ARCHIVES OF THE BALKAN MEDICAL UNION

609-611

Authors: Is there an implication of intestinal microbiota in cardiovascular diseases?

Nowadays, more and more evidence points out to the interrelationship between intestinal microbiota and cardiovascular diseases. Gut microbiota is composed of a large number of microorganisms that live in the human gut and are involved in many physiological processes. Changes in the composition and activity of intestinal microbiota may lead or may accelerate the evolution of some cardiovascular diseases. Alterations in the composition of gut microbiota will induce dysbiosis, causing inflammation and initiating the development of cardiovascular diseases. These alterations may be secondary to intestinal infections, exposure to some environmental factors, changes in dietary habits, high stress, use of antibiotics. Studies have shown that gut microbiota is composed of six families, the Firmicutes, Bacteroidetes, Proteobacteria, Actino-bacteria, Fusobacteria, and Verrucomicrobia phyla1. These microorganisms are involved in the immune processes of the host, the fight against the pathogenic microorganisms and also in maintaining the integrity of intestinal barriers. Coronary heart disease and arterial hypertension are chronic diseases with a high prevalence. Some studies have demonstrated a link between the composition of gut microbiota and the increased risk of atherosclerosis, which is the main cause of coronary heart disease2,3. These studies have identified different species of bacteria, both in the gut and in the atheromatous plaques, suggesting that gut is a source of atherogenic bacteria2,3. The mechanisms by which these bacteria can initiate the atherosclerotic process (or in some cases protect against it) are still unknown. Trimethylamine N-oxide (TMAO) is a microbial metabolite that was studied for its effects on cardiovascular diseases after the discovery of a positive correlation between the serum level of TMAO and the atherosclerotic plaque area. This correlation was partially explained by the role that TMAO plays in the inhibition of reverse cholesterol transport and the accumulation of macrophage cholesterol4,5. One study has found that the TMAO level in patients with an acute coronary syndrome is an independent predictor of short-term and long-term major adverse cardiac events6. The implication of gut microbiota in arterial hypertension has been demonstrated by animal studies7,8. Adnan et al have shown that the blood pressure can be influenced by the exchange of gut microbiota between spontaneously hypertensive rats and Wistar-Kyoto rats7. The ratio of Firmicutes and Bacteroidetes is considered specific for intestinal dysbiosis9. In animal studies, the alteration of this ratio correlated with arterial hypertension, suggesting that gut microbiota could be a potential target of future antihypertensive therapies9. Heart failure is the final stage of evolution of the majority of cardiovascular diseases, with high mortality rates. One study has comparatively analyzed the bacteria and fungi in the feces of patients with heart failure with those of healthy controls and demonstrated that patients with chronic heart failure have more pathogenic bacteria10. Moreover, some species, like Candida, Shigella, and Campylobacter, were positively correlated with the severity of the heart failure10. Patients with heart failure, with decreased cardiac output, have gastrointestinal mucosa congestion and ischemia, with subsequent alterations in the composition of gut microflora and also intestinal functions. These alterations will lead to bacterial translocation, the release of endotoxins in the circulation, promoting a systemic inflammatory response. Some authors suggested that TMAO can be used as a biomarker for prognosis stratification in patients with heart failure11, although the exact mechanisms of increased levels of TMAO in patients with heart failure are still unknown. Other gut microbiota metabolites, p-cresyl sulfate and phenylacetylglutamine, have been suggested by some studies to be involved in the appearance of cardiovascular diseases12,13. Based on the above findings, the future cardiovascular therapies may include gut microbiota and their metabolites as potential targets. These therapies could be represented not only by drugs but also by diet changes and supplementation with prebiotics and/or probiotics.

621-629

Authors: Berik N. DZHUMABEKOV, Auyeskhan T. DZHUMABEKOV, Dzhumagaly K. ISMAILOV, Talgat A. BAITILEUOV, Ildar R. FAKHRADIYEV

Introduction. Wound regeneration is an important process in surgical interventions. Failure of an intestinal anastomosis is an important intestinal surgery problem. The objective of the study. To evaluate the effect of platelet-rich plasma (PRP) and compare the effectiveness of various application methods in intestinal anastomosis regeneration in rabbits. Methods. Platelet-rich auto-plasma was obtained from 81 rabbits, which was used to study two methods of applying PRP (injection into the muscle layer / soaking in the intestinal wall) in comparison with the control group, on the end-to-end small-intestinal anastomosis. Results. The analysis of the histological and morphometric data showed that the regeneration between the samples of intestinal anastomosis treated with PRP soaking and injections into the intestinal wall is more favorable in comparison with the control group, which, in turn, was determined by the quantitative ratio of inflammatory infiltrate, fibroblast proliferation, neo-angiogenesis, and collagen deposition. PRP soaking in the intestinal wall significantly increased the number of adhesions battles. The analysis of the deformation and strength characteristics of the formed anastomoses also showed significantly high values ​​of the rupture strength of the anastomoses treated with PRP, in contrast with the control group. Conclusion. PRP injection into the muscular layer of the intestinal wall significantly reduces the development of adhesions in comparison with the PRP-saturated group of intestinal anastomoses. Further research is needed to clarify the optimal method of PRP application, which will improve the regeneration of the intestinal anastomosis.

639-646

Authors: Tatiana V. KHMARA , Pavlina V. HRYHORIEVA, Svitlana D. NOVYCHENKO, Olga P. KHAPITSKA

Introduction. A clear knowledge on the variations of blood supply and innervation of muscles in different areas of the body allows the surgeon to select the neurovascular pedicle, when performing muscle transposition operations using microsurgical techniques, to correctly choose the muscle flap, the method of replacing the defect and the localization of the donor area. The objective of the study: to clarify the information about the sources of innervation and blood supply to the gracilis muscle, adductor muscles and pectineus muscles, as well as to investigate the intramuscular distribution of nerves and arteries in the muscles of the medial group of the thigh in human fetuses aged 4-10 months. Materials and methods. The peculiarities of the fetal topography of the arteries and nerves of the medial femoral group muscles were studied in 42 human fetuses aged 4-10 months using the methods of macro microscopic preparation, vascular injection, surface staining of the prepared vessels and nerves, and morphometry. Results. It has been established that the distribution of nerves and arteries is uneven in the thickness of the muscles of the medial group of the thigh, at the same time the middle third of all adductor muscles is supplied with blood and innervated more intensively. The places where nerves penetrate into the thickness of the muscles of the medial femoral group, do not coincide with the places where the arteries enter, pectineus muscle is an exception. The nature of the intramuscular distribution of nerves and arteries depends on the structure and function of the muscle. The intramuscular nerve trunks are interconnected in the gracilis and adductor magnus muscles, forming loops and arcades. Nerve connections between the obturator and sciatic nerves are found in the thickness of the adductor magnus muscle. Conclusions. In the picture of the intramuscular distribution of nerves and arteries in the muscles of the medial group of the thigh in human fetuses, three forms can be distinguished: loose, trunk, and mixed. In the thickness of the muscles of the medial femoral group, the distribution of nerves and arteries is uneven. Segmentation is preserved in the intramuscular distribution of arteries in the muscle gracilis, adductor longus and magnus muscles, while in the distribution of nerves in these muscles segmentation is absent.

653-658

Authors: Milena D. KARCHEVA , Anton P. GEORGIEV, Alexander B. BLAZHEV

Introduction. Rubella is a worldwide contagious disease with self-limited symptoms and a generalized rash. Epidemiology of rubella changed after licensing the vaccine in 1969. Children’s rubella is a self-limited infection, but when it occurs during pregnancy, there is a risk of severe damage to the fetus. Objectives. The aim of this study was to determine the immunity against rubella virus in pregnant women in Pleven Region, Bulgaria. Methods. A cross-sectional study was carried out on pregnant women hospitalized in a Clinic of obstetrics and gynecology, University Hospital-Pleven, Bulgaria. Quantitative determination of specific Immunoglobulin G (IgG) antibodies against rubella virus was performed by Enzyme-Like Immunosorbent Assay (ELISA). Data were analyzed using the Microsoft Office Excel 2007 software. Results. Between January 2018 and December 2018 there were collected and tested to Rubella virus IgG antibody 242 serum samples. Two hundred and four (84.30%) of them were positive, 29 (11.98%) were negative and 9 (3.72%) – equivocal. The age of examined women was between 14 and 45 years, average 27, sd±6.429. We found high seropositivity within age group 21-30 years of age. The immunization status of the investigated women shows – unimmunized – 79, selectively immunized with one dose of monovaxin – 58, immunized with combined (measles, mumps, rubella) vaccine one dose – 82, with a double immunization schedule – 23. In each group there were seropositive women. Conclusions. Data analysis shows that pregnant women have high immunity and a tendency for lower morbidity rates of acute rubella infection.

659-671

Authors: Maria CHRISSINI, Dimitra SIFAKI-PISTOLLA, Nikolaos TZANAKIS, Ioanna TSILIGIANNI

Introduction. The identification of the type and site of origin in undifferentiated tumours of unknown primary site using immunohistochemistry is a frequent requirement in pathology practice. There are many histologic lesions that display similar morphologic aspects, with misdiagnosis potentially resulting in over- or undertreatment. This makes the diagnostic accuracy extremely important in the era of targeted therapies. The objective of the study was to evaluate the process of diagnosis in 50 melanoma cases presenting as poorly differentiated or undifferentiated tumours with unknown primary origin, with emphasis on the immunohistochemical algorithm. Methods. 50 cases were selected to analyse the utility of IHC testing in diagnosing poorly differentiated malignancies. The immunohistochemical evaluation was based on the staining percentage of cells: focal positive <50%, diffuse positive >50%, negative (-) 0%. Results. After applying the Fan Lin algorithm, for most of the cases (45), the cytokeratin and CD45 proved negative, while S100 and vimentin were positive in diffuse or zonal patterns. For the 3 cases analysed by applying the Turin algorithm, the first antibody panel consisted in testing CK7/CK20, that showed no expression for all 3 cases. Conclusions. In this study, we demonstrated that the immunohistochemical examination of poorly differentiated malignant tumours is a reliable and valuable test and is recommended as a standard method in diagnosis along with the correlations with clinical and histological data.

685-691

Authors: Aleksandra CATIC´-ÐORÐEVIC´ , Nikola STEFANOVIC´, Ivana STOŠIC´, Ivana DAMNJANOVIC´, Ivana MILANOVIC´, Novica BOJANIC´, Radmila VELICˇKOVIC´-RADOVANOVIC´

Introduction. The risk of inappropriate prescribing and inadequate drug use in the elderly population is growing with ageing associated physiological changes and polypharmacy due to increased number of chronic diseases. In order to optimize the therapy, numerous criteria have been developed which can help pharmacists and physicians to implement rational pharmacotherapy. The objectives of the study were to survey the practice of medication use in patients older than 65 years with different stages of renal failure and to identify potentially inappropriate prescribing, as well as to justify the role of pharmacists in pharmacotherapy optimization. Material and methods. This retrospective study included 100 patients with average age of 72.30±5.00 years. Demographic, clinical and pharmacotherapy data were collected from hospital discharge summary after one day hospital examination at the Clinic of Nephrology of Clinical Center Niš, Serbia. Potentially inadequate drugs were identified by STOPP criteria (Screening Tool of Older Persons’ Prescriptions), while START criteria (Screening Tool to Alert doctors to Right Treatment) pointed out the lack of potentially helpful drugs in therapy. Results. 63 STOPP and 60 START criteria were identified. The most common STOPP criteria were the use of benzodiazepines (14%) and duplication of therapy (11%). The greatest influence on the occurrence of STOPP criteria was the total number of medications in therapy. START criteria identified the lack of statins in therapy in 19% of patients with cardiovascular disease and in 13% with diabetes mellitus type 2. The occurrence of START criteria was mostly influenced by the number of comorbidities. Conclusions. The presence of potentially inadequate prescribed and the lack of potentially useful drugs in the complex pharmacotherapy of elderly patients is the reason for including pharmacists in a team which creates optimal pharmacotherapy for elderly.

699-704

Authors: Mihaela C. OLARIU, Elena L. STOICHITOIU, Adriana NURCIU, Gabriela ANDRIESCU, Mihai H. OLARIU , Camelia C. DIACONU

Introduction. In the last years, the non-invasive methods of evaluating liver fibrosis were imposed in the current medical practice. The objective of the study was to evaluate the role of 2D Shear Wave elastography in the dynamic monitoring of liver fibrosis compared to a validated method – Fibromax. Materials and methods. 37 patients with chronic hepatitis C infection and advanced fibrosis (F3/F4) who received treatment with Paritaprevir/Ritonavir + Ombitasvir + Dasabuvir were included. The evaluation was done at baseline, 12 weeks after the end of treatment and 48 weeks after therapy. Results. There was a significant and positive correlation of high degree, according to the Spearman’s rho correlation coefficient, between 2D Shear Wave elastography and Fibromax, showing very similar results both at the beginning of therapy (p<0.001, R=0.726) and one year after its completion (p<0.001, R=0.961). The correlation between platelet count and the non-invasively estimated liver fibrosis degree is statistically significant, being moderately negative (p=0.009, R=0.426) – patients with low platelet count at baseline did not present an improvement of fibrosis or it was not statistically significant one year after stopping the treatment. Direct antiviral therapy with Paritaprevir/Ritonavir + Ombitasvir + Dasabuvir, besides the chronic hepatitis C eradication rate of 99-100%, also determines a statistically significant improvement (p<0.001) of the degree of liver fibrosis. Conclusions. There is a strong correlation between the two non-invasive methods analyzed, which recommends routine use of 2D Shear Wave elastography alone or in combination with other tests. In addition to the remarkable effectiveness of the therapeutic regimen used (SVR rates >95%), there is also a significant improvement of fibrosis, which prevents progression to cirrhosis and hepatocellular carcinoma.

712-719

Authors: Andreea TOMA, Patricia FURDUI, Alexandra CHIRILA, Alina L.A. OANCEA, Raluca GRIGORE, Serban V.G. BERTESTEANU

Inflammation of the salivary glands manifest differently, depending on the etiologic agent and patient population. Inflammatory and infectious pathology of the salivary glands is multifactorial and has a multimodal therapy. Bacterial infections are the result of ductal blockage or decreased salivary production. On this background, retrograde contamination of glandular parenchyma occurs. Some systemic viral infections produce salivary pathology such as mumps or AIDS. Many granulomatous infections can affect salivary glands such as tuberculosis (TB), syphilis, tularemia, toxoplasmosis, actinomycosis, and bartonellosis. Salivary inflammation occurs either in the secretory canal or in the whole gland. Suppuration of the salivary glands in immunosuppressed individuals can extend to cervicofacial regions and the mediastinum and require immediate treatment. Interdisciplinary collaboration with the infectionist, parasitologist and radiologist is the golden standard towards the benefit of the patient. Authors describe the clinical features and treatment of inflammatory diseases of the salivary glands.

725-730

Authors: Lucian IORGA, Dragos MARCU, Ovidiu BRATU, Bogdan SOCEA, Tiberiu P. NEAGU2, Simona BUNGAU, Ana Maria A. STANESCU, Camelia C. DIACONU, Dan MISCHIANU

Primary extragonadal germ-cell tumors (EGCTs) are a rare group of neoplasms, that can exist anywere along the midline of the body, without the evidence of a primary gonadal tumor. Their morphology varies widely and includes teratoma, seminoma, yolk sac tumor, embryonal carcinoma, choriocarcinoma, and mixed GCTs. The ethiopathogenesis of EGCT is poorly understood, existing multiple theories. Diagnosis is often difficult, but an accurate one should be made in order to apply a correct management.

739-744

Authors: Ana-Maria CIOTI, Ana Maria A. STANESCU , Ioana V. GRAJDEANU, Daniela MIRICESCU, Bogdan SERBAN, Ovidiu G. BRATU, Camelia C. DIACONU

Human Papilloma Virus (HPV) is the virus responsible for the most common and widespread sexually-transmitted infection. Most sexually active people will acquire at least one type of HPV in their lifetime and some may be repeatedly infected. In most cases, HPV infection is transient and asymptomatic, but when the infection persists it can cause benign diseases, precancerous lesions and malignancies of various locations. Low risk HPV types can produce proliferative lesions either in the skin or mucosa, whereas high risk types possess carcinogenic potential. This paper is a review of the latest data in the literature regarding the clinical manifestations of HPV infections, current prevention and therapeutic possibilities.

749-752

Authors: Madalina A. MUNTEANU, Gina GHEORGHE, Ana Maria A. STANESCU, Ovidiu G. BRATU, Camelia C. DIACONU

Despite considerable improvements in medical care over the past 25 years, cardiovascular disease (CVD) remains a major public health challenge. Dyslipidemias are one of the topics of greatest interest in cardiology. Decreasing serum cholesterol level is a central objective for preventing cardiovascular events. The current European Society of Cardiology guidelines recommend evaluation of the cardiovascular risk, treatment decisions being based on this risk, and clinician–patient discussion about the risk (shared decision making).

759-763

Authors: Mihail TUSALIU , Iulia TITA, Lavinia G. ILINCA, Cristina M. GOANTA, Florentin A. VREJU, Octavian D. PALADE

Introduction. Sialolithiasis is one of the most common pathologies of the salivary glands. When calculi are present in the distal excretory duct, in the hilum or in the parenchyma, complete removal of the submandibular gland is recommended. Case report. We present the case of a 43-year-old male patient, suffering from left chronic submandibular sialadenitis. The patient accused recurring colic and intermittent swelling of the left submandibular gland experienced for about 10 years, with a progressive evolution. CT scan revealed a lower volume of the left submandibular gland compared to the right submandibular gland, the presence of a microcalcification in the parenchyma and an oval calcification corresponding to the projection area of the left submandibular gland’s duct. A left sub mandibulectomy was performed. Conclusion. Complete removal of the submandibular gland is the most effective therapy for sialolithiasis, being associated with better long-term outcomes and low operative morbidity.

771-775

Authors: Alexandra BOLOCAN, Bogdan SOCEA, Dan N. PADURARU, Oana BOTEZAN, Octavian ANDRONIC, Andra MORAR, Cristina MOLDOVAN, Alexandra ENE, Roxana TURTUREA, Mara CARSOTE , Ana VALEA

Introduction. Pineal tumors are an inhomogeneous group of lesions with pineal origin, characterized by various degrees of hypothalamic-pituitary dysfunction. Case presentation. We present the case of a patient with pineal germinoma and hypogonadotropic hypogonadism who was evaluated in several medical centers. A 31-year-old male patient with a history of primary hypothyroidism and pineal germinoma, for which he underwent surgery, radiation and chemotherapy, was admitted for frontal-temporal headache, nausea and moderate intensity asthenia. Clinical examination revealed normal weight, normal blood pressure, left eye strabismus, pale skin, diminished facial and body hair, bilateral gynecomastia. The endocrine profile showed adequate thyroid hormone replacement, low normal basal cortisol levels (5.88 µg/dL, normal 5-25 µg/dL), low IGF-1 (Insulin-like Growth Factor) (93.2 pg/mL, normal 115-307 pg/mL), low gonadotrophins, testosterone (0.57 ng/mL, normal 1.3-8.53 ng/mL) and estradiol (<10 pg/mL, normal 15-60 pg/mL). Breast ultrasound showed bilateral asymmetric gynecomastia, BIRADS-2. No tumors or surgery complications were found on MRI (Magnetic Resonance Imaging) exam. A diagnosis of hypogonadotropic hypogonadism was established and surgical cure of gynecomastias, as well as testosterone replacement therapy were recommended. Conclusions. Pineal germinomas are rare tumors associated with increased risk of endocrine dysfunctions, including hypogonadotropic hypogonadism, as a consequence of germinoma-specific therapy. Frequent biochemical assessment as well as follow-up imaging are needed, in order to prevent tumor recurrence and long-term complications related to the germinoma itself or the chosen therapy.

781-786

Authors: Leonid I. DVORETSKY , Mariya A. KARNAUSHKINA, Roza M. VAKOLYUK, Nelly V. DUBROVSKAYA

Introduction. Evans’ syndrome (autoimmune hemolytic anemia combined with thrombocytopenia) is a rare hematological syndrome in the elderly. Case report. A 94-year-old patient was diagnosed with Evans’ syndrome with the secretion of monoclonal protein. The disease manifested initially by a periodic decrease in hemoglobin and platelet counts, accompanied by a deterioration of the clinical condition, and the development of a hemorrhagic syndrome. Long-term glucocorticoid therapy led to the development of osteoporosis, complicated by compression fracture of the lumbar vertebra. The main clinical manifestations of the disease (pain, limited mobility) were associated with the development of this complication. Conclusions. Diagnosis of Evans’ syndrome in elderly patients requires the exclusion of other similar diseases. Long-term glucocorticoid treatment can cause complications, such as osteoporosis with a risk of vertebral fracture. The resulting complications can disrupt the quality of life to a much greater extent than the underlying disease. When choosing a treatment for elderly patients with Evans’ syndrome, it is necessary to consider the possible benefits and the risk of complications.

. 522-531

Authors: Tamila V. SOROKMAN , Snizhana V. SOKOLNYK1, Alexandra-Maria V. POPELYUK, Tetyana O. BEZRUK, Volodymyr V. BEZRUK, Natalia O. POPELYUK

Introduction. Giardiasis is the most frequently reported human intestinal parasitic infection. The objective of the study was to investigate the frequency of giardiasis, carry out the genotyping, estimate the growth and determine the level of fecal calprotectin in children. Material and methods. 688 children aged 6-18 years were examined for Giardia duodenalis by direct microscopy. Two groups were formed: group I – children with a positive test for Giardia duodenalis (n = 90); group II – children with a negative test (n = 110). Genetic examination, anthropometry and fecal calprotectin (FC) evaluation were carried out in these children. Results. Out of the 688 children examined, 90 had a positive result (G. duodenalis (+)). The leading clinical feature of G. duodenalis infection (+) was abdominal pain, followed by nausea and diarrhea. The FC content in the feces of the group I was significantly higher (p <0.05) compared to children of group II, and did not depend on sex. The analysis of the sequences characterizing the amplification of Glutamate dehydrogenase (GDH) revealed the presence of subgroups AII (54%, 13/24), BIII (8.3%, 2/24) and BIV (37.5%, 9/24). Annual body weight gain in children of group I is shifted by 1 year and 1 cm compared to the ones from group II. Conclusions. The socio-demographic factors can be considered as predictors of the development of giardiasis in children. In the clinical course of giardiasis, the digestive tract’s disease dominates. Direct and indirect methods of diagnosis are necessary to improve the diagnosis accuracy in children. Children with increased FC need further examination. Our study suggests that G. duodenalis infection is accompanied by the growth retardation and intestinal inflammation in children.

404-410

Authors: Galya Ts. STAVREVA , Violeta Y. DANCHEVA, Lyudmil G. TERZIEV, Plamen K. KRASTEV

Introduction. The widely used antiarrhythmic amiodarone (AD) has been linked to many health problems, including pulmonary toxicity. The objective of the study. In the present study we assessed the protective effect of 21-aminosteroid U-74389 G due to its antioxidative and membrane-stabilizing potency on amiodarone-induced pneumotoxicity in rats. Material and methods. The study was carried out on 72 male Wistar rats, divided into four groups: (1) – control; (2) – treated with AD intratracheally; (3) – treated with AD and U-74389G; (4) – treated with U-74389G alone. AD was instilled twice on days 0 and 2 (6.25 mg/kg with a concentration 3.125 mg/mL). U-74389G was injected intraperitoneally on days 0, 1 and 2 in a dose of 5 mg/kg. The activity of super-oxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GP), malondialdehyde (MDA) content and hydroxyproline content were performed on days 3, 7, 14 and 28 in lung homogenate. Hydroperoxide concentrations were measured in the plasma. Results. AD administration affected antioxidant defense system in the lungs, promoted lipid peroxidation, and caused pulmonary fibrosis. Conclusions. The 21-aminosteroid U-74389G significantly inhibited lipid peroxidation and mitigated fibrous changes in rat lungs provoked by AD.

417-421

Authors: Oleh Y. AKIMOV , Arthur V. MISCHENKO, Vitalii O. KOSTENKO

Introduction. Certain regions in Europe and Ukraine have high concentration of fluorides in drinking waters. Highly developed agriculture can result in increased concentration of nitrates in ground and drinking waters. Therefore, their combined excessive intake with food and water is not excluded. The objective of the study was to determine the influence of combined nitrate-fluoride intoxication on concentration of different fractions of glycosaminoglycans (GAG) and L-hydroxyproline concentration in gastric mucosa of rats. Materials and methods. Chronic intoxications were induced by intragastric injection of sodium fluoride in a dose of 10 mg/kg, sodium nitrate in a dose of 500 mg/kg and their combination during 30 days. Concentration of GAG was determined by carbazole method. To evaluate concentrations of different fractions of GAG we used the method of differential precipitation with ethanol. For L-Hydroxyproline concentration estimation, we used Hydroxyproline Colorimetric Assay Kit (BioVision K555-100). Results. The total concentration of GAG decreases during chronic fluoride and nitrate intoxications, but increases during combined intoxication. Concentration of Heparin/Heparan GAG fraction and Keratan/Dermatan GAG fraction drops during nitrate and fluoride intoxications, but increases during combined intoxication. Chondroitin GAG fraction shows no statistically significant changes during fluoride intoxication, but increases during combined and nitrate intoxications. Concentration of L-hydroxyproline increases in all studied groups. Conclusions. We established that chronic excessive fluoride or nitrate intake can cause oxidative and nitrosative stress-depended collagen degradation, simultaneously decreasing the concentration of anti-inflammatory GAG. Combined intoxication leads to even more severe connective tissue degradation, but subsequently activates compensatory mechanisms through increase in concentration of anti-inflammatory GAG.

431-437

Authors: Olga G. KMET , Nataliia D. FILIPETS, Tamara I. HRACHOVA, Yurii M. VEPRIUK, Kateryna V. VLASOVA

Introduction. One of medical-social chronic consequences of diabetes mellitus is encephalopathy, with an advancing course and development of neurodegenerative disorders in the central nervous system. Objective: to examine carbacetam effect as a new modulator of gamma-aminobutyric acid activity on protein peroxide oxidation and morphological condition of the cerebral cortex and hippocampus in rats under conditions of experimental neurodegeneration in case of type 2 diabetes mellitus. Materials and methods. Changes in the content of protein peroxide oxidation in the cerebral cortex and hippocampus under effect of carbacetam (5 mg/kg) are examined in nonlinear laboratory albino male rats with neurodegeneration under conditions of type 2 diabetes mellitus simulated by streptozotocin and high-fat diet. Results. In rats with type 2 diabetes mellitus, the degree of protein peroxide oxidation in the cerebral cortex and hippocampus increases, which is associated with increased amount of cells with karyopyknosis, decreased relative density of staining of the neuron tigroid substance and partial denudation of vessels. After carbacetam administration during 14 days in rats with type 2 diabetes mellitus in the cerebral cortex and hippocampus the level of protein peroxide oxidation decreases, the amount of cells with karyopyknosis reduces, a relative density of staining of the neuron tigroid substance increases, and denudation of vessels is lacking. Conclusions. Decreased intensity of the protein peroxide oxidation processes, histological destruction of the cerebral cortex and hippocampus are indicative of a neuroprotective potential of carbacetam under conditions of neurodegeneration caused by type 2 diabetes mellitus.

445-454

Authors: Anton BURLAKA, Tymur RUDIUK , Anatoly BURLAKA, Olena KOLESNIK

Introduction. Surgical injury can stimulate tumor growth in metastatic colorectal cancer (mCRC), due to mitochondrial dysfunction. The objective of the study was to analyze the clinical significance of the molecular marker of 8-hydroxydeoxyguanosine and the oncological influence of the liver parenchyma warm ischemia on the prognosis of mCRC. Materials and methods. The study involved 89 CRC patients with metachronous metastatic liver disease treated in The National Cancer Institute of the Ministry of Health, Kyiv, Ukraine, from 2015 till 2018, and 19 conditionally healthy donors. 8-Hydroxy-deoxyguanosine (8-OHdG) level in the urine of patients with mCRC was determined. Urine sampling was done 24-hours before and on day 3 after surgery. Measurements of the marker of oxidative DNA damage were repeated three times. The state of the hepatocyte detoxification energy system, the levels of superoxide radicals (O2-) in the tumour tissue were determined by electron paramagnetic resonance (EPR) and Spin Trapping Technology. Results. The urinary 8-OHdG level of donors was within 0.24±0.063 nM/kg ∙ day, whereas before the resection and on day 3 after the R0-resection of liver in mCRC patients it was 3.42±0.18 nM/kg∙day and 2.12±0.08 nM/kg∙day (p < 0.05), respectively. On day 1 after the liver resection with a total duration of warm ischemia period < 30 min and > 30 min have had marker at level 2.108 ± 0.13 nM/kg∙day and 2.9883 ± 0.159 nM/kg∙day (p < 0.0001), respectively. The volume of metastatic tissue (Vmts) significantly and directly increased the level of urine 8-OhdG. The duration of surgical intervention (resection t) and duration of warm liver ischemia (t ischemia) significantly increased urine level of 8-OhdG. Conclusions. R0-resection of liver metastases in mCRC patients decreases urine 8-OHdG level after surgery. Warm liver ischemia during the Pringle maneuver (≥ 40 min), surgical intervention duration (≥ 300 min) and metastatic tissue volume (≥ 12 cm3) in liver parenchyma in mCRC patients significantly increase urine 8-OHdG levels. The level of 8-OHdG correlates with the extent of organ resection, duration of ischemia, volume of post-resection liver tissue, volume of metastases and rate of superoxide radicals’ generation.

461-466

Authors: Oksana S. KHUKHLINA, Olha B. KUZMINSKA , Alona A. ANTONIV, Tamara H. KOPCHUK, Svitlana P. MELNYCHUK

The aim of the study was to determine the level of cytokeratin 18, adiponectin and leptin in plasma of the patients with nonalcoholic steatohepatitis (NASH) and coronary heart disease (CHD) and their association with the degree of cytolysis, disorders of carbohydrate and lipid metabolism. Materials and methods. We examined 60 patients with NASH, who were divided into 2 groups: group 1 – 30 patients with NASH on the background of obesity of 1st-2nd degree, group 2 – 30 patients with NASH and CHD (the 1st and 2nd functional classes of stable angina pectoris) and obesity of 1st-2nd degree. The mean age of patients was 55.13±6.34 years. The control group consisted of 20 practically healthy persons (PHP). Serum CK18, adiponectin and leptin levels were determined by the immunoassay analysis. Results. Our research showed that NASH is closely associated with disorders of adipocytokine homeostasis. In patients with NASH, comorbid CHD, and obesity of 1st-2nd degree, there is an increase level of CK 18, proinflammatory adipokine leptin and a decrease in the level of adiponectin. Conclusions. The significant increase of liver aminotransferases activity and the level of CK 18 in patients with NASH, their close positive correlation relationship suggest that the leading pathophysiological mechanism of progression of NAFLD is the necrosis and apoptosis of hepatocytes. The determination of serum fragments of CK 18 can be used as a non-invasive test for diagnosis of NASH and liver steatosis.

473-479

Authors: Andrii V. PANTUS , Nazar Ya. SLYUSARENKO, Nataliia E. KOVALCHUK, Iryna R. YARMOSHUK, Volodymyr L. KOGUT

Introduction. One of the most specific areas in practical dentistry is the use of various biological matrix structures that serve as a backbone for osteogenic cells and a framework for vascular components that provide the gradual formation of a new bone tissue in the area of defect formed by the resultant enucleation. Objective. To establish the efficiency of using fibrous matrix and polymeric membrane in the process of restoration of defects of the bone structure after the procedure of the enucleation on the lower jaw and to analyze the results with those that were registered when performing bone defects with collagen sponge. Materials and methods. The study was conducted in the Department of Surgical Dentistry of Ivano-Frankivsk National Medical University, Ukraine, during 6 months, between September 10, 2018-March 10, 2019. The selected sample of patients randomly were divided into two groups: 1st group – the study group, which included 24 persons (filling the main bone defect in this group was carried out using the material developed by the authors, of fibrous matrix and polymer membranes); 2nd group – the comparison group, in which 25 people were included (the completion of the main part of the bone defect in this group was carried out using CollaTape Collage Spot (Integra Life Sciences). Results. The average index of reduction of the geometric radiological defect size in the research group was 89.4±2.5%, while in the comparison group, this indicator was equal to 90.2± 1.6%. The largest reduction in both the research group and the comparison group was noted in the horizontal (87.8-93.6%) and in the diagonal (88.4-91.5%) components of the defect. Six months after the intervention, the index of reduction increased and reached 1.74 (72.50%). Conclusions. The absence of registered statistical differences between the above described criteria for assessing surgical treatment of patients in both groups suggests that the use of fibrous matrix and polymeric membranes does not provoke significant violations in the process of physiological bone regeneration after the removal of cyst

486-491

Authors: Andrii BAMBULIAK

Introduction. The use of stem cells in dental practice has become possible due to the phenomenal discovery in biology and biotechnology regarding the ability of stem cells, after injecting them into the recipient’s body, to enter the places of damaged tissues and restore their cellular structure. Since bone healing occurs by replacing a defect with connective tissue, our task was to transplant multipotent stem cells, which will later differentiate into the actual bone tissue. The aim of the study was to determine the biocompatibility of mesenchymal stromal cells of adipose tissue (MMSC – AT) with osteoplastic materials. Material and methods. The research was conducted within the Bukovinian State Medical University, Chernivtsi, Ukraine, from May 2018 to February 2019. Samples of adipose tissue were obtained from the neck area of 60 experimental animals (white Wistar line rats). We conducted an analysis of phenotypic markers multipotent mesenchymal stromal cells of adipose tissue. It was determined the degree of remineralization of these samples, which was confirmed by Alamar Blue test (AB). Results. Analysis of the degree of mineralization of the extracellular matrix revealed that the investigated samples with the contents of multipotent mesenchymal stromal cells of adipose tissue (MMSC-AT) had osteogenic potential, which was more pronounced in the samples of MMSC-AT + platelet-rich plasma (PRP) and MMSC-AT + PRP + Kolapan. The cultured MMSC-AT tissues from experimental rats of the 2nd passage express the markers characteristic of MMSC, MMSC-AT capable of differentiation in the osteogenic direction, with the prevalence of this process in tissue samples containing Platelet-Enriched Plasma and Kolapan. Conclusions. Consequently, the tissue equivalent of bone tissue based on MMSC-AT can be used in regenerative medicine, and also can be used in different directions of dentistry.

497-502

Authors: Oleksii KORZH , Sergiy KRASNOKUTSKIY, Olena PANKOVA

Introduction. Given the prevalence and burden of arterial hypertension, it is necessary to obtain an optimal control of blood pressure in order to improve the prognosis of these patients. Adherence to antihypertensive therapy is poor, leading to non-optimal disease control. The objective of the study was to investigate the adherence to therapy in hypertensive patients and to assess the impact of health education and self‐action plan in improving the compliance to the therapy in primary care settings. Material and methods. A prospective study was conducted in 750 patients diagnosed with primary hypertension for 3 years. After inclusion in the study, patients were monitored for 24 weeks to evaluate treatment non-compliance. In patients without adherence to antihypertensive therapy, we used various health education strategies to improve compliance. Results. A total of 750 patients with essential hypertension who started therapy over duration of 3 years were included in the study. At the end of 24 weeks, it was observed that only 324 patients (43.2%) had regular compliance and 426 patients (56.8%) were noncompliant to antihypertensive treatment. The factors that were associated with poor compliance were: a low level of education, burdensome treatment, dislike of drugs, remote pharmacies, concerns about side effects, anger about the condition or its treatment, forgetfulness or complacency, as well as the patients’ poor attitude to health. After employing various strategies for improving the compliance in these patients, the compliance increased in 263 patients (61.7%) among the earlier defaulted patients, while the remaining 163 patients (38.3%) were found to be noncompliant even after various educational techniques. Conclusions. Failure to treat hypertension is a reality, and none of the strategies for improving compliance are likely to be as effective as a good doctor-patient relationship. Optimal self-management, which allows to optimize control of arterial hypertension by adjusting drugs, can be carried out by self-regulation using a written plan of action or by regular medical examination.

508-513

Authors: Olena A. TIULIENIEVA, Igor S. DAVYDENKO, Oleksandra V. GARVASIUK, Anastasiia V. HOIAN

Introduction. During pregnancy, the uterus suffers a huge number of morphological changes. Placental changes lead to an adequate supply of the fetus and a normal process of childbirth. In particular, the uterine-placental area appears where the fertilized ovum attaches to the uterus. Myometrium increases in size and changes the spatial configuration. The objective of the study was to assess the relative immunohistochemical concentration of the von Willebrand’s factor in endothelial cells of different types of vessels of the uterine-placental area and myometrium in pregnancy. Material and methods. The biopsy material was obtained from pregnant women during the cesarean section. Three parts (central, pericentral, peripheral) of each biopsy were developed. Multiple paraffin sections were stained in three ways: 1) immunohistochemical von Willebrand’s factor staining with an antigen thermal exposure (DACO); 2) differentiated histochemical fibrin and collagen Slinchenko’s staining; 3) hematoxylin-eosin staining. Digital images were analyzed with a computer program ImageJ (1.48v, W. Rasband, National Institute of Health, USA, 2015). We also calculated the arithmetic mean and its average error for optical density (computer program PAST 3.19, Ø.Hammer, 2018). Results. The method was tested in 65 pregnant women during the cesarean section. The main results of the staining quantitative analysis in myometrium are: 1). Arterial type vessels 0.415±0.0029 units of optic density; 2). Venous type vessels 0.381±0.0024 units of optic density; 3). Microcirculatory system 0.375±0.0022 units of optic density. The main results of the staining quantitative analysis in uterine-placental area are 1). Arterial type vessels 0.404±0.0027 units of optic density; 2). Venous type vessels 0.380±0.0024 units of optic density; 3). Microcirculatory system 0.373±0.0021 units of optic density. Conclusions. Immunohistochemical study of von Willebrand’s factor allows investigation of the endothelial dysfunction in all types of vessels of both UPA and myometrium. This is very promising for the early detection of placental dysfunction and establishing of morphological preconditions for fetal insufficiency.

532-539

Authors: Diana DEREWICZ , Roxana TARAS, Cosmin FLORESCU, Mihaela BALGRADEAN, Maria SAJIN

Introduction. The most common diagnosis after a kidney biopsy in pediatric population is minimal change disease. When the prognosis is not favorable in spite of the minimal change disease diagnosis, there is a clinical suspicion of focal segmental glomerulosclerosis. The objective of this study was to identify the ultramicroscopic changes in minimal change disease and focal segmental glomerulosclerosis focused on podocyte foot process effacement. Moreover, to find if there is a correlation between podocyte foot process effacement and proteinuria level. Material and methods. 100 patients were included in the study: 50 in the control group, 25 in the minimal change disease group and 25 in the focal segmental glomerulosclerosis group. For each patient 5 images were taken, focused on different capillary loops to identify podocyte foot process effacement. We measured the foot process effacement related to glomerular basal membrane. Furthermore, we investigated the possible correlation with proteinuria using statistical analysis. Results. The mean value of podocyte foot process effacement (%) in the control group was 8.42 ±4.59%, in the focal segmental glomerulosclerosis group was 55.44±16.17, while in the minimal change disease group it was 74.35±13.01. Compared with the proteinuria level, we established a correlation with foot process effacement (p value < 0.001) in the affected groups: minimal change disease and focal segmental glomerulosclerosis groups. Conclusions. In this study, we demonstrated that there is a correlation between proteinuria level and podocyte foot process effacement in children.

549-555

Authors: Radu V. COSTIN

Introduction. This article presents a new mesh fixation technique for “onlay hernia repair”, based on a new principle – the “Equally-Distributed-Tension Principle”. Methods. The fixation technique is based on a continuous suture, different from any other continuous suture, with no stiffened points of attachment. It allows a slight glide of the thread, making possible the equally-distribution of tension. Based on this technique it is possible to realize a mesh fixation under tension. The „tension-free” concept is not suitable for ventral hernias. The mesh should be sutured under tension – the only way to remove the tension from the midline suture and offer the posibility for the aponeurotic layer to heal and regain its strenght. A new fixation system is necessary, a more efficient one, that will sustain this tension, without failure. In the same time, this system is the only one capable to realize an uniform distribution of tension. Results. Between February 2016 and November 2018, 49 patients were treated by this method in the Ilfov County Emergency Hospital, Bucharest, Romania, with only one recurrence until now (a bridging technique was used in this case). Conclusions. The new suture system is very easy to apply, very fast, extremely reliable and offers the posibility to manage a large variety of ventral hernias.

561-570

Authors: Mihaela HOROI, Serban V. BERTESTEANU, Bogdan POPESCU, Raluca GRIGORE, Marie-Paule THILL

What we should know about cerebellopontine angle non-vestibular schwannoma? A patient with pontocerebellar pathology has complaints in the ENT field, like hearing loss, tinnitus, vertigo or facial pain The vestibular and non-vestibular schwannoma are the most frequent pathologies of this anatomical region, and because of their “mild” clinical manifestations, the diagnosis can be delayed during a regular follow-up. Improvement of differential diagnosis between vestibular schwannoma and non-vestibular schwannoma requires a detailed anamnesis as well as radiological and electrophysiological exams. Nevertheless, the non-vestibular tumors are often misdiagnosed as vestibular tumors. The surgeon must have all the knowledge and skills in order to provide, case by case, the right diagnosis and the best care for his patient. The aim of this publication is to overview the most recent data related to pontocerebellar non-vestibular schwannoma.

576-580

Authors: Nicolae BACALBASA, Irina BALESCU, Cristian BALALAU, Mihaela VILCU, Iulian BREZEAN

Gastric cancer has been for a long period of time one of the most aggressive malignancies due to the fact that it was usually diagnosed in advanced stages of the disease. However, in the last decades, introduction of upper digestive endoscopy on a wider scale led to a higher detection of this malignancy in earlier stages. Therefore, surgery with curative intent and, in consequence, better long-term outcomes, has been reported. In order to maximize the effect of surgery and to minimize the postoperative complication rates, in the Eastern studies the concept of sentinel lymph node biopsy has been implemented with satisfactory results. This is a literature review of the studies conducted so far on the theme of sentinel lymph node detection in gastric cancer patients.

585-590

Authors: Strahil A. STRASHILOV , Angel D. YORDANOV, Polina P. VASILEVA

Introduction. Skin burns are one of the most common traumatic injuries in human society. Most of them are small in area and not life-threatening, due to which people hardly look for specialized medical care for their treatment. This is not the case with large burns, which even of a low grade may result in serious complications and even death. According to the injury depth the burns are divided into 1st, 2nd, 3rd and 4th degree, while the most frequently used method to define their area relative to the total body surface is that of the nines. The treatment of burns is a difficult and slow process and is directly depending on their depth, area and injuring agent. Surgical and non-surgical method are used, their goal being the following: pain reduction, prevention of infection, removal of avital tissues, preventing the formation of coarse scars, keloids and contractures of the joints or if the patient has them, they to be as minimal as possible and finally overcoming the consequences. Cases presentation. We present here two clinical cases of 3rd degree limited burns, initially treated with necrectomy and antiseptic silver dressings, and subsequently alternatively with Тheresienöl. Conclusions. Тheresienöl is a good alternative to the free skin graft plastics, when it refers to 3rd degree, small size burns.

219-221

Authors: Camelia DIACONU

Oxidative stress is involved in the pathophysiology of many chronic diseases, including heart failure. Oxidative stress is an imbalance between the production of reactive oxygen species (ROS) and the antioxidant defense. The overproduction of ROS can lead to cellular damage and eventually cellular death. This applies also in patients with chronic heart failure, who present a dramatic increase of oxidative stress associated with a pronounced decrease of the antioxidant defense mechanisms. The components of the antioxidant defense mechanism of myocardial cells are superoxide dismutase (SOD), catalase, nicotinamide adenine dinucleotide (NAD+), glutathione peroxidase (GPx), and glutathione (GSH). Experimental animal studies have demonstrated the decrease of the activity of SOD, catalase and GPx in animal models with heart failure1,2. Furthermore, excessive ROS induce myocardial fibroblasts proliferation with cardiac remodeling. The promising results of experimental studies in animals with heart failure led to the hypothesis that oxidative stress may be a therapeutic target in patients with heart failure. Clinical trials have studied the effects of antioxidant treatments in humans with heart failure. Treatment of oxidative stress can have different approaches: inhibition of oxidative stress producers, increase of endogenous antioxidant capacity, and increase of antioxidant capacity by administration of exogenous antioxidants, such as vitamin C, vitamin A, vitamin E, folic acid. Inhibition of xanthine oxidase by the administration of allopurinol or oxypurinol in patients with chronic heart failure is the most studied treatment 3,4. Different trials have demonstrated that treatment with allopurinol or oxypurinol (inhibitors of oxidative stress) had beneficial effects on myocardial function, endothelial dysfunction, and led to the decreased levels of serum natriuretic peptides and improved left ventricle ejection fraction3,4. Other trials failed to demonstrate the beneficial effects of oxypurinol5. Other clinical studies focused on the effects of increasing the antioxidant capacity in patients with heart failure, by administration of vitamin A, vitamin C, vitamin E or folic acid. Despite the initial enthusiasm regarding the effects of these antioxidants, a recent meta-analysis of 50 randomized trials on their cardiovascular effects, including almost 300,000 patients, has demonstrated that supplementation with vitamins and other antioxidants failed to demonstrate a decrease of the cardiovascular risk. The third therapeutic approach, increase of endogenous antioxidant capacity, may be achieved by supplementation of cellular antioxidants GSH and NAD+6. This strategy has been studied only in a few trials, but their results until now seem to be promising. Supplementation with NAC, which is a precursor of GSH, in patients with chronic heart failure can be a potential approach in order to decrease the oxidative stress secondary to myocardial injury6. The improvement of the expression and activity of the gamma-glutamyl cycle and NAD+ producers is another option to increase the endogenous production of antioxidants in heart failure. Some studies have demonstrated that a few components of the gamma-glutamyl cycle (gamma-glutamyl-cysteine synthetase, GPx, OPLAH) are correlated with the risk of heart failure and its progression7. Therefore, the overexpression of these enzymes may have cardioprotective effects. OPLAH is a cytoplasmic enzyme of the GSH cycle, with a central function in the gamma-glutamyl cycle and also with an important antioxidant function; its expression is decreased in heart failure. Therefore, the stimulation of the expression and activity of OPLAH in patients with heart failure may play an important role for their prognosis. In conclusion, oxidative stress may play an important role in patients with chronic heart failure. Experimental studies have demonstrated the beneficial effects of therapies addressing the oxidative stress in animals. However, until now, these effects have not been fully demonstrated by clinical trials in humans. Further antioxidant strategies must be studied.

227-234

Authors: Olga AVILOVA, Victoria EROKHINA

Background. The burden of immunodeficiency and infectious diseases is rapidly increasing worldwide. Thus, it becomes necessary to find effective and affordable immunomodulatory drugs that may modify the response of the immune system. Objectives. To investigate ultramicroscopic changes that occur in parathyroid glands and thymus of male rats after administration of the immunomodulatory agent imunofan. Methods. Thirty-six WAG matured male rats were divided randomly into two groups. The first group received imunofan in a dosage of 0.7 mg/kg animal body weight by intramuscular injection. Rodents were sacrificed on the 3rd and 30th day after injection and specimens were dissected out and processed for electron microscopy. The second group served as control and was provided 0.9% soluble sodium chloride. Results. The results showed that imunofan exposure caused marked ultramicroscopic changes in parathyroid glands and thymus of rats. On the 3rd day after injection, the amount of the active chief cells significantly increases. A significantly increased number of secretory granules is recognized as the ultrastructural hallmark of chief cells change. Thymus in this term of imunofan administration showed no significant ultrastructural changes in comparison to control group. On the 30th day after the administration, the examination revealed that all the glands of the experimental rats have big amounts of active cells with well-developed secretory apparatus. Floccular оr particulate material was observed in the enlarged intercellular spaces surrounded by three or more chief cells. A significant amount of the secretory granules as the material might be excreted by exocytosis into the intercellular spaces. Electron microscopy of thymus revealed that imunofan injection causes changes in organ as a result of the activation of cell-mediated and antibody-mediated immunity on 30th day. Apparently, it also causes temporary delay of age-related thymic involution. Conclusion. The dynamics of changes in the electronic microscopic structure of rats’ parathyroid glands and thymus indicates a high degree of organs reactivity in response to immunotropic drug administration.

245-252

Authors: Olena P. BABKINA , Dmytro O. MATYUKHIN, Svitlana I. DANYLCHENKO, Igor. S. KOROBKO, Oleksiy O. GALMYZ, Andriy A. CHERNOZUB, Illia I. VAKO

Introduction. Liver injury is an important cause of death in patients with traumatic injuries. The objective of the study. To study the dynamics of changes in histological parameters of injured liver tissues in case of mechanical trauma, depending on the time of damages in the absence of alcohol intoxication. Materials and methods. We examined liver tissue of 52 individuals (38 men and 14 women) aged 20-60 years, who died at known and unknown time in the absence of alcohol in the blood in the Lugansk region of Ukraine. The cause of death was a mechanical trauma. The study was conducted by means of histological, histochemical methods, statistical analysis. Results. Regular histological changes were observed in the area of injured liver tissue. These changes directly depend on the time elapsed since the caused damage. Usage of the histological method was proved to be expedient for determining the time of injury, both in the isolated liver injury and in combined injuries of the abdominal organs. This method allows to increase the objectivity of the results determining the time of injury. Conclusions. The study determined changes of histological parameters of liver tissue depending on the time of injury, time of death, presence of traumatic illness, which can help in solving the question on the injury duration.

260-266

Authors: Oleksandra Yu. KUSHNIR, Iryna M. YAREMII, Inna G. KYSHKAN, Kyrylo A. PANTSIUK, Iryna D. VIZNIUK

Introduction. Melatonin, a potent antioxidant agent, is essential for glucose homeostasis. The objective of the study was to determine the influence of melatonin on basal levels of glucose in blood, activities of glucose-6-phosphatase in kidney and liver, pyruvate kinase in muscles and heart, content of glycogen in muscles and heart of rats with alloxan-induced diabetes. Materials and methods. Diabetes was induced in male Wistar rats by single intraperitoneal injection of alloxan monohydrates (170 mg/kg). Four days after diabetes induction, rats were divided into diabetic and melatonin-diabetic groups (10 mg/kg «Sigma» USA, daily and intraperitoneal for 14 days starting from the 5th day). Results. Melatonin injections caused normalization of the elevated serum glucose level in diabetic group of rats compared with basal glucose level before treatment. The activity of pyruvate kinase in muscle and heart tissue of diabetic animals was 45% and 63% less than in control groups, respectively. Regarding kidney and liver of diabetic rats, the activity of glucose-6-phosphatase was increased in average by 148% compared with control value. The glycogen content in the heart and skeleton muscles of diabetic animals was reduced in average by 20% compared with the control. Melatonin restored all these indexes back to normal level. Conclusions. These findings suggested that melatonin restored the events in Cori cycle by possible activation of glycolysis in skeletal and heart muscles and normalization of gluconeogenesis in liver and kidneys.

274-280

Authors: Olga S. SHEVCHENKO, Lilia D. TODORIKO , Iryna A. OVCHARENKO, Yevheniia B. RADZISHEVSKA, Olga M. SHVETS, Sergiy S. OVCHARENKO, Igor O. SEMIANIV, Volodymyr V. VIVSYANNUK

The objective of the study was to evaluate the dynamics of reorganization of connective tissue, aldosterone and glucose level as markers of favorable course of multidrug-resistant pulmonary tuberculosis. Materials and methods. The study was performed on 84 patients with firstly diagnosed multidrug-resistant pulmonary tuberculosis. Aldosterone, free and protein-bound hydroxyproline and glucose levels were measured in all patients. Results. It was found that in group I patients, free hydroxyproline levels are lower than in group II during the first two months of treatment for 60% at treatment onset and for 29.4% after 2 months of treatment. There was an increase in this index during the first 2 months of treatment in both groups. Protein-bound hydroxyproline level was higher in group I by 21.7%. The level of aldosterone at the treatment onset was almost identical in both groups. After 2 months of treatment, its level decreased in both groups. However, after 2 months of treatment in group I, its index was lower than in group II by 12.7%. Conclusions. Our results suggest that patients with a favorable course of multidrug-resistant tuberculosis have more pronounced decrease in aldosterone level, which may act as a pro-inflammatory agent and free hydroxyproline, which is a marker for the destruction of connective tissue. Inverse correlation between protein-bound hydroxyproline and glucose levels confirm the importance of normal glucose concentration for repair process.

288-292

Authors: Andreea D. IORDAN DUMITRU, Horia LAZARESCU, Andrei KOZMA , Agnes K. LACKNER, Doriana AGOP-FORNA

The objective of the study was to analyze a phenomenon that is more and more common in dental practice, i.e. the simultaneous presence on the arch of both the temporary tooth and the successor tooth. Material and method. The study has been conducted for over a year (1.01.2018-31.12.2018) by the authors practicing in Romania. From the total number of patients, we selected and studied those who had in the oral cavity both their temporary teeth and their successor teeth. In addition to their recording in the oral cavity, where appropriate, the temporary teeth extraction was used to place the definitive ones so that the functions of the dental-maxillary apparatus would not be altered. Results. 272 children with different pathologies at the oral cavity level were evaluated, of whom 102 children (37.5%) presented both temporary and definitive successor teeth. There were no significant differences between the two sexes. In the majority of cases, the temporary teeth and the definitive teeth were not in the same plane so that, on the arches line, the temporary ones and the permanent ones had an ectopic position; the temporary teeth had unreabsorbed roots and the final teeth had a defective position. Conclusions. Presence on the arches of both the definitive teeth and the temporal teeth leads to malocclusions that, if not corrected, the entire oral cavity will be damaged. If teeth with malposition do not return to their normal place on the arch, the patient will be directed to the orthodontic specialist.

300-306

Authors: Tamila V. SOROKMAN , Snizhana V. SOKOLNYK, Alexandra-Maria V. POPELYUK, Sergii O. SOKOLNYK, Olena V. MAKAROVA, Volodymyr V. BEZRUK

Introduction. A progressive increase of obesity prevalence, both among adults and children, is observed in many countries. Today, obesity is seen as a chronic systemic inflammation with low activity. Currently, new data are available about the biological and clinical significance of metal proteins in the inflammatory processes. The objective was to study the transferrin and ceruloplasmin indices in overweight and obese children. Material and methods. We have examined children with excess body weight (EBW, 30 children), obesity (40 children) and 30 healthy children aged 13-18 years. The evaluation included history, anthropometric data (height, body weight, body mass index, waist-to-thigh ratio – WTR), serum glucose, insulin, HOMA-IR calculation, transferrin (TF) and ceruloplasmin (CP). For statistical analysis of the results, statistic modules of Statistica v.6.0, MedStat and on-line SISA calculator were used. Results. In a total sample of 325 children, excess body weight was observed in 75 (23.1%) cases and obesity in 68 (13.6%) children. Boys prevailed, with 40 (53.3%) cases of EBW among those and 38 (55.8%) with obesity. The content of TF and CP in children aged 16-18 years was higher (28.1±0.8 mg/dL and 3.90±0.70 g/L, n = 22, p <0.05) than in children aged 13-15 years. The highest TF level (3.98±0.9 g/L, n = 16) and CP level (28.9±0.8 mg/dL, n = 16) were recorded in children with grade II obesity. There was no apparent difference either in the gender indices of TF and CP, nor in obese children combined with insulin resistance or obesity without insulin resistance. Less obvious changes in TF and CP were found in children with EBW. The weak relationships between the increase in BMI in children and the CP and TF (r = 0.28; p <0.001) level in the blood plasma of obese children (r = 0.23; p <0.0001) were detected, though they are highly statistically significant. Conclusions. Early identification of children with EBW and monitoring of their health, including the assessment of systemic inflammation markers, is an up-to-date and promising area for optimizing the obesity prophylaxis.

315-319

Authors: Tengiz VERULAVA, Tinatin ASATIANI, Beka DANGADZE, Revaz JORBENADZE

Introduction. In the past years, the role of social workers in the oncological disease treatment processes has significantly increased. The role implies supporting patient’s psycho-social conditions. The objective of the study was to study the psycho-social challenges of oncological children and their families and to define a role of social work in this area. Material and methods. As part of a qualitative study, five interviews were conducted with pediatric oncologists, also 15 in-depth interviews with family members of oncological patients and a focus group with 8 members. For the quantitative study, 62 beneficiaries and 12 medical specialists were interviewed. Results. The children with oncology conditions and their families faced psycho-social challenges and were in need of social workers’ support in overcoming those challenges. The study demonstrated a low level of public awareness. There is a lack of information among both doctors and beneficiaries. Both psychologists and social workers are involved in re-socialization of oncological children and they care for the improvement of children’s quality of life and support their families. However, there are only a few of such organizations. Therefore, many people who need their support have no chance to take such services. Conclusions. Implementing the social work in the pediatric oncology will be a major step toward the medical quality standards.

320-324

Authors: Simona BOBIC, Bogdan SOCEA , Ovidiu G. BRATU, Ana Maria A. STANESCU, Vlad D. BALEANU, Dragoș V. DAVITOIU, Mihai C.T. DIMITRIU, Dan DUMITRESCU, Dumitru C. BADIU, Vlad D. CONSTANTIN

Introduction. Cognitive impairment is a key symptom of schizophrenia and is known to be due to neurodevelopment changes. The aim of our study was to compare verbal fluency of patients with paranoid schizophrenia (PSch), first grade relatives (FGR) and healthy control subjects (HC) and to find additional risk factors for poor verbal fluency test performances in cases with PSch. Material and methods. 108 PSch (66 males, 44 females, mean age 38.86±10.02 y), 58 FGR (30 males, 28 females, mean age 36.71±11.74 y) and 60 HC (37 males, 23 females, mean age 35.68±11.36 y) were studied during the period 2015-2017 at the Department of Psychiatry and Medical Psychology, University Hospital Pleven, Bulgaria. After giving informed consent, they underwent full somatic and neurological examinations and fulfilled Isaac’s Set Test (IST) and K, A, M, E literal fluency test (LF). Results. PSch obtained lower scores on both LF and IST than other two groups. FGR had poor performance only on LF. Ageing, level of formal education, severity and duration of schizophrenia were associated with LF and IST performances. Conclusions. PSch show significant LF and semantic fluency difficulties. FGR have only LF changes. Verbal fluency is related to ageing, formal education, duration and severity of schizophrenia.

334-338

Authors: Nicolae BACALBASA , Irina BALESCU, Cristian BALALAU, Mihaela VILCU, Iulian BREZEAN

Pancreatic adenocarcinoma remains one of the most aggressive malignancies worldwide which is unfortunately associated with very poor long-term survival. However, it seems that the only option in order to improve the outcomes of these patients remains radical surgery consisting of in block resection of the tumor and the surrounding tissues. When it comes to the extent of the lymph node dissection, a permanent debate still exists between the eastern and the western countries; while the Western countries consider that an extended lymph node dissection increases the postoperative complication worthwhile, the Eastern countries consider that this should be the treatment of choice as long as these tumors usually disseminate on the lymphatic route. In order to establish what patients could benefit most from an extended lymph node dissection, certain authors proposed performing the sentinel lymph node biopsy technique. This is a literature review of the largest studies conducted on this theme.

345-350

Authors: Gina GHEORGHE, Madalina ILIE, Bogdan SOCEA, Ana Maria A. STANESCU, Ovidiu G. BRATU2,4, Mihaela A. IANCU2, Mihaela C. OLARIU, Gheorghe CIOBANU, Camelia C. DIACONU

Budd-Chiari syndrome (BCS) is a rare disease characterized by obstruction of the hepatic veins, regardless of mechanism and degree, in the absence of heart disease, pericardial disease or sinusoidal obstructive syndrome. In relation to etiology, BCS is classified in primary BCS, when it is caused by an intravascular thrombosis, and secondary BCS, when the obstruction is due to extrinsic compression or tumor invasion. The positive diagnosis is based on patient’s medical history, clinical examination, and paraclinical investigations. The clinical picture is polymorphous. The most common signs and symptoms include fever, abdominal pain and abdominal tenderness on palpation, hepatomegaly, ascites, edema of the lower limbs, gastrointestinal bleeding and hepatic encephalopathy. Laboratory tests can detect the degree of liver injury, with decreased serum albumin, altered coagulation, hepatic cytolysis and cholestasis, while imaging investigations may reveal the venous obstruction. Regarding treatment, all patients with BCS are recommended systemic anticoagulation to reduce the risk of thrombus extension and prevention of further thrombotic episodes. Depending on patient’s individual characteristics, angiography with or without stent, thrombolysis, trans-jugular intrahepatic portosystemic shunt and liver transplant are to be considered. The syndrome’s severity and prognosis are dictated by the underlying disease, ranging from a possible curability to quick death.

357-362

Authors: Raluca T. TATAR, Doina I. NACEA

Introduction. Skin and soft tissue defects in lower extremity are challenging clinical situations that have to be dealt with on an individual basis. Closure technique must be tailored to the wound size, location and etiology, and also to the patient’s characteristics (age, other comorbidities etc.). This paper aims at emphasizing the clinical particularities of lower extremity wound closure in children. Material and methods. We review the clinical data, surgical strategy and operative staging, and also the postoperative outcome of three cases of children (aged between 4 and 9 years old) with skin and soft tissue defect cause by trauma and infection, operated in our department in 2017. Results. The three patients presented with lower leg and anterior foot skin and soft tissue defects, ranging from 5 to 10 cm on the long axis, with deep involvement (including joint exposure in one of them). Etiology was traumatic in two cases, one complicated by infection due to inappropriate initial cure. In the third case, the skin defect was caused by foot cellulitis that was incised and debrided in another hospital, and was referred to us for closure of the remaining uncovered wound. The surgical approach was to use local flaps and skin grafts, alone or combined, after thorough debridement and removal of all infected and devitalized tissue, combined with systemic antibiotics. Postoperative assessment at 1-2 months showed very good graft take and convenient scar appearance, with no functional impairments and no other complications. Conclusions. Surgical protocol for closing lower extremity skin and soft tissue defects raises technical problems, even in the young patient. However, a careful planning of closure steps and preparation of good quality underlying tissues may ensure fast and satisfactory results for the patient and his/her family, as well as for the treating physician.

368-371

Authors: Andra M. IONESCU, Bogdan SOCEA, Mihai C.T. DIMITRIU, Vlad D. CONSTANTIN, Cringu A. IONESCU, Alexandra MATEI, Diana C. GHEORGHIU, Irina PACU, Teodora VLADESCU, Mihai B. NICULAE

Introduction. Struma ovarii represents a rare tumor, only 1% of the ovarian tumors, with an incidence of 0.3-0.7%. The positive diagnosis is obtained by microscopic examination; sometimes elevated serum levels of thyroid hormone, CA 125 and ultrasound aspects can suggest the preoperative diagnosis. Case presentation. We report the case of a 56-year-old woman with unilateral struma ovarii and no clinical or paraclinical evidence of the diagnosis to come. Transvaginal ultrasound revealed polyfibromatous uterus and apparently normal adnexa. Partial hysterectomy with bilateral salpingo-oophorectomy (considering the patients’ age) through laparotomy was performed under spinal anaesthesia. The histopathological result showed an endometrial polyp, multiple intrauterine leiomyomas, left ovary with thyroid follicles, which looked like normal thyroid tissue. The evolution of the patient was favorable, with no complications at the 6 months’ follow-up. Conclusions. In the literature, there are only a few cases of benign struma ovarium, and even less cases of malignant struma ovarium or bilateral presentation of the tumor. The particularity of the case consists in the diagnosis of struma ovarii only after surgery, in a patient without clinical or paraclinical evidence of this diagnosis.

375-378

Authors: Florin GROSEANU , Stefan CUCULICI, Radu VISAN, Bogdan SOCEA, Stefan CRISTEA

Introduction. Scaphoid non-union associated with avascular proximal pole necrosis represent a really challenging problem for orthopedic surgeons and its treatment is still in debate. Case presentation. We present the case of a 33-year-old patient, with scaphoid non-union, who was treated according to Zeidenberg’s technique using a vascularized radial bone graft. The primary objectives of treatment were to obtain union of the scaphoid, to improve the functional recovery of the wrist and to allow professional reimplantation of the patient. We were able to obtain a functional graft and after 9 months the results were very good. Conclusions. Vascularized bone grafts represent the optimal method of treatment of scaphoid non-union associated to avascular proximal pole. It is mandatory to be associated to rigid osteosynthesis such as Herbert compression screw. The technique of Zeidenberg offers good results in these cases, but it should not be performed without magnifying lens and tourniquet uses.

384-390

Authors: Oksana BOYARCHUK, Andrii CHORNOMYDZ , Iryna CHORNOMYDZ

Introduction. The Kasabach-Merritt syndrome is a rare and severe disease that occurs in children in the presence of a large-sized hemangioma, accompanied by coagulation disorders. This disease complicates the course of many somatic diseases in children, including community-acquired pneumonia, due to the clotting disorder. Case presentation. A case of a 4.5-month-old child with a combination of capillary hemangioma of the dextral chest surface, complicated by Kasabach-Merritt syndrome, and community-acquired right-sided focal pneumonia is presented. The possible effect of the Kasabach-Merritt syndrome on the course of community-acquired pneumonia has been analyzed. Additionally, the drugs’ effect on the coagulation disorder, the state of hemangioma, and the course of community-acquired pneumonia in children have been investigated. Conclusions. Severe coagulation disorders may occur in patients with Kasabach-Merritt syndrome and community-acquired pneumonia. Constant monitoring is essential during hospitalization. Such combination of diseases should be treated considering the ability of the drugs to influence both the hemostasis system and the progression of hemangioma’s growth.

3

Authors: Konstantinos LAIOS, Gregory TSOUCALAS, George ANDROUTSOS, Marianna KARAMANOU

Hernia was a common problem in Hellenic antiquity as we may infer by a plethora of references in ancient Greek and especially in Byzantine medical literature. However, in ancient Greek art there discovered only two examples representing this rather common surgical entity. Hernia is depicted in two Hellenistic terracotta figurines, one male and one female. They were part of a course in an ancient school or votive offerings in a sacred ancient temple. Although surgery was an existent medical branch at the era, it seems that only a radical ablation, probably fatal, was performed by medico-philosophers and surgeons.

4

Authors: Dan DUMITRESCU, Costel SAVLOVSCHI, Sorin OPRESCU, Dragos SERBAN, Sebastian GRADINARU, Tiberiu TROTEA, Bogdan SOCEA, Catalin ALIUS, Victor DUMITRESCU

Introduction. Considered by many authors a vestigial structure, the appendix is a small dimensions organ with mostly unknown functions. Acute appendicitis is the most common condition of the ileocecal appendix, having multifaceted clinical manifestations, often masquerading as various unrelated syndromes, but causing increased morbidity, especially when diagnosed late. Although the disease could manifest at any age, there is a progressive increase of its incidence from birth, with a maximum between 10 to 40 years. Case presentation. We report the case of an 84 years-old female patient, who presented with significant abdominal pain in the lower quadrants, mainly in the right iliac fossa and in whom the CT examination was suggestive of a utero-appendicular fistula, a very rare complication in daily practice and even more seldomly encountered in the elderly. Conclusions. Acute appendicitis remains a condition for which surgery is still the optimum treatment, especially in the case of an elderly patient having a radiologically suspected fistula with the uterus that could easily lead to septic gynecological complications and possibly progression to multiple organ failure.

6

Authors: Mihail TUSALIU, Alexandru PANFILOIU, Lavinia G. SAVA, Cristian IONITA, Cristina M. GOANTA, Vlad A. BUDU

Introduction. The parotid gland, the largest salivary gland, can be the site of various pathology. Any swelling located in the parotid gland requires thorough investigations. Symptoms usually include a painless, unilateral tumor, with a slow evolution. Histology establishes the therapeutic plan. Case presentation. We present the case of a 60 years-old patient, known with a tumoral mass in the parotid region for 3 years, who came to our clinic for a history of 3 months persistent dysphonia. Endoscopic laryngoscopy revealed a tumoral mass occupying two thirds of the right vocal cord, covered in keratin plates, with normal mobility of both vocal cords. From the patient’s record, we note an ultrasound fine needle aspiration biopsy, performed at the onset of the parotid tumoral mass, which did not reveal any malignancy criteria. Conclusions. Differential diagnosis for parotid gland pathology must include inflammatory, infectious and tumoral conditions. A complete set of investigations must be performed in order to establish the therapeutic approach. Treatment, depending on the histological type of the tumor, is commonly surgical and can be followed by radiotherapy and in some cases, chemotherapy.

7

Authors: Dumitru MATEI, Andrei KOZMA, Andreea-Dona IORDAN-DUMITRU, Roxana FLORESCU

Introduction. The glucose-6-phosphate-dehydrogenase (G6PD) deficiency is probably one of the most frequent genetic alterations and represents a public health issue, affecting more than 400 million people worldwide. Due to migration, G6PD deficiency cannot any longer be determined in a specific geographical location, but it can occur anywhere, including Romania. Case presentation. We present the case of a newborn hospitalized for prolonged neonatal jaundice because of a combination of risk factors (preterm birth, breastfeeding and G6PD deficiency) and medication – paracetamol and hepatoprotective syrup from Ayurvedic traditional medicine, that triggered the hemolytic crisis. After the diagnosis was established, the intake of drugs received at home was stopped and the hemoglobin and hemoglobinuria values were monitored; the iso-group iso-Rh erythrocyte mass was administered and the posttransfusion hemoglobin was determined. At discharge, the family was trained to know the factors that delineate the hemolytic crisis, as well as the recognition of the occurrence of a hemolytic crisis, in order to address the emergency specialized service. Berberine, the hemolysis trigger factor, is found in green pharmacy preparations and as such in the present context – of mixed races population and of the globalization – we can expect an increase in hemolysis incidence associated with G6PD deficiency. Conclusions. The identification of high-risk populations – through well conducted family medical history and screening – reduces the possibility of irreversible neurological damage. Educating the parents and the medical staff involved in the care of these newborns plays an extremely important role, avoiding the exposure to the chemical, medication and alimentary triggers being a very efficient way of preventing the hemolytic crisis.

10

Authors: Gregory TSOUCALAS, Eleni PANAGOULI, Konstantinos LAIOS, Marianna KARAMANOU, Theodoros PAPAIOANNOU, Aliki FISKA, George ANDROUTSOS, Panagiotis SKANDALAKIS

Pétrequin was a French surgeon born in the town of Villeurbanne, near the city of Lyon. He lived in an era when surgery was evolving towards a more complex and modern specialty. His magnificent career was shared between surgical pathology and history of surgery. His two most significant works were “Traité d’anatomie médico-chirurgicale et topographique” (An Assay of Medical and Surgical Anatomy and Topography) and “La chirurgie d’Hippocrate” (The Surgery of Hippocrates). Having realized the need for surgery to be combined with anatomy, he was the scholar who introduced the concept of surgical anatomy. His innovations, travels and publications won him a series of nominations and a place among th greatest European surgeons and philosophers of all times.

18-24

Authors: Mykola TURCHYN, Ivan KLISHCH, Mariya MARUSHCHAK, Inna KRYNYTSKA, Solomiia SHMYR

The objective of the study was to investigate the features of free-radical oxidation and apoptotic leukocyte death in the dynamics of mechanical non-penetrating corneal injury in rabbits. Material and methods. The peculiar features of free-radical oxidation (the content of TBA-reactants and Schiff bases) in blood and aqueous humor were determined using biochemical methods. The analysis of blood leukocytes samples to determine reactive oxygen species was evaluated by the flow laser cytometry method, using 2.7-dichlorodihydrofluorescein diacetate. The percentage of apoptotic blood leukocytes was evaluated by the flow laser cytometry method, using specific kit. Results. In case of experimental non-penetrating mechanical corneal injury, the percentages of reactive oxygen species and spontaneous apoptosis of blood leukocytes increased significantly from the 3rd day of the experiment, with the highest values within 14th and 21st days of observation. Also, the intensification of lipid peroxidation (increased content of TBA- reactants and the Schiff bases) in blood and aqueous humor, with a maximal increase on the 14th day of observation (p<0.05), has been observed. The strongest correlations between the percentage of apoptotic blood leukocytes, the content of TBA-reactants and the percentage of ROS were observed within the 7th-14th days of the experiment. Conclusions. One of the important signaling pathway of blood leukocytes apoptosis triggering in case of mechanical non-penetrating corneal injury in rabbits is reactive oxygen species overproduction and possible disruption of the mitochondrial inner membrane (direct relationship between the increase of TBA-reactants, reactive oxygen species and percentage of annexin-positive blood leukocytes (r=0.99; p<0.05)).

32-37

Authors: Irina BAGMUT, Oleksii HALMIZ, Svetlana GRAMATIUK, Anna TITKOVA , Svetlana KRYZHNA

The objective of the study was to compare the NADPH/ H2O2 system and the expression of enzymes in the culture of thyroid gland cells, depending on the sex. Material and methods. The thyroid gland was collected from adult female donors (n=20) and men (n=15). The cells were washed twice with HBSS and centrifuged at 1000 × g for 5 minutes, and then cultured to 106 cells in 0.5 ml culture medium per well in 24-well plates (Thermo Fisher Scientific, USA). H2O2 levels in the cells were determined quantitatively using a hydrogen peroxide sensor Premo™ Orp1-roGFP (Life Technologies, USA) according to manufacturer’s instructions. Statistical analysis of the results was carried out using Statistica 6.1 (StatSoft, Inc., USA). Results. We found that the expression of DUOX1 and NOX4 in the thyroid gland was significantly higher in women than in men (1.5 times, p<0.05). Expression of DUOX2 in female cells was 1.5 times higher than in men, but statistically significant (p=0.06). We have found that the thyroid gland of women produces a significantly higher H2O2 content than the male gland cells (p<0.05). The expression of DUOX1 and NOX4 is significantly higher in cells derived from the female thyroid gland than in cells derived from males. H2O2 levels were also higher in cells derived from female thyroid gland than in male cells. Conclusion. As a result of our experiment, the expression of DUOX1 and NOX4 is significantly higher in cells derived from the female thyroid gland than in cells derived from males. We have shown during the experiment that NOX4 is regulated both at the transcription level and at the level after transcription, and the level of sustained-release NOX4 mRNA does not accurately reflect the content and function of the NOX4 protein. Chronic effects on the female thyroid gland at higher concentrations of H2O2 can potentially cause many adverse effects.

45-50

Authors: Alexandru I. ULMEANU, Dora BOGHITOIU, Anamaria A. ULMEANU, Coriolan ULMEANU

Introduction. The actual prevalence of toxic nephropathies in children is not fully known, because renal functional and structural changes caused by nephrotoxins are nonspecific. The objective of the study was to evaluate the aetiology and renal involvement in severe poisoning with lethal potential in children. Methods. We retrospectively analyzed a group of patients, aged between 0-18 years, with deaths due to acute intoxication, who were investigated at the National Institute of Legal Medicine “Dr. Mina Minovici” Bucharest, Romania, during a 9 years period. We analyzed the aetiology of deaths by poisoning in children, the aetiology and the frequency of nephrotoxic injury and the pathological aspects of nephrotoxic poisonings. Results. From a total of 69 children deaths due to acute intoxication, the most common cause of death was acute poisoning with carbon monoxide (23 cases). The other etiologies were represented by multidrug poisoning – 9 cases, organophosphorus intoxications – 9 cases, and intoxications with illicit drugs – 8 cases. Acute renal injury was present in 20 patients, mainly in acute multidrug poisoning. The most common aspect was tubular nephrosis in 15 cases, followed by the appearance of acute tubular necrosis in 10 cases, tubulo-interstitial nephritis in 1 case, and non-specific aspects with renal stasis in the remaining 6 cases. Conclusions. Kidney involvement in pediatric poisoning is rare, but when acute kidney injury occurs, the prognosis of the intoxication becomes severe. Renal injury was present in 30% of cases, either by direct kidney damage with acute tubular necrosis, or by association of haemodynamic, cardiogenic, or septic shock.

57-63

Authors: Mariia A. SHULHAI , Halyna A. PAVLYSHYN1 Olexandra M. SHULHAI

Introduction. Lipid metabolism disorder is recognized as one of the risk factors for vitamin D deficiency, and the amount of adipose tissue is crucial in its metabolism and biological role. Childhood obesity is an important public health problem in Ukraine, especially among adolescents. The objective of the study was to determine peculiarities of the prevalence and risk factors for vitamin D deficiency in overweight and obese adolescents in Ukraine. Material and methods. 146 children, aged 12 to 17 years, with excessive weight and obesity, and 63 healthy children with normal body weight were examined. The vitamin D status was determined by the level of 25(OH) D in blood serum. The multiple logistic regression analysis was used to determine the risk factor affecting the development of vitamin D deficiency. Results. The study has established that the average level of 25(OH) D in adolescents with normal body weight was 19.76±4.28 ng/mL, in adolescents with excess body weight 15.24±3.47 ng/mL, and in obese children 13.87±2.71 ng/mL. The prevalence of vitamin D deficiency in overweight adolescents was 70.62%, and in adolescents with obesity 77.19%. Conclusions. The study has established the main risk factors and prevalence features for vitamin D deficiency in overweight and obese adolescents.

72-77

Authors: Yurii BANDRIVSKY, Orysia BANDRIVSKA, Romam GNID, Lidia MINKO, Maryana SHEVCHUK

Introduction. The close relationship of the osteoporosis with the periodontal tissue disease is of great importance in dentistry, because of the development of inflammatory-destructive processes of tooth holding tissues. A database to individualize the basics of metabolism in terms of bone remodeling in patients with generalized periodontitis (GP) in connection with AB0-belonging will reveal the fundamental basis of the influence of group-specific features of blood flow and treatment of generalized periodontitis. The aim of the study was to assess the dynamics of bone remodeling markers in blood and oral liquid of patients with generalized periodontitis, with different blood groups. Material and methods. The clinical and laboratory studies were conducted in 175 patients with generalized periodontitis (main group) and in 120 persons without somatic and dental diseases (comparison group), who were divided into groups in connection with AB0-belonging. It was determined the activity of acid and alkaline phosphatase in blood and oral liquid of patients, by conventional biochemical methods, and levels of osteocalcin and C-end telopeptide by ELISA. Results. Patients with generalized periodontitis presented a significant increase of the markers of bone resorption (acid phosphatase and C-end telopeptides), while healthy persons presented a reduction of these parameters of bone formation (osteocalcin and alkaline phosphatase) in blood and oral liquid, regardless of blood group affiliation. Further, processes of bone resorption in blood and oral liquid were examined in patients with GP, carriers of O(I) and A(II) blood groups. It was noted that the process of bone formation for these levels of osteocalcin and alkaline phosphatase were significantly lower in patients with GP, in O(I) and B(III) blood groups. Conclusions. The results of the study showed that in patients with GP there is an imbalance in the processes of bone remodeling, regardless of AB0-belonging. The study of the composition and functions, not only of blood, but also of saliva, can find high regulatory and trophic potential of this biological environment and the diversity of its protective and compensatory features.

89-96

Authors: Larysa P. SYDORCHUK, Boris V. SYROTA, Andrii R. SYDORCHUK, Oleg V. GERUSH, Natalia Y. MUZYKA, Michael I. SHEREMET, Oksana M. KOROVENKOVA, Natalia S. BOHDAN, Olha Y. SKRYNCHUK, Liviya V. NIKYFOR, Oksana M. IFTODA, Serhiy I. IVASHCHUK, Oksana V. KUSHNIR

Background. Escherichia coli enteritis is one of the most common causes of diarrhea in developed countries and is caused usually by pathogenic strains of Escherichia coli. Objectives. To investigate the role of reactive response of polymorphonuclear neutrophilic granulocytes (NG) of peripheral blood in the systemic inflammatory response mechanisms of acute Escherichia enterocolitis (AEC), depending on genes polymorphism of heat shock proteins (HSP) family 70-2 (HSP70-2, 1267A®G) and interleukin 10 (IL-10, C-592A). Material and methods. The genes polymorphism was analysed by PCR based method in 95 patients with AEC and 30 healthy individuals. Clinical markers of immune disorders were evaluated after hematological indices, based upon an extended general clinical blood analysis, using verified formulas. Results. The endogenous intoxication severity did not depend reliably on genotypes of IL-10 gene (rs1800872), however it was significantly 23.68% (р=0.043) higher in GG-genotype carriers of HSP70-2 gene (rs1061581). The reduction of cellular reactivity by 14.71-19.08% (р<0.01) did not depend on the analyzed genes genotypes. But general non-specific immune reactivity decreases 3.49-4.24 times (р<0.001) was deeper in GG-genotype carriers of HSP70-2 gene and AA-genotype carriers of IL-10 gene by 17.78% (р=0.009) and 12.37% (р=0.023) respectively. The immunologic resistance index was lower by 18.75% (р=0.024) in GG-genotype carriers than in patients with А allele. Conclusions. Hematological indices, based upon an extended general clinical blood analysis, are indicative and reliable non-specific clinical markers of immune disorders in case of AEC.

104-109

Authors: Volodymyr I. PIATNOCHKA

Introduction. The results of the surgical treatment of ventral and incision hernias in the obese patients are poor, because of the high incidence of complications and relapses. The objective of the study was to analyse the outcomes of patients with hernias, obesity and non-specific connective tissue dysplasia (NSCTD), and to define the main predictors of complications development. Methods. We analysed the outcomes of treatment in 1133 patients, who underwent surgery for primary and incision ventral hernia between 2006-2017. Results. Pulmonary embolism was diagnosed in 0.62% of the patients, abdominal compartment syndrome (ACS) in 3.0% of the individuals, after stretching hernioplasty. The highest incidence of wound complications was evidenced in patients with stage 3 obesity – 35.14%. The signs of NSCTD were present in 53.45% of the patients with recurrent hernia, and in 18.61% of the patients with no recurrence of hernia. In patients with obesity stage 1 and 2, the development of ACS depended only on the chosen method of surgical intervention. In patients with no recurrent hernia, the division of patients according to their blood groups did not significantly differ from the general population. Conclusions. The non-stretching methods of hernioplasty should be a priority, especially for patients with morbid obesity, stage 2-3, and significant comorbidity. The risk group for relapses also includes the patients with NSCTD and A(2) blood group, since the incidence of NSCTD in these individuals is statistically significantly higher.

115-123

Authors: Kristina A. CHYMPOI, Alla S. BORYSIUK, Maryna P. TYMOFIEVA, Olesia I. PAVLIUK, Svitlana P. MELNYCHUK, Tamara H. KOPCHUK

Introduction. Liver cirrhosis (LC) is a chronic disease characterized by destruction of liver cells, changes in its lobular structure and vascular system, enlargement of connective tissue and irreversible dysfunction of the organ, with severe mental and psychological complications. Not only the treatment and prevention of complications, but also the psychological support of the patients with liver cirrhosis and their families are important. The objectives of the study. To explore empirically the individual psychological features of patients with LC, as well as to identify the gender peculiarities of the personality of the patient with LC. Material and methods. The study was conducted in the gastroenterology department of Chernivtsi Regional Clinical Hospital, Ukraine, from September 2017 to April 2018. The research involved 24 patients (9 women and 15 men). The average age of patients was 64 years. Methods as observation, conversation, R. Cattell’s Multi-Factor Questionnaire were used to diagnose individual psychological peculiarities. Results. As indicated by the results of the study of the communicative qualities of patients with LC, high levels were detected in such factors as Dominance (54%) and Vigilance (83%). As for the group of intellectual qualities, the average level prevails. Concerning the group of emotional qualities, the average level of internal stress, emotional sensitivity, anxiety, self-control, courage and organization in social contacts prevails among the patients with LC disease. According to the results of the study of the regulatory qualities of patients with LC, the vast majority of respondents demonstrated a high level of self-discipline (79%). Conclusions. A comparative analysis of gender peculiarities has shown that women with LC tend to demonstrate sociability, internal stress; they are more self-disciplined than men, whereas men with LC are more open to the perception of new things. It is worth paying attention to the fact that both men and women of this sample were found to have a low level of emotional sensitivity.

130-138

Authors: Oksana BOYARCHUK, Maria KINASH, Tetiana HARIYAN, Tetiana BAKALYUK

Introduction. An early diagnosis of primary immunodeficiencies (PID) prevents the development of complications and improves the quality of life of children with PID. A large number of PID are undiagnosed or misdiagnosed. An important challenge is improving the awareness of physicians about these diseases. The objective of the study was to evaluate the knowledge about primary immunodeficiencies among postgraduate medical students of different specialties. Methods. A survey among postgraduate medical students of different specialties on awareness of PID was conducted. The study involved postgraduate medical students (interns) of I. Horbachevsky Ternopil State Medical University, Ukraine. There were 93 participants: 17 pediatricians, 27 general practitioners / family (GP/F) physicians, 39 internists, 10 surgeons. The survey consisted of a questionnaire containing 25 questions. Results. The average percentage of correct answers given by the surveyed postgraduate medical students was 63.6%, and ranged from 24.7% to 91.4%. The highest level of knowledge was demonstrated among pediatricians (76.9%). The lowest knowledge was revealed concerning the specific signs of PID, in particular verification of ataxia-telangiectasia and management of Nijmegen breakage syndrome. The percentage of correct answers about warning signs of PID in children was 88.2% among pediatricians and 63.5% among internists. Conclusions. The study has shown insufficient knowledge about PID among postgraduate medical students of different specialties. Identified weaknesses in educating and training of postgraduate medical students about PID will help to enhance the educational programs that may benefit of early diagnosis, patient’s management and improve quality of life of children with PID.

147-154

Authors: Elena BIVOL, Livi GRIB

Introduction. Multiple studies have assessed the role of the stress, as well as of the quality of life, in patients with heart failure. However, specific data about the quality of life in patients with cardiorenal syndrome (CRS) are limited. The objective of the study. To assess the quality of life and the level of psychosocial stress in patients with type 2 cardiorenal syndrome. Materials and methods. We performed a case-control study for the comparative analysis of two groups of heart failure (HF) patients, with mid-range or reduced ejection fraction: 78 cardiorenal syndrome patients and 64 patients with no renal impairment. Results. The quality of life parameters were diminished in most of the patients with HF, being more noticeable in the cardiorenal group, 23.6 vs. 28.62 points (p <0.001). HF patients with renal impairment have a more altered psychological state compared to patients without renal impairment, due to depression, anxiety and reduced vitality related to heart disorders, as well as renal dysfunction (32.67 vs. 36.06 points, p <0.05). The stress level was lower in subjects with CRS compared to those with no CRS – 315.57 vs. 329.97 points (p˂0.05). Factors enhancing stress resistance were more common in the CRS group. Conclusions. CRS influences patients’ status significantly, mostly by diminishing the quality of life.

485-487

Authors: Camelia Diaconu

The international guidelines for the management of type 2 diabetes mellitus have seen many changes over the last decade. They have moved from a strict glycemic control in all patients with diabetes to a more individualized approach of the diabetic patient. These changes are the result of some trials which have demonstrated, for example, that in patients with long-standing type 2 diabetes a strict glycemic control may increase the risk of complications, such as hypoglycemia and cardiovascular events1-3. While glucose lowering prevents the appearance of microvascular complications, its impact is less significant on the cardiovascular and renal complications. The most preferred oral antidiabetic drug is undoubtedly metformin. There are six antidiabetic drug classes currently recommended by the American and European international societies, in addition to metformin: sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide 1 receptor agonists, dipeptidyl peptidase 4 inhibitors, sulfonylureas, thiazolidinediones, and insulin. SGLT2 inhibitors are a promising new class of antidiabetic drugs, that have entered very recently in the diabetes therapeutic armamentarium. These drugs enhance the urinary glucose excretion and decrease hyperglycemia, acting independently from insulin and being effective in all diabetic patients with preserved renal function. They have a favorable efficacy-to adverse event profile in type 2 diabetes patients with moderate-to-high risk. Currently, there are four SGLT2 inhibitors approved by the US Food and Drug Administration (FDA) and the European Medicines Agency: canaglifozin, dapaglifozin, empaglifozin, and ertuglifozin3. These may be used as monotherapy or in combination with other antidiabetic agents.SGLT2 inhibitors have also pleiotropic effects, such as reducing body weight by 2-3 Kg, decreasing the blood pressure (both systolic and diastolic), decreasing plasma triglycerides, increasing HDL cholesterol, attenuating some factors associated with nonalcoholic steatohepatitis and nonalcoholic liver disease, improving the whole-body sodium balance and volume status by stimulating the natriuresis, which leads further to a better endothelial function by reducing the vascular stiffness1. Due to these effects, SGLT2 inhibitors are useful especially in obese patients with arterial hypertension. They may be indicated as single or combination therapy, with other antidiabetic agents, and are contraindicated in patients with kidney failure1 with a GFR < 45 mL/min/1.73 m2. Regarding the glucose control, in a meta-analysis, the HbA1c reduction at 24-weeks was higher in studies that included younger patients, with a shorter duration of diabetes and a higher body mass index, HbA1c and basal glucose4. The cardiovascular benefits of SGLT2 inhibitors have been demonstrated by some major trials, such as EMPA-REG OUTCOME trial (Empaglifozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients)5 and CANVAS (Canaglifozin Cardiovascular Assessment Study)6. EMPA-REG OUTCOME trial has found a reduced incidence of cardiovascular death in diabetic patients treated with Empaglifozin and also a decreased rate of hospitalization for heart failure5. CANVAS Program has showed also a decreased rate of hospitalization for heart failure in patients treated with Canaglifozin6. This is extremely important, especially for patients with type 2 diabetes and already established cardiovascular diseases, as they may benefit most from the treatment with SGLT2 inhibitors. The main side effects of SGLT2 inhibitors consist in the increased risk of genital infections (up to four-fold in clinical trials). Other side effects, more rarely, may be the risk of hypoglycemia, diabetic ketoacidosis, bone fractures (with Canaglifozin). Recently, the US Food and Drug Administration warned about the risk of necrotizing fasciitis of the perineum (Fournier’s gangrene) in patients treated with SGLT2 inhibitors7. This is an extremely rare, but life-threatening infection of the tissues around the perineal muscles, nerves, fat and blood vessels. In conclusion, SGLT2 inhibitors are the newest antidiabetic drugs class, with cardiovascular benefits in a selected population of type 2 diabetes patients. There are ongoing studies with these antidiabetic agents expected to report their data in the near future.

497-505

Authors: Tatiana V. KHMARA1 , Illia I. OKRIM1, Mariana O. RYZNYCHUK1, Igor I. ZAMORSKII1, Oleksandr M. RAK1

Introduction. It is necessary to clearly understand the norms of morphometric parameters of thorax during the fetal period of human ontogenesis, which is one of the main directions to solve the problem of modern normology. Objective. To trace the dynamics of changes of morphometric parameters of the bony thorax in human fetuses aged 7-10 months. Materials and methods. The anatomical study involved 39 human fetuses specimens of 231.0-375.0 mm of crown-rump length (CRL). The study was conducted by means of macro-microscopic preparation, morphometry and variation statistics method. Results. It was found that the length of the costal cartilage increases from rib I to VII and is the longest in the rib VII. The ribs are the highest along the midclavicular line. At the same time, the height of the ribs decreases along the posterior axillary line and becomes the shortest along the scapular line. It was revealed the greatest width of the II and III intercostal spaces along the parasternal and midclavicular lines. The width of the four superior intercostal spaces along the midclavicular line on the right and on the left is larger than the height of the corresponding ribs. The width of the II-X intercostal spaces on the right and on the left along the scapular lines exceeds the height of the corresponding ribs in 1.33-1.65 times. The greatest width of the II, IV and VII intercostal spaces was along the posterior axillary line both sided. The greatest width of the II, IV and X of the intercostal spaces was noted along the scapular lines. Conclusions. The length of the costal cartilage increases from rib I to VII and is the largest in VII ones. The smallest value of the length of the costal cartilage was found in the rib XII. During the 7th-10th months of the intrauterine development, an intensive increase in the length of costal cartilages of the ribs I-III occurs, on average, by 1.5 times, and there is a slow increase in the length of the costal cartilage of the rib VII. The ribs along the midclavicular line are the highest. At the same time, the height of the ribs decreases along the posterior axillary line and along the scapular line it is the lowest.

512-516

Authors: Natalia D. FILIPETS1, Taras I. KMET1 , Tamara I. HRACHOVA1, Tetiana S. BULYK1, Mariana I. KRYVCHANSKA1

The objective of the study was to investigate the changes of the kidney functions in mature rats with rapid acetylation type, under conditions of subacute cadmium-nitrate intoxication and preventive introduction of Echinacea purpurea. Methods. Male rats, 6 months of age, with rapid acetylation type, were divided into 3 groups: І – control; ІІ – rats with of subacute cadmium-nitrate intoxication model; ІІІ – rats receiving intragastric alcohol tincture of fresh rhizomes with roots of Echinacea purpurea (LC “State Municipal Enterprise “Pharmaceutical Plant Vishpha””, Ukraine; 0,25 mk/rg). Results. Under the effect of preventive introduction of Echinacea purpurea in rats with rapid acetylation type and cadmium-nitrate lesion of the kidneys, diuresis and glomerular filtration rate became normal; distal transport of sodium ions increased; hyponatraemia and decreased natriuresis remained without changes; concentrations of creatinine in the blood plasma, potassium ions in the blood plasma and urine, kaliuresis decreased. Similar to the group of rats without Echinacea purpurea, proximal reabsorption of sodium ions, which is standardized by glomerular filtration, decreased. Conclusion. Under conditions of preventive introduction of Echinacea purpurea, volume regulating kidney function is maintained in mature rats with rapid acetylation type and subacute cadmium-nitrate intoxication, but it does not prevent the development of toxic nephropathy, with prevailing lesion of the nephron proximal portion, disorders of ion regulating kidney function and water-electrolytic balance.

523-528

Authors: Liliia STOIKO1 , Khrystyna KURYLO2

Introduction. Throughout the centuries, plants have been used not only as a source of nutrition, but also in the fight against diseases. The most interesting are medicinal plants being well tolerated by patients regardless of age. One of these plants is Centaurium erythraea Rafn. The aim of the study was to develop an optimal technology for obtaining an alcoholic extract with the highest content of biologically active substances: hydroxycinnamic acids, phenolic compounds. Materials and methods. We have performed a study of the concentration of ethanol and multiplicity of dilution with the help of a symmetric rotary composite plan of the second order. Results and discussion. The regression equations were adequate – Fexp. < Ftab. The nature of the influence of the studied factors was determined by the magnitude and signs of the coefficients from regression. To obtain the alcohol extract with the highest content of hydroxycinnamic acids and phenolic compounds, the concentration of ethanol should be 69%, and the ratio of raw material to extractant should be 1 to 5. Conclusions. Further pharmacological studies showed the extract obtained reliability of its application for an increase in gastric acid secretion.

535-543

Authors: Michael I. SHEREMET1 , Viktor O. SHIDLOVSKYI2, Olexandr V. SHIDLOVSKYI2, Vitaliy V. MAKSYMYUK1, Volodimir V. TARABANCHUK1, Nina P. TKACHUK1, Oleksandr V. BILOOKYI1, Hana Ya. STUPNYTSKA3, Galina V. GRYGORUK4, Igor O. MALISHEVSKY5, Lalita M. HERASYM6, Ala A. HALAHDYNA6, Ivanna I. ABRAMCHUK7 , Natalia V. VATAMANYUK7

Introduction. Autoimmune thyroiditis is one of the most important problems of modern endocrinology, with inadequately studied etiological and pathogenic mechanisms of development. It is characterized by the lack of objective and reliable diagnostic methods, effective treatment methods, uncertain therapy or indications for the choice of treatment methods. The aim of the study. Determination of markers for prediction of clinical course and choice of surgery’ volume in patients with nodular goiter and autoimmune thyroiditis, taking into account the oxidative, autoimmune and apoptotic processes. Material and methods. A total of 95 patients who were operated for a nodular endemic goiter on the background of autoimmune thyroiditis were examined. The status of pro- and antioxidant systems, the activity of proinflammatory cytokines, hormonal function of thyroid gland, the level of antibodies to thyroperoxidase, thyroglobulin antibodies and ultrasound structural changes in the thyroid gland have been evaluated in all patients, before and after surgery. Results. In patients with nodular endemic goiter and autoimmune thyroiditis, in the remote period after surgical treatment, there is a significant increase in the peroxide oxidation index and a decrease in the activity of antioxidant defense systems, against the suppression of apoptotic processes and the activation of pro-inflammatory cytokines. These processes lead to functional failure, hyperplasia and the progression of structural thyroid abnormalities, with progression of the functional incapacity of the thyroid gland and inadequate long-term outcome of treatment. Conclusions. The study allowed to clarify the indications and contraindications of different methods of treatment in patients with NGAIT, taking into account the parameters of severity of peroxide oxidation processes, the activity of apoptosis and functional capacity of the gland.

551-556

Authors: Dan ANGHELESCU1 , Elisa POPESCU1, Diana MIHALCEA2, Laura CARSTOCEA3, Florentina GHERGHICEANU3, Adrian CURSARU1,3, Bogdan SERBAN1, Catalin CIRSTOIU1,3

Introduction. A better predictive tool to use for assessing the risk of cardiovascular complications and postoperative mortality in elderly with femoral neck fracture is still not fully developed, and new data in stratifying the cardiovascular risk are still necessary. The objective of the study was to determine the influence of preoperative variables from the cardiovascular preoperative assessment on mortality, and to try to set some standards in the preoperative management of patients with cardiac risk and hip fractures who need surgery. Material and methods. We analyzed age, metabolic equivalents according (METS) to Duke Activity Status Index (DASI), hemoglobin, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and high sensitive C-reactive protein values, echographic measurements such as left ventricular ejection fraction (LVEF), left ventricular diastolic volume (LVDV) and diameter (LVDD), left ventricular wall hipertrophy (LVH) calculated as a mean of the posterior wall and the interventricular septum, the left ventricular contraction velocity S, pulmonary artery pressure (PAPs), the tricuspid anular plane systolic excursion (TAPSE), and time to surgery, for 72 patients aged over 60 y.o, hospitalised in the Orthopaedics Department of the University Emergency Hospital of Bucharest, Romania, between 2015-2016. Results. The deaths after 3 months from surgery were 13 (18%). The best correlation with 3 month mortality was the delay in surgery over 4 days (p<0,0001), with an area under the ROC curve of 0.943 and NT-proBNP values over 731 pg/L (p<0.0001) and an area under the ROC curve of 0.898. Good correlations were found for an echocardiographic value of s < 7.7, with an area under the curve of 0.745 and a TAPSE < 19.5, corresponding to a area under the curve of 0.807. Conclusions. The mortality was relatively high, and in our opinion, the gold standard should be speeding up the cardiovascular investigations and compensation of cardiovascular pathology, to allow surgery as early as possible, for a better survival of patients with femoral neck fractures.

563-567

Authors: Oksana V. BAKUN1 , Svitlana Y. KARATIEIEVA1, Svitlana B. SEMENENKO1, Oksana I. YURKIV1, Ksenia V. SLOBODIAN1

Introduction. The study of anti-ovarian autoantibodies in patients with ovarian insufficiency against the background of normal levels of gonadotropins, prolactin and androgens shows that the incidence of autoimmune oophoritis among such women varies from 19.2% to 31.5%. The objective of the study was to study the anti-ovarian antibodies level in infertile women at the preparatory stage for in vitro fertilization. Materials and methods. We examined 30 women, who were divided into the following groups: control group – 10 reproductively healthy women, who had a birth in the history (from 1 to 3); study group – 20 women with infertility of tube origin, who were included in the in vitro fertilization program. The study was performed between 2015-2017 in the Bukovinian State Medical University and Centre of Reproductive Medicine, Ukraine. The women signed the informed consent. Results. The anti-ovarian antibodies level in infertile women was found out to be 1.7 times less than in the control group. Reduction of the level of anti-ovarian antibodies in patients from the study group was marked by the obstetric and gynecological history. Conclusions. Anti-ovarian antibodies are present in both reproductively healthy women and in patients with infertility. The level of anti-ovarian antibodies can be both increased and reduced, depending on the pathological process that caused infertility. In both cases, this fact can testify the infertility. After plasmapheresis, the increased level of anti-ovarian antibodies sharply decreases.

573-579

Authors: Marius S. POP1 , Petru MIHANCEA2, Daiana DEBUCEAN1

Introduction. In recent years, the incidence of chronic cervical pain, as the result of degenerative processes, increased among younger people. Studies show a close relationship between cervical pain and sedentarism, as well as occupational risk factors. Throughout life, intervertebral discs are prone to a physiological wear-out process; in the degenerative discopathy, the wear is accelerated, even when it comes to young people, due to the increasingly frequent postural alterations. Objectives. To demonstrate a direct link between the postural system receptors disruption and the degenerative disc pathology, as well as the importance of postural rehabilitation strategies and specific manual therapy in the clinical-functional and therapeutic approach of degenerative cervical discopathies with a painful component. Methods. 174 patients divided into two groups undergone specific assessment tests. The study group followed a personalized therapeutic program (manual therapy, postural re-education), while the control group benefited exclusively from the standard therapeutic program, according to the medical prescription. Results. The data confirm the increased incidence of cervical algic syndromes of myofascial origin among the young population and its close relationship to postural syndromes and CCM biomechanical changes identified in the patients included in the study. This study also highlights the importance of a multidisciplinary approach of the patient with myofascial cervical pain. Conclusions. A significant and long lasting improvement in postural balance results in an obvious improvement in cervical algic syndromes and in slowing the evolution of the cervical disc degeneration process.

585-589

Authors: Konstantinos LAIOS1 , Grégoire TSOUCALAS2, Efstathia LAGIOU 1,3, Georges ANDROUTSOS4, Marianna KARAMANOU1,4

The mandrake, not just a narcotic: its place in medicine and ancient greek civilization Hippocrates and his followers, as well as Pedanius Dioscorides, Pseudo-Galen and Aretaeus of Cappadocia are just a few of the many ancient Greek physicians who have used the plant mandrake. Its narcotic properties were not limited to palliate pain during surgery, but they have been also used to treat pulmonary, neurological and mental diseases. Moreover, mandrake was celebrated in ancient Greek mythology, religion and comedy.

594-598

Authors: Alin BODOG1, Nicolae BACALBASA2,3,4 , Irina BALESCU5, Ioan SUCIU6, Mihaela VILCU3,4, Iulian BREZEAN3,4

Vulvar cancer is a rare gynecologic malignancy usually amenable to surgery, especially in cases diagnosed in early stages of the disease. Although initially it had been considered that extended radical surgery should be routinely performed in such cases, the high rates of perioperative complications led to the modification of the therapeutic protocol, more limited surgical procedures being proposed. The extent of the surgical procedure was modified in terms of both vulvar resections and extent of lymph node dissection, sentinel lymph node dissection being widely recommended in the last decade. This is a literature review of the most consistent studies conducted on the theme of sentinel lymph node biopsy for early stage vulvar cancer patients.

603-607

Authors: Elena-Codruța DOBRICĂ1, Mihnea-Alexandru GĂMAN1 , Matei-Alexandru COZMA1, Florentina GHERGHICEANU1, Anca PANTEA STOIAN1, Bogdan SOCEA1,2, Ana Maria A. STĂNESCU1, Ovidiu G. BRATU1,3, Tiberiu P. NEAGU1,4, Camelia C. DIACONU1,5

Introduction. Primary cardiac tumours are very rare neoplasms, usually with a late diagnosis in clinical practice, because of nonspecific symptoms and clinical signs. Case presentation. We report the case of a 28-yearold woman, who presented for right flank and right iliac fossa pain, radiating to the right lower limb. The pain was progressive and had had its onset 3-4 days previously. The patient was known with renal calyceal microlithiasis (with renal colic in the history) and mild iron deficiency anaemia, and had a medical history of recurrent miscarriages. Physical examination revealed: sinus bradycardia (50-54 bpm), low-grade fever, and positive Giordano sign on the right side. The pain was considered as right renal colic and analgesics and antispasmodics were administered. Blood tests revealed normocytic, hypochromic anaemia and a mild inflammatory syndrome. Abdominal ultrasound revealed bilateral renal microlithiasis and also a triangular, hypoechoic area in the right kidney parenchyma, with no colour Doppler ultrasound signals. Echocardiography revealed a left atrial mass with a diameter of 1.5 cm, hyperechoic, heterogeneous, mobile, attached to the interatrial septum. Chest-abdomen-pelvis CT confirmed the presence of the cardiac mass, as well as an area of right renal infarction. Anticoagulant therapy with low molecular weight heparin was initiated. The patient was referred to the cardiovascular surgery department, where the cardiac mass was removed and sent for histological examination, which confirmed the diagnosis of left atrial myxoma. The patient had a favourable evolution. Conclusions: The presence of sinus bradycardia in a young patient, without known cardiac diseases, led to the necessity of an echocardiography, which revealed the left atrial mass. Peripheral embolization with right kidney infarction represented the clinical onset of the cardiac tumour. In this patient, who presented with abdominal and right flank pain, the previous known diagnosis of renal microlithiasis was initially misleading. Cardiac tumours have unspecific symptoms and the first manifestations could be due to the embolization of tumour fragments in the periphery, mimicking, thus, other disorders.

612-615

Authors: Bogdan SOCEA1 , Anca A. NICA1, Alexandru C. SMARANDA1, Ovidiu G. BRATU2, Camelia C. DIACONU3, Vlad D. BĂLEANU1, Dragoș V. DAVIȚOIU1, Mihai DIMITRIU4, Alexandru C. CARÂP1, Simona BOBIC1, Vlad D. CONSTANTIN1

Hereditary spherocytosis (HS) is an inherited abnormality of the red blood cell, caused by defects in structural membrane proteins. The condition is dominantly inherited in 75% of people. The severity of the disorder is related to the type and amount of membrane disruption, which is genetically determined. A patient who suffers from this disorder is commonly found in a surgical ward when the disease becomes unmanageable by a hematologist. Surgeons encounter complications such as: jaundice, splenomegaly, gallstone sand severe anemia. We present the case of a 66-year-old woman with a history of hereditary spherocytosis who presented at the emergency room for pain in the right upper quadrant, jaundice and anemia and was diagnosed with gallbladder stones and common bile duct obstruction.

619-622

Authors: Bogdan SOCEA1 , Alexandru C. SMARANDA1, Anca A. NICA1, Ovidiu G. BRATU2, Camelia C. DIACONU3, Vlad D. BĂLEANU1, Cezar E. MOCULESCU1, Mihai DIMITRIU4, Alexandru C. CARÂP1, Simona BOBIC1, Vlad D. CONSTANTIN1

Sigmoid volvulus happens when the sigmoid wraps around itself and its mesentery. Sigmoid volvulus accounts for 2% to 50% of all colonic obstructions. This pathology generally affects adults, and it is more common in males. The etiology is multifactorial and controversial; the main symptoms are diffuse abdominal pain, distention and constipation, while the pregnant signs are abdominal distention and tenderness. Laboratory findings are not pathognomonic: abdominal X-ray radiographs show a dilated sigmoid colon and multiple intestinal air-fluid levels, abdominal CT and MRI demonstrate a whirled sigmoid mesentery. Flexible endoscopy reveals a spiral sphincter-like twist of the mucosa. The diagnosis of sigmoid volvulus is established by clinical, radiological, endoscopic, and sometimes operative findings. Although flexible endoscopic detorsion is advocated as the primary treatment choice, emergency surgery is required for patients who present with peritonitis, bowel gangrene, or perforation, or for patients whose non-operative treatment is unsuccessful. Although emergency surgery includes various non-definitive or definitive procedures, resection with primary anastomosis is the most commonly recommended procedure. After a successful non-operative detorsion, elective sigmoid resection and anastomosis is recommended. The overall mortality is 10% to 50%, while the overall morbidity is 6% to 24%.