Traumatology in the period 2015-2019. The data analysis was carried out on the applied method of surgical treatment, the associated postoperative complications, antibiotic therapy applied, etc. Results: 27 out of the total number of patients underwent necrectomy and extensive wound debridement surgery in the first hours upon admission. 14 patients required additional decompression incisions in the underlying skin and fascia. 4 patients out of the total number presented visible signs of carbonization on the affected areas upon admission, therefore they were subjected to an emergency amputation. Out of 27 patients classified as “delayed emergency” cases, 13 patients were subjected to amputation of the corresponding segments. Conclusions: Electrical injuries are a severe cause of disability, as well as a challenging issue for reconstructive surgery, which is concerned with restoring the damaged structures with prosthetic amputation abutments, therefore improving the aesthetic and psychological appearance of the patients.

47-50

Authors: Diana Rotaru-Cojocari, Victor Rascov, Rodica Selevestru, Svetlana Sciuca

Background: Foreign body aspiration (FBA) is a typical occurrence in children. The clinical signs are influenced by various causes, and the differential diagnosis is important, especially when the suffocation crisis is not recognized. The aim of this study was to evaluate the clinical and imaging symptoms in children with FBA. Material and methods: A retrospective study is provided of 156 children who were hospitalized and examined (clinical and paraclinical tests) in the Pneumology Clinic between 2011 and 2020 after having a foreign body removed from their airways, using rigid tube bronchoscopy or fibrobronchoscopy. Results: The most affected age group was 1-3 years, which constituted 77.6% (95% CI 70.2% -83.8%). The most common symptoms were: cough – 98.7% (95% CI 95.4%-99.8%), dyspnoea – 94.2% (95% CI 89.3%-97.3%), wheezing – 61.5% (95% CI 53.4%-69.2%). Chest radiography was relevant for foreign body aspirations in 55.8% of cases (95% CI 47.6%-63.7%). The foreign body was extracted from the right bronchus in 32.1%, from the left bronchus in 21.8% of cases, from the lobar / segmental bronchi – 22.5%, and in 21.2% – multiple locations. The etiological structure of the endobronchial foreign body was dominated by the organic ones – 96.8%. Conclusions: Cough, dyspnoea, and wheezing are suggestive of this pediatric emergency. Chest radiography provides diagnostic information only for every second child.

56-61

Authors: Victor Tomacinschii, Maria Robu, Sanda Buruiana, Veronica Finciuc, Ana Grecu, Cristina Dudnic, Dumitrita Urescu, Marina Suschevici

Background: Non-Hodgkin’s lymphomas (NHL) are malignant tumors that develop from lymphoid tissue. Primary lymph node (LN) involvement is the most common localization (52-70%). The integration of Rituximab (R) in the NHL treatment represented a turning point. The aim of this study was to evaluate the therapeutic impact of the use of R in combination with conventional polychemotherapeutic (PChT) in the treatment of nodal onset NHL. Material and methods: A descriptive cohort study was performed on 80 patients diagnosed with NHL. Results: In the study participated: men – 39(48.8%), women – 41(51.2%). The mean age of the patients was 56.09 ± 13.6 years. The onset of NHL occurred in peripheral l/n in 85.0% of cases, in mediastinal LN – 7.5%, and abdominals in 7.5%. Stages I-II were identified in 21(26.2%) patients, stages III-IV in 59(73.8%) cases. Aggressive NHLs were diagnosed in 54(67.5%) patients, indolent NHLs in 26(32.5%) cases. In 61(76.3%) patients, first-line R+PChT treatment was applied – group 1(G1), and in 19(23.8%) cases conventional PChT was applied – group 2(G2). The overall response rate (ORR) in G1 was 86.8%, in G2 – 63.1%. Complete remissions (CR) were obtained in G1 in 63.9% of patients, in G2 – 47.3% of cases. Progression-free survival (PFS) in G1 had a median of 20 months, and in G2 the median was 12 months (p <0.05). Conclusions: The use of Rituximab increased the ORR rate (86.8% vs 63.1%), the frequency of CR (63.9% vs 47.3%) and PFS (20 months vs 12 months (p <0.05).

70-75

Authors: Valeriana Pantea, Marina Gamaniuc, Veaceslav Popa

Background: Currently, there is a growing interest in new local coordination compounds (CC), which demonstrated antitumor properties, but their influence on the erythrocyte antioxidant system has not been studied. The aim of the study: to study the effects of CC, thiosemicarbazide derivatives –TIA-160, CMT-67 and CMJ-33 on indices of the antioxidant system indicators in erythrocytes peripheral blood in vivo experiments. Material and methods: The action of CC on superoxide dismutase, catalase, total antioxidant capacity was evaluated on a group of 34 white rats, randomly divided into 4 groups: the first control group was injected subcutaneously with saline. The other groups (2 – TIA-160, 3 – CMT-67 and 4 – CMJ-33) were given subcutaneously 3 times a week for 30 days, 0.1μM / kg CC. Results: It was established that the TIA-160 compound demonstrated the highest capacity to induce the expression of erythrocyte catalase that exceeded the control level of 1.8, which did not correlate with the enzymatic superoxide dismutase (SOD) activity. Thus, this study showed that there are differences in the mechanisms of action of thiosemicarbazone derivatives. Conclusions: The influence of tested CC on the indices of the antioxidant system is selective. This selectivity may be the base to their strong selective antiproliferative and cytotoxic action on tumor cells, but not on healthy ones.

5-9

Authors: Aliona Nastas

Background: Septic purulent nosocomial infections (SPNI) are one of the most significant healthcare challenges of post-surgical procedures. SPNI are associated with increased morbidity, mortality and admission costs. It is a priority to determine the level of nosocomial infections (NI). This study aims to evaluate the bacterial contaminations after cardiac surgery within the Department of Acquired Heart Defects (DAHD). Material and methods: A cross-sectional study was designed and the medical records of 1189 patients who underwent cardiac surgery within the DAHD of a multiprofile hospital were retrospectively analyzed. The data were collected and stored in a Microsoft Excel spreadsheet. Results: The incidence rate of SPNI following cardiac surgery was 317.57‰ compared to 15.02‰ officially reported (p <0.001). Of the most common infections among the total of 418 cases of SPNI studied, 32.06% were surgical site infections, 23.18% were associations of infections, 19.14% – respiratory tract infections. A patient with SPNI has an average of 22.25 days/bed spent in hospital, compared with the average for a patient without SPNI of 12.27 days/bed. The etiological structure includes 28 species of microorganisms including gram-positive (61.92%) and gram-negative (38.08%). Conclusions: Given the relatively high incidence of the SPNI and its impact, it is imperative to take more serious measures to prevent and control these infections.

17-22

Authors: Diana Guranda, Cristina Ciobanu, Nicolae Ciobanu, Rodica Solonari

Background: Urinary tract infections are the most common urogenital diseases, with an increased incidence in men and older people. Urogenital infections are caused by Gram-negative bacteria, in which Escherichia coli predominates with a share of 80%. The evolution of microbial resistance to preparations used in curative-prophylactic institutions, induces the need of the reintroduction of nitrofurans, noteworthy for their wide spectrum of antibacterial activity. Material and methods: For the study, suppositories with furazidine were prepared by hand rolling and by melting and molding methods. Quantitative analysis was performed spectrophotometrically on a UV-VIS Perkin Elmer Lambda 40 spectrophotometer. All solvents and reagents had the degree of purity ”pure for analysis” and ”chemically pure”. Results: Duble cast method was applied to identify the exact mass of hydrophobic (cocoa butter, suppocire) and hydrophylic (polyethylene glycol mixtures) excipients. All the formulated suppositories were subjected to quality tests and showed acceptable physical characteristics and uniformity of drug contents. The UV-VIS spectrophotometric method for quantitiative determination of furazidine was developed and validated. The validation results showed that the developed method is simple, fast, accurate and robust. Conclusions: Suppositories with furazidine were prepared by classic technological methods. Preparation of the suppositories with furazidine on cocoa butter excipient is a suitable alternative for individual medicinal prescriptions. The UV-VIS spectrophotometric dosing method for furazidine in suppositories was developed and validated.

29-34

Authors: Alexandru Ghetiu

Objectives: To present the survey questionnaire used for the medical assessment of patients requiring alveolar ridge reconstruction as well as the study of concomitant pathologies and their influence on the healing process. Material and methods: The study involved 173 patients aged between 18 and 69 years. All patients have been assessed according to the survey questionnaire developed to determine the patient’s general condition, life anamnesis, and medical history. Results: Out of the total of 173 patients, 72 (41.6%) had no concomitant pathologies, 8 patients (4.6%) had concomitant pathologies that did not interfere with the operation, 40 (23.1%) had pathologies that might affect the outcome of alveolar ridge reconstruction but still were admitted to surgery, and 53 patients (30.6%) had pathologies that could affect the outcome of the reconstruction procedure and were not admitted to bone grafting. Conclusions: Assessment of patients with alveolar ridge defects during preparation and planning of preimplantation bone reconstruction identified a number of concomitant pathologies, more or less noticed by the patient, which may remain unclear due to superficial study of the patient’s condition that is able to influence the surgical treatment outcome. These issues can be both intraoperative and postoperative and lead to failure of surgical treatment and further reoperation.

39-44

Authors: Boris Golovin, Mihail Peștereanu, Tatiana Bicic, Svetlana Lupu, Ludmila Petcu, Nicolae Doni

Background: In the last 2 years, some changes have occurred in the structure of emergencies at the prehospital stage in the Republic of Moldova, being largely influenced by the COVID-19 pandemic. Material and methods: Retrospective analysis of the Prehospital Emergency Medical Service (PEMS) Request Sheets of the National Centre of Prehospital Emergency Medicine (NCPEM) of the Republic of Moldova for the years 2019-2020. Results: According to the nosological profile in 2020 at the prehospital stage, respiratory emergencies were on the first place with 23% of the 761.416 of total number of requests. On the second – cardiovascular (20.6%), on the third – neurological (13.3%), infectious – 3.1%. In 2019, on the first place – cardiovascular with 22.3% of the 845.572 of total number of requests, followed by respiratory – 19.3%, neurological – 13.6%, infectious – 2.2%. In 2020, on the first place were respiratory emergencies, which compared to 2019 increased practically by 4% and the infectious emergencies by almost 1%. The number of endotracheal intubation procedures and medical-assisted transportations practically doubled in y.2020 compared to y.2019. Conclusions: All these changes: increased respiratory and infectious emergencies, intubation procedures, and assisted-medical transportations, have occurred exeptionally due to COVID-19 infection.

50-54

Authors: Daniela Blanita, Chiril Boiciuc, Doina Turcan, Victoria Sacara, Natalia Usurelu

Background: Congenital Disorders of Glycosylation (CDG) are a group of inherited metabolic disorders caused by the defect in various steps in the biosynthesis of glycoproteins and other glycoconjugates. Material and methods: 40 patients under clinical suspicions for CDG at the Institute of Mother and Child were examined by isoelectric focusing of transferrin (IEFT) in collaboration with RadboudUMC, Netherlands and U.S.A. The spectrum of clinical presentations of these patients was multisystem damage, predominantly neurological manifestations. Results: Most of the patients (55%) had early neurological manifestations from the birth, such as hypotonia, psychomotor disability, cerebral MRI abnormalities, seizures (25%), cutis laxa (17.5%), total alopecia (2.5%), abnormal fat pads (2.5%), myopia (7.5%), nystagmus (5%), strabismus (2.5%), stroke-like episodes (2.5.%), ataxia (7.5%), abnormal coagulation (10%), hepatomegaly (35%) and liver cirrhosis (2.5%). Serum samples analyzed by IEFT showed the results: 37 normal, 2 questionable and 1 abnormal patterns. Two samples questionable belongs to the patients with Galactosemia and Fructosemia, which give the false-positive results. The last positive sample is performed additionally for glycomics profiling. In some cases, with IEFT negative profile was performed genetic test and were diagnosed other diseases, mimicking CDG, such as: NARP syndrome, late diagnosed PKU, GSD, Manosidoses, Prader-Willi Syndrome and chromosomal aberrations. Conclusions: The CDG is a rare metabolic disease with multisystem impairment and variety of symptoms which determine overlapping of phenotype with other genetic disorders. The process of diagnosis is very complex and can take several years.

62-65

Authors: Ion Sirbu, Sergiu Matcovschi

Background: It was intended to study the structure of the symptoms in patients suspected of having SARS-CoV-2 virus infection, as well as to find any correlations between the clinical, paraclinical and radiological manifestations in positive versus negative patients, in order to further facilitate the diagnosis and triage of patients. Material and methods: 101 patients seeking medical attendance at the COVID-19 Triage Center in Chisinau have been examined, presenting various respiratory symptoms. The frequency of symptoms and the results of the paraclinical investigations were evaluated based on the results of the PCR tests for SARS-CoV-2 infection and the assessment of correlations (Pearson). Results: Out of 101 subjects, 50 tested SARS-CoV-2 positive, and the remaining 51 – negative. The clinical manifestations of SARS-CoV-2 suspects were as follows: fatigue – 72%, sweating – 54%, chills – 52%, fever – 49%, subfebrility – 39%, myalgias and arthralgias – 37%, cough – 35% (sputum – 17% and hemoptysis – 2%), dyspnea – 34%, chest pain – 23%, anosmia – 12%, headache – 11%, dyspeptic syndrome – 8%. Infiltrates on chest radiography were found in 22% of cases. A weak inverse correlation (R = -0.22, P <0.05) between the leukocyte count and SARS-CoV-2 test results was found. An average direct correlation between the presence of fever (R = 0.36, P <0.05) and a positive COVID-19 test was also noticed. Conclusions: Certain symptoms such as anosmia were more commonly seen in patients with positive COVID-19 tests. The absence of pulmonary infiltrates and the presence of dyspnoea have been negative predictive factors for COVID-19. Leukopenia has been noticed only in SARS-CoV-2 positive patients. Subfebrility has not shown a predictive significance of COVID-19.

69-71

Authors: Lilia Rotaru

Background: Parkinson’s disease (PD) – the most common neuro-degenerative movement disorder – is considered a result of a multifactorial pathogenic process modulated by cumulative and interactive effects of genes and exposures. An environmental exposure could enhance or create dopaminergic neurons vulnerability and increase PD risk. The purpose of the study was to find if excessive exposure to toxic environmental factors may influence clinical pattern of PD. Material and methods: The study was conducted on 111 patients diagnosed with PD, study group being defined as PD exposed to toxins (33 patients), control group including PD patients without toxin exposure (78 patients). General epidemiological data and clinical data were recorded. Results: Toxin exposure was found in 33 patients (29.73%), more of them – men and rural residents. Toxin exposed PD patients had an insignificantly younger age. The most common disease phenotype in the study group was the akinetic-rigid phenotype (64.7%, p = 0.040), bradykinesia being the most common sign at the disease onset (57.6%, p = 0.008). Levodopa equivalent daily dose also was higher in the study group (659.02 ± 232.46, p = 0.042). Conclusions: Excessive exposure to toxic environmental factors may influence the clinical pattern of PD. In this study the akinetic-rigid type was the predominant disease phenotype associated with toxin exposure. Doses needed for treatment were higher in PD patients exposed to toxins, as an indicator of a more severe motor impairment in this group.

5-10

Authors: Felicia Lupascu-Volentir, Gabriela Soric, Ana Popescu, Anatolie Negara, Elena Cosciug, Irina Stoicova

Background: Problems of nutritional status are widespread, of which malnutrition occurs more frequently in vulnerable groups of the population, especially in the low-income elderly, including the institutionalized elderly. Material and methods: The study was performed on a group of 50 participants over the age of 65, from the nursing home; the nutritional status was assessed according to the Mini-Nutritional Assessment (MNA) score, the frailty syndrome (FS) was established based on Fried criteria and severity of FS – based on the Clinical Frailty Scale. The obtained data were statistically processed by using the “Statistica 6.0” software program. The difference was considered statistically significant with p <0.05. Results: The MNA score showed a positive correlation with reduced physical activity: r= 0.4*, between reduced physical activity and reduced walking speed: r= 0.66*, reduced physical activity and fatigue (lack of energy): r= 0.94* (p≤0.05). The cluster analysis revealed that against the background of the same food intake, body weight, mobility, neurological status can easily change, the phenomenon underlying the separation of the elderly in different clusters (1 and 2), while moderately low food intake in the last 3 months led to significantly reduced mobility, impaired neurological status (severe dementia or depression). Conclusions: This study reported that the elderly in the nursing home have an increased risk of malnutrition, being associated with nutritional pattern, such as: involuntary weight loss, the presence of neuropsychiatric disorders, decline in food consumption, affecting the quality of life.

16-24

Authors: Lilia Grati

Background: This article analyzes the professional stress at healthcare professionals (HCP), related to their job. Health care providers can serve as role models in promoting healthy lifestyles; however, HCP commitment to help individuals to quit smoking may be influenced by their own smoking behavior. Material and methods: In order to determine the level of perceptual stress, the Perceived Stress Questionnaire (PSQ) was applied, PSQ developed by Levenstein et al. In order to determine the level of addiction to smoking, the Fagerstorm nicotine addiction test was applied. The research was attended by 210 subjects from 5 medical institutions: doctors, nurses, and resident doctors. Confidentiality is maintained. Results: The doctors accumulated 32% on the scale of severe dependence, 8% moderate dependence and only 9% mild dependence, after calculating the score and interpreting the data. The resident doctors have accumulated the maximum score on the scale of mild dependence, 7% moderate dependence and only 3% severe dependence, which speaks of the fact that they are the youngest category of medical workers at the beginning of their careers and still do not have good defense mechanisms. The nurses, who represent 9% of the entire group of subjects, accumulated 0% on the scale of severe dependence, 8% moderate dependence and 1% mild dependence. Conclusions: Comparative data on smoking dependence levels in doctors of 32% according to the perceived stress level 71% confirm this. Stressed health workers are more likely to smoke, have different social problems and are males. The results of research have shown that the prevalence of smokers among health care professionals is high (51%), implying the ineffectiveness of the current government anti-tobacco strategy. Introducing new pillar – Harm Reduction in National Antismoking Action Plan, along with prevention, cessation and protection from second-hand smoking, can improve current smoking situation in general. It would be helpful to implement training programs about Tobacco Harm Reduction for healthcare workers to improve their ability in smoking cessation counselling techniques to provide active support to their patients.

28-31

Authors: Maria Moldovanu, Cornelia Calcii

Background: Arterial ischemic stroke is a rare disease found in the pediatric population, with an incidence of 2-13 out of 100000 children per year. Children develop seizures more often in the initial phase of stroke compared to adults. Material and methods: There have been included children examined by brain MRI hospitalized in the department of neurology (early aged children), Hospital of Mother and Child Health Care, with a diagnose of ischemic stroke, with an acute focal neurological syndrome installed. The children not having an imagistic confirmation of arterial ischemic stroke were excluded. Results: The study lot was composed of 78 children, who corresponded to all the inclusion criteria for this study (Tab.1). The children were examined by 1.5T and 3T MRI with multiplanar assessment of brain structures. In cases with acute / subacute stroke specific diffusion sequences (DWI and ADC) were applied to determine the type of stroke, approximate installation period. Ischemic brain lesions on MRI are presented by areas of cytotoxic edema in acute/ subacute cases, in chronic / late cases by the appearance of changes such as lacunar defects, areas of encephalomalacia. Conclusions: The vast majority of children with brain lesions on MRI have convulsions with early onset and have developed recurrent seizures after the acute phase of stroke.

36-39

Authors: Mikhail Postnikov, Svetlana Chigarina, Ksenia Gaylis, Svetlana Plamadeala, Elizaveta Postnikova, Cristina Postaru

Background: The study of the patient’s quality of life is an important condition for assessing the effectiveness of the treatment and the clinical condition of patients after treatment, in addition to objective diagnostic methods. The purpose of the study was to investigate the dynamics of changes in the quality of life of dental patients suffering from caries of the contact areas of the lateral group of teeth, after treatment in accordance with the established plan for the use of various matrix systems, in the study groups. Material and methods: The study involved 147 patients: 48 patients of the 1st experimental group; 54 patients of the 2nd experimental group; 45 patients of the 3rd experimental group. Results: In the course of the study, it turned out that such a criterion as the quality of life is an informative dynamic indicator, the value of which depends on the method of treatment used. Conclusions: In the course of the study, the effectiveness of the use of a separation-retaining device for the restoration of the lateral group of teeth during the treatment of caries in the contact areas of the teeth was assessed as a factor influencing the quality of life of patients.

44-49

Authors: Elena Costru-Tasnic, Mihail Gavriliuc, Elena Manole

Background: Ischemic stroke is one of the leading causes of mortality and disability worldwide. Numerous studies were performed to assess the risk of clinical deterioration of acute ischemic stroke patients, including the risk of haemorrhagic transformation. The complexity of cerebral ischemia pathology raised the possibility of a multitude of candidate-molecules to be studied as stroke biomarkers. The blood brain barrier integrity biomarkers have shown promising results both in fundamental and clinical studies. Matrix metalloproteinases have been extensively analysed and gave encouraging results for predicting unfavourable neurological outcome, including the risk for haemorrhagic transformation. Matrix metalloproteinase-9 plays a crucial role in the disruption of the blood-brain barrier following focal cerebral ischemic stroke. Elevated matrix metalloproteinase-2 levels are responsible for the degradation of tight junction proteins, basal lamina and neuronal injury after ischemia, and may contribute to infarction and hemorrhagic volume. The review provides an overview of matrix metalloproteinases’ role in the prognosis of acute ischemic stroke patients, regarding the stroke outcome and the risk of haemorrhagic transformation. Conclusions: Matrix metalloproteinases, especially gelatinases, are extensively studied for their predictive value in ischemic stroke evolution. Matrix metalloproteinase-2 and matrix metalloproteinase-9 correlate with stroke severity and haemorrhagic transformation in acute ischemic stroke, but large validation studies are needed for practical translation. Future studies should focus on developing a biomarker panel for predicting outcomes in stroke patients.

54-61

Authors: Eugene Calenici

Background: Review is based on the biggest observational population study of all the risk factors of COVID-19 infection. The study was carried out in Royal College of General Practitioners, Oxford, and covering over 4 million of people. Were studied and analyzed risk factors as: age, sex and ethnicity, socioeconomic level, living space dimensions, rural-urban population, body mass index, smoker status, pregnancy, hypertension, chronic kidney disease, ischemic heart disease, chronic respiratory diseases including asthma, and chronic obstructive pulmonary disease, and type 1 and 2 diabetes. Patient variable with malignancy and immunocompromised status was separated due to the small number of patients in each group. Conclusions: By September 2020 more than 28.000 articles had been published related to COVID-19 in less than 9 months, 211 new papers every day. Most of them had small population of the studies. In the investigated sample, it was found that increasing age, male sex, economic deprivation, urban location and black ethnicity were associated with higher chances of testing positive for SARS-CoV-2. Active smoking decreased the chance of a positive test. The review covers the most important subjects influencing the development of severe infection outcomes.

68-77

Authors: Valentin Friptu, Diana Mitriuc, Olga Popusoi

Background: Multiple studies have found a relatively increased risk of placenta-mediated pregnancy complications in women with congenital thrombophilia, especially early recurrent pregnancy loss, fetal loss, early-onset preeclampsia, intrauterine growth restriction, and premature abruption of normally positioned placenta. However, the extent of the association and the absolute risk are very modest, but they significantly increase in pregnant women with severe obstetric complications. Conclusions: There is convincing evidence that deficiency of natural anticoagulants (antithrombin, protein C, protein S) is a risk factor for late fetal loss. Factor V Leiden G1691A gene mutation and prothrombin G20210A gene mutation are associated with a double risk for early and unexplained recurrent pregnancy loss and for non-recurrent late fetal loss. The association of congenital thrombophilia with preeclampsia is much more uncertain, being probably limited factor V Leiden G1691A gene mutation and more severe cases of preeclampsia. Fewer data are available on intrauterine growth restriction (IUGR) and premature abruption of the normally positioned placenta. There is insufficient evidence to suggest an association of other forms of congenital thrombophilia with adverse pregnancy outcomes. In addition, genetic and epidemiological research suggests that placenta-mediated pregnancy complications are of polygenic multifactorial etiology, with a risk determined by the interaction of multiple genetic variants and other risk factors.

5-11

Authors: Mariana Sprincean, Svetlana Hadjiu, Cornelia Calcii, Nadejda Lupusor, Ninel Revenco, Stanislav Groppa

Background: Ischemic stroke (IS) in children is a major neuropediatric emergency. The incidence of stroke in children is from 2 to 13 for 100000 children. IS in perinatal period occurs in 1 for 2300 – 5000 live births. Material and methods: In 2010 – 2019 in the Republic of Moldova was carried out a retrospective as well as prospective study on a cohort of 458 children diagnosed with stroke. Were studied possible risk factors related to IS. Out of 458 children, 284 children with IS were selected and diagnosed during the reference period. Results: IS was determined in 284 cases with the diagnosis of stroke (62%, 95CI 59.73-64.27). Among the most common risk factors for the development of neonatal IS are pathologies of amniotic membranes in 113 cases (39.8%, 95CI 36.9-42.7), pathologies of amniotic fluid with meconium in 135 cases (47.5%, 95CI 44.54-50.46), and history of urgent caesarean section in 132 cases (46.5%, 95CI 43.54-49.46). Among the etiological causes of IS in the studied children were: congenital heart anomalies in 52 cases (18.3%, 95CI 16.01-20.59), neonatal encephalopathy in 27 cases (9.5%, 95CI 7.76-11.24), genetic syndromes in 18 cases (6.3%, 95CI 4.85-7.75), sickle cell disease – 5 (1.8%, 95CI 1.06–2.54), MELAS syndrome – 4 (1.4%, 95CI 0.7-2.1). Conclusions: IS risk factors are an important problem in clinical research. Most often, there is not a single risk factor responsible for the development of IS in children.

16-20

Authors: Victoria Duca

Background: Mental disorders in people with epilepsy are an old problem that remains crucial nowadays. The specialized literature has reported increasingly significant values of anxiety and depressive disorders associated with epilepsy in women during their child bearing age. The prevalence of depression comorbidity related to epilepsy has accounted for 55% of cases, many of which remain undiagnosed. Anxiety exceeds the frequency of depressive cases by 10-15%, which tends to be milder, however showing a chronic evolution. It is important to find out the correlation between the occurrences of mental disorder in women with epilepsy from the Republic of Moldova. The purpose of the study was to assess the depressive and anxiety symptoms associated with epilepsy in women of reproductive age. Material and methods: A retrospective cohort study was conducted on a group of 128 women with epilepsy. Patients were divided into 2 groups, with anxiety and depression respectively. Hospital and Anxiety Depression Scale (HADS) was applied for estimating anxiety and depression, being considered a priority compared to Hamilton scales, the Beck Inventory, the Zung scale. Results: It has been proved that the disease duration and seizure recurrence are directly proportional to prevalence of depression and anxiety cases. The type of seizure remains a controversial topic. Conclusions: Anxiety and depression in epilepsy patients show a heterogeneous nature due to clinical pleiomorphism. The HAD scale is effective for the early diagnosis of anxiety and depression in epilepsy women.

26-32

Authors: Artiom Surev, Lucia Cioban, Mihaela Ivanov, Ion Popovici, Valeriu Cobet, Mihail Popovici

Background: Nowadays, the impact of the delayed myocardial revascularization (DMR) (>72h) in patients with myocardium infarction without STsegment elevation (NSTEMI) having either intermediate or low cardiovascular risk (ILCR) on quality of post-infarction myocardial remodeling is not well established. Aim of the study: The comparative evaluation of cardiac functional recovery of NSTEMI patients undergoing either revascularization <72h or DMR (72h–30 days) in a follow-up of 6 months. Material and methods: The study was realized in 2 homogenic series of NSTEMI patients with ILCR exposed to revascularization: <72h (control) or to DMR (72h–30 days). The echocardiographic and physical test indices were registered at the 2nd day since revascularization and after 6 months. Results: The increasing ratio of ejection fraction was significantly higher in patients with DMR compared to control (5.24% vs 1.73%). Likewise, the contractility ability of left ventricle improved better, proven by systolic volume diminution, lower value of akinetic areas, and less patients with class III of heart failure according to New York Heart Association (4 vs 29%). More than that, DMR was associated with higher physical endurance. Conclusions: NSTEMI patients with ILCR exposed to delayed myocardial revascularization (72h–30 days) had a better post-infarction recovery after 6 months according to dynamics of echocardiographic and physical tolerance indices in comparison with patients revascularized <72h.

37-41

Authors: Angela Ciuntu

Background: Cytokines are functional class of tiny proteins and glycoprotein and fundamentally they are monomers that function as soluble mediators in an autocrine or paracrine manner. Cytokines are produced by a number of cell types, predominantly leukocytes, and their targets implicate both immune and non-immune cells. Material and methods: This study was performed on 75 children with glomerulonephritis (GN), aged from 2 up to 17 years. There were 20 children with steroid-sensitive nephrotic syndrome (SSNS), 15 children with steroid-resistant nephrotic syndrome (SRNS), 20 children with chronic glomerulonephritis (CGN) nephrotic form and 20 children with CGN mixed form. This study was performed on patients experiencing disease relapse and clinical remission. The control group consisted of 20 healthy children. Results: The results of this study demonstrated increased levels of cell signaling molecules (IL-8, TNF-α, MCP-1, MIP-1α) in the urine during clinical manifestations, valuable result due to their major role in the immunopathogenic mechanism of proteinuria in nephrotic syndrome. Conclusions: Determination of urinary concentrations of cellular signaling molecules may be useful as a predictive non-invasive method for estimating disease activity, monitoring disease progression, differentiating steroid-sensitive nephrotic syndrome from steroid-resistant nephrotic syndrome, and assessing the effectiveness of treatment in children with different variants of GN.

49-52

Authors: Stella Samson, Viorel Nacu

Background: Cone-beam computed tomographic (CBCT) imaging is a valuable tool in dental practice. It is widely used in endodontic treatment for the root canal morphology examination. Therefore, the purpose of this study was to use CBCT to calculate the volume of the pulp chamber at different tooth groups. Material and methods: This study conforms to protocols approved and in accordance with the ethics committee’s requirements, informed consent was obtained from each patient. Morphologic measurements of 120 maxillary and 120 mandibular molars (from 40 patients, aged 18–45 years) were included in this study. CBCT images were taken using a Kodak 9500 (Dental Systems, Carestream Health) operated at 90 kVp with a voxel size of 300 mm and a field of view of 90-50 mm. All scans were taken following the manufacturer’s recommendation protocol. According to the examination requirements, C-shaped roots, single-rooted molars, crowned teeth, and teeth with caries and/or restorations violating the pulp chamber were excluded. All measurements were taken on the coronal plane view. Results: In the present study, we used CBCT imaging to gather information regarding pulp chamber volume. With the scanned 3-dimensional images, we were able to clinically determine the pulp chamber parameters using a standardized and defined spatial approach. Conclusions: The data we collected here serve as a proof of principle for the analysis of dental landmarks before collecting stem cells. In this particular study, existing CBCT scans were used to provide useful information that can be used as a guide to determine the volume of the pulp chamber.

58-64

Authors: Mihail Tasnic, Ilia Catereniuc

Background: Myocardial bridges are variants of the intramyocardial position of the coronary arteries. In the specialty literature, hot topics in cardiovascular field are myocardial infarction and non-obstructive coronary artery disease with frequent connection with myocardial bridges. Material and methods: The morphological study was based on the analysis of 200 human hearts and fragments of coronary arteries. The retrospective study was focused on the analysis of 6168 coronary angiography reports, to identify patients with myocardial bridges, their preferred location, the degree of systolic stenosis, the association between myocardial bridges and proximal to bridge and under the bridge coronary atherosclerosis. Results: The complete myocardial bridges were described in 62% of the analyzed hearts and only in 5.3% of the total number of studied coronarographies. In the majority of cases, the complete myocardial bridges covered the anterior interventricular branch. The degree of subpontine arterial systolic stenosis varied within 10-95%. The comparative study did not determine any correlations between the degree of subpontine vascular compression and the degree of the left ventricular myocardial hypertrophy. In 32% of cases were described proximal to bridge atherosclerotic plaques and only in one case (0.5%) – distal to bridge atherosclerotic plaques, located immediately under the bridge. Conclusions: The research findings underline the differences in anatomical and angiographic incidence of myocardial bridges, and the inability of all bridges to reduce the lumen of under bridged artery. Current study emphasizes attention to the topography of bridges, the correlation with ventricular hypertrophy and coronary atherosclerosis.

70-78

Authors: Iulia Rodoman, Ina Palii, Victoria Sacara, Sergiu Gladun

Background: Cardiomyopathy (CM) associated with Duchenne muscular dystrophy (DMD) is a commonly recognized appearance of this neuromuscular disease, significantly increased morbidity and mortality, as well as the necessity for cardiological management. CM in DMD is defined by left ventricular (LV) systolic dysfunction and both atrial and ventricular dysrhythmias and is associated with higher mortality than other cases of pediatric dilated CMs. Notwithstanding the high rate of cardiac involvement, patients are usually asymptomatic despite significant LV dysfunction, because of likely poor mobility that masks the usual heart failure (HF) symptoms. Also, imagistic predictors are provided to be very helpful in defining early LV dysfunction, especially electrocardiogram and cardiac imaging (transthoracic echocardiography, speckle-tracking, cardiac magnetic resonance) are used to detect the onset and progression of dilated cardiomyopathy (DCM) in DMD. Conclusions: As most DMD patients are asymptomatic for a long time of their life, so identifying predictors of HF is crucial to support these patients. Ventricular dysfunction based on the ejection fraction (EF) measurement helps to choose therapy. In the case of early DCM (LVEF≥50%) the great purpose is to prevent ventricular dysfunction incipience with first-line HF therapy with Angiotensin-converting-enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARBs). Current guidelines recommend the use of conventional HF medication in case of disease progression and DCM with MidRange Reduction of LV EF (40-49%). The therapeutic approach for patients with DCM and severe ventricular dysfunction (<40%) has been studied less profoundly and contemporary guidelines recommend all drugs used for HF treatment.