Moldovan Medical Journal

3-8

Authors: Greta Balan, Olga Burduniuc

Background: Biofilms are surface-attached groups of microbial cells that are embedded in an extracellular matrix. One of the main features of biofilms is their resistance to antimicrobial drugs; therefore, the biofilm-based infections are extremely difficult to treat. This study aimed to investigate the biofilmforming capacity of Staphylococcus spp. and Candida spp. strains isolated from collected clinical samples, as well as to assess their antibiotic susceptibility. Material and methods: The study was conducted on 134 strains of Staphylococcus spp. and 147 strains of Candida spp. isolated from various clinical specimens. Both biofilm formation and antibiotic susceptibility of the isolated strains were studied using contemporary standardized microbiological methods. Results: The results of the study showed a high biofilm-forming capacity among the clinical strains of Staphylococcus spp. and Candida spp., as well as a higher level of antibiotic resistance in biofilm-producing strains compared to biofilm non-producing ones. Conclusions: The high rates of antibiotic resistance and biofilm-forming capacity of strains represent a major public health challenge. The study showed a strong correlation between biofilm formation and antimicrobial resistance patterns.

13-18

Authors: Vasile Oprea, Vladimir Valica, Constantin Cheptanaru, Mihai Nistorica, Serghei Oprea, Liviu Movila

Background: Zinc is an important trace mineral in human body, therefore development of new methods for zinc determination in drugs is an actual task. Material and methods: Assay of standard solutions of zinc ions and solutions of ointments to be analyzed was performed automatically using the titrator TITRION, which recorded, then displayed on the screen each amperometric titration curve. The titration curves had a sudden break in the current intensity at the equivalence point, caused by anodic oxidation of the titrant and cathodic reduction of H+ at pH 3 – 4. The stoichiometry of Zn2+ ion sedimentation reaction with [Fe(CN)6 ]4- ions was studied and confirmed in the presence of the background electrolyte and the ZnO calculation formulas in the analyzed ointments were deduced. Results: Two different ointment masses were weighed for the Zoxitin ointment and the separate calculation results were 0.4172±0.0051 g/g and 0.4212±0.0051 g/g of ointment, and in the zinc oxide ointment ω(ZnO) was 10.208±0.078 %.These results were compared with the results of ZnO analysis in ointment by the classical complexometric titration method. For the Zoxitin ointment m(ZnO) was 0.4223±0.007 g/g of ointment, and for the ointment with ZnO ω(ZnO) was 10.18±0.11%. Conclusions: An automatic amperometric titration method was developed to quantify ZnO in ointments. The method is based on the sedimentation reaction of zinc ions with potassium ferrocyanide solution in presence of acetate buffer solution as background electrolyte.

26-28

Authors: Angela Tomacinschii, Oleg Lozan

Background: Preventing and decreasing overweight becomes a priority for public health both, worldwide and the Republic of Moldova is not an exeption. The phenomenon of overweight is not deeply studied in the country so far. The latest data available are reflected in the national research on the prevalence of risk factors for non-communicable diseases in the Republic of Moldova, where it is stated that about 50% of the adult persons (18 years and over) suffer from excess weight. In this context, it was proposed to determine the prevalence of excess weight among adults over 18 years in the Republic of Moldova and to estimate the risk of overweight depending on demographic factors. Material and methods: Descriptive, transvers study (cross-sectional study) based on primary data collection was carried out. 1200 adults over 18 years participated at this study. Statistical analysis of the data involved: frequency analysis, group comparisons, estimation of risk associated with excess weight OR (odds ratio) according to the geographical area, residence area, age group and gender. Data interpretation was performed on the basis of statistical significance (p <0.05) at the 95% confidence interval. According to the WHO, excess weight (overweight) is considered when BMI values are equal to or greater than 25.0 kg / m2. Results: The results of the research reveal significant differences of excess weight depending on the age, sex and geographical areas. The highest prevalence of excess weight was observed among persons over 40 years (74.7%), women (57.9%), residents of the Center area (62.2%) and of the rural area 62.4%. Conclusions: The prevalence of excess weight in the Republic of Moldova constitutes 57.6% among the adult population, with the predominance among persons over 40 years of age, women and inhabitants of the Center area and the rural area.

33-38

Authors: Svetlana Lozovanu, Ion Moldovanu, Victor Vovc, Tudor Besleaga, Andrei Ganenco

Background: Reduced HRV is associated with a variety of conditions such as diabetic neuropathy, sepsis, myocardial infarction, but lately it has gained increased interest in psychiatry due to the connection between autonomic dysfunction and psychiatric pathologies. Borderline personality disorder (BPD) with an increased rate of cardiovascular mortality, and characterized by emotional instability, is ideal for studying heart rate variability. Material and methods: 203 subjects were initially evaluated with Personality Inventory for DSM-5, PID-5, (DSM-5 – Diagnostic and Statistical Manual of Mental Disorders, 5th edition), and 2 groups have been selected: control group that included 69 subjects and borderline personality disorder (BPD) group that included 34 subjects. Heart rate variability (HRV) was analyzed from an electrocardiography signal, recorded in 3 conditions: resting, pain stimulation, period following the pain stimulation. Results: In post-pain period, in subjects with BPD, the HRV parameters indicate an increase of sympathetic influences on heart rate and a reduction of vagal modulatory effects. The values in these subjects did not return to the initial values in the post-pain period as they did in the control group, but, on the contrary, the accentuation in the dynamics of the sympathetic influence was registered, even compared to the pain period. Conclusions: Subjects with BPD presented an increased vagal modulation at rest, which was reduced during pain stimulation and did not return rapidly to the initial value after removing the painful stimulus, which can be proof of the inertia of autonomic influences in these subjects.

44-51

Authors: Oleg Calenici

Background: The presence of aortic narrowing is common in the elderly and the prognosis is very poor in symptomatic patients. Prior to the era of percutaneous treatment of aortic stenosis, surgical aortic valve replacement (SAVR) was considered the “gold standard” of symptomatic aortic stenosis treatment. However, the records have shown that about 40% of patients at that time were not operated due to their age and their cardiac and non-cardiac comorbidities. The subsequent work was the implantation of aortic valve by transfemoral approach – transcatheter aortic valve implantation (TAVI). Several studies have acknowledged the place of aortic valvuloplasty which has become the reference technique for patients with contraindications or high surgical risk and even recently appeared as at least equivalent to, or even superior to, the surgery in patients at intermediate risk. This development was accompanied by a renewed interest in aortic valvuloplasty, a TAVI that cannot reasonably be executed at first attempt in some patients. In Europe, where this technique was born, the great experience that has been gained has led to a gradual simplification of the procedure. The purpose of this article is to describe the state of the art of TAVI and to discuss its future. Conclusions: The aortic stenosis disease affects a large scale of people across the globe. The appearance of a new treatment method TAVI opens new era of treatment of this disease. The new TAVI method is a less invasive procedure than an open heart surgery and can be used in almost all the cases of patients with an aortic stenosis.

59-63

Authors: Nicoleta Cheptanari-Birta

Background: Healthcare professionals are not fully aware of the harm caused by medication errors in terms of patient discomfort and economic burden. The problem being presented, we propose the analysis of the specificity of the pharmaceutical activity and the research of the errors committed by the pharmacists for the elaboration of the recommendations for their prevention. Material and methods: This research is a meta-analysis in which it quantitatively combined the results from previous studies to obtain a summary value. The research was carried out in 4 stages: identification, selection, extraction and data analysis. Results: Studying the specialized literature we identified great gaps in the knowledge of the actual data about the frequency of medication errors and their classification. Quality research is needed to determine the effectiveness of the following interventions: implementation of efficient and qualitative tools that will contribute to reducing medication errors; educational interventions regarding risk factor management; developing an anonymous system for reporting medication errors; review of the schedule, workload and conditions under which pharmacists work. Conclusions: Medication errors require clear and unambiguous definitions where patients, doctors, manufacturers, and regulators will understand each other. The pharmacists’ ethics manifests itself in honest acknowledgment of their mistakes, because in this profession, as in no other profession, the slightest inaccuracy will lead to serious consequences and can be fatal for the patient.

3-8

Authors: Iuliana Feghiu, Sergiu Cobiletchi, Galina Frunza, Sergiu Sandru, Anatol Scripnic

Background: Induction of general anesthesia with midazolam or thiopental is often associated with cardiovascular changes. Material and methods: The study group involved 94 patients. The analysis of heart rate variability and the changes in cardiac vegetative tonus was performed after premedication with fentanyl solution and after induction of general anesthesia with midazolam combined with fentanyl (midazolam group) or thiopental combined with fentanyl (thiopental group). Results: After administration of fentanyl in doses of 1.0 mkg/kg for premedication there were no significant changes of heart rate variability and vegetative heart tonus in both groups. Administration of midazolam 0.2-0.3 mg/kg combined with fentanyl 1.0 mkg/kg for induction of general anesthesia leads to a significant reduction of heart rate variability. The LFun (marker of sympathetic heart tonus) reduced by 24.2% (69.1 (95%CI 65.9-72.3) vs 52.4 (95%CI 42.9-70.0) (p=0,02), meantime the HFun (marker of parasympathetic cardiac tonus) enhanced by 34,9% (30,9 (95%CI 27.6-34.1) vs 47.5(95% CI 30.4- 57.4) (p=0.01). Administration of thiopental 6.0-7.0 mg/kg combined with fentanyl 1.0 mkg/kg for induction of general anesthesia leads to a significant reduction of heart rate variability. Conclusions: Administration of fentanyl solution in doses 1.0 mkg/kg for premedication is not associated with significant changes of vegetative tonus of the heart. Administration of midazolam in combination with fentanyl for induction of general anesthesia leads to significant decrease of heart rate variability and enhanced parasympathetic cardiac tonus. Induction of general anesthesia with thiopental and fentanyl leads to enhanced sympathetic tonus of the heart and reduced parasympathetic tonus of the heart.

14-20

Authors: Evelina Lesnic, Tatiana Osipov, Alina Malic

Background: It is known that the main barriers in the anti-tuberculosis treatment delivery are social, economic, educational and psychological issues. According to the estimations the Republic of Moldova (RM) remains a high risk zone showing an inadequate concern regarding social determinants that represent the risk factors for achieving high treatment outcome. Tuberculosis is concentrated in areas with high density of the population, poor environmental and sanitation conditions: poverty, food insecurity, low living conditions. Material and methods: A retrospective selective, descriptive study of socioeconomic, epidemiological peculiarities, case-management, diagnosis and microbiological characteristics of 693 patients with tuberculosis registered in Chisinau in 2016 was performed. Results: Despite the fact that criteria for selection of patients for video-assisted anti-tuberculosis treatment (VOT) were defined, a range of risk factors can endanger treatment performing, such as: deep social economic vulnerability, comorbidities associated or not with psychic impairment, disease related characteristics, such as extensiveness, severity, duration of the tuberculosis evolution, positive microbiological state and multi-drug resistance are conditions which can exclude the ambulatory treatment and VOT. The low treatment outcome shows the limited potential of VOT to improve the epidemiological indices due to the complexity of patient’s risk factors. Conclusions: VOT can be implemented in the management of tuberculosis patients in the actual epidemiological state of the RM, if a complex of patients supporting measures are performed.

29-35

Authors: Valentina Nicolaiciuc, Shiran Yed

Background: Deep carious lesions cause pulpal inflammation, if not managed, they may result in pulp necrosis and involvement of the periradicular tissues, with possible pain requiring, endodontic treatment or extraction. Material and methods: This study included 35 patients with deep dental caries, 14 males and 21 females with the age range 25-37. The patients are divided into 2 groups. First group – with deep caries treated by capping material “Trioxident” based on mineral trioxide aggregate (MTA), and second group – with deep caries treated using calcium hydroxide. Results: In our work for the treatment of deep caries, we used the preparations: “Trioxident” based on MTA and “Ultra Blend Plus” based on calcium hydroxide. Applications by material “Ultra Blend Plus” for 3-6 weeks on dentin surface show good results because sterile environment, significant alkaline reaction and calcification of the dentinal tubules. In this regard, it should be noted that the material “Trioxident” does not have porosity in the formed “dentin bridge” and is free from this disadvantage. The use of medical pads with MTA and calcium hydroxide with direct and indirect pulp capping methods did not reveal negative results (complicated caries). Conclusions: Theoretical data is important for setting correct diagnosis and most suitable protocol of treatment. The described in the article materials – “Trioxident” and “Ultra Blend Plus” provide anti-inflammatory, analgesic and plastic effect. They stimulate the formation of a new secondary dentin layer. The first material – “Trioxident” (based on MTA), in our opinion, is more preferable because it has a number of useful advantages.

39-44

Authors: Oleg Arnaut

Background: Trauma remains an unresolved medical problem and its severity often requires the transfer of patients to specialized trauma institutions (centers). The elaboration of the predictive models represents an effective tool for improving the prognosis of the transported patients by optimizing the management of the trauma and/or improving the national interhospital transfer system. The survival probability predictive models in severe trauma were proposed in this pilot research. Material and methods: Data were collected from 39 patients with severe trauma (NISS > 15) transported to the Emergency Medicine Institute (EMI), Chisinau, the Republic of Moldova, from district hospitals. These data were statistically processed using multivariate logistic regression where NISS, MPMoIII, age and biological gender were considered as covariates. Results: There were developed three predictive models: based on the estimation of anatomical lesions (NISS), based on physiologic parameters estimation and conditions during/immediately after hospital admission (MPMoIII) and their combination (NISS + MPMoIII). The last of these showed significance only after the resampling, the characteristics of the model being superior (the coefficient of determination over 0.8, the sensitivity and the specificity over 80%) compared to the first two taken separately. Age and biological gender were insignificant and were not included in the equations. Conclusions: Developed models are perspective (especially a combined one) in predicting survival rate of severe trauma patients transported to EMI from district hospitals. At the same time, taking into account the particularities and limitations related to the pilot study, the models can be recommended for use in clinical practice after validation procedure only.

49-55

Authors: Tatiana Malcova, Tatiana Balutel, Anatol Ciubotaru, Viorel Nacu

Background: Heart valve disease is a clinically serious condition. The replacement of damaged valves practiced since the 1950’s is the ultimate treatment for end-stage heart failure caused by severe valve dysfunction. The choice of adequate prosthesis is challenging. Unfortunately, the treatment options available today do not satisfy completely physicians and scientists’ needs. Mechanical valves require long-term anticoagulation therapy because of poor hemocompatibility. Biological substitutes have better hemodynamics, but need replacement in ~ 10 years due to calcification and degeneration. In order to overcome the shortcomings of current treatment options many researches are motivated to fabricate a functional, living heart valve replacement by tissue engineering. Conclusions: Tissue engineering is a promising approach that may lead novel constructs that will satisfy the need and overcome the limitations of current valve prosthetics. Scaffolds, fabricated from synthetic or biological materials, do not require donor tissue, but have struggled to recreate the macro- and micro valve anatomy and mechanical properties of native valve. Decellularized cardiovascular grafts have the opportunity to improve patients care by reducing the risk of sensitization to donor antigens, calcify and stenosis and providing with a good graft that will grow (especially important in children). In this way the emotional and financial drain on the patient and family of enduring multiple surgeries may be significantly minimized. The choice of decellularization method can be rational if mechanism of action is contemplated and clearly understood.

61-69

Authors: Petru Butucel, Viorel Nacu, Vitalie Lisnic

Background: Nowadays, the cerebrovascular event is the second cause of death and the third cause of disability worldwide. In the last few decades, stem cell-based approaches are widely analyzed as a potential treatment for this disease. One of these types of cells are bone marrow-derived mononuclear cells (BMMNCs). In this review, we analyzed 9 completed clinical trials with the use of BMMNCs in patients with ischemic stroke, which we found in the clinicaltrials. gov and PubMed databases, using the keywords “stroke“ and “bone marrow mononuclear cells”. Our goal was to analyze the safety and efficiency of this therapeutic approach, as well as the optimal therapeutic time window, transplantation route and cell dose used. The best stroke phase to apply this therapy is the subacute stage. Higher numbers of CD34+ cells, derived from BMMNCs were correlated with a trend toward a better outcome. All the clinical trials support the idea that BMMNCs transplantation is a safe therapy. Conclusions: In conclusion the author points out that the autologous transplantation of BMMNCs is harmless and not associated with severe complications. Although some clinical studies stated a better outcome in patients treated with BMMNCs, further clinical trials are needed to establish their therapeutic efficiency.

3-6

Authors: Dan Croitoru, Zinovia Zorina, Galina Certan, Mihaela Galescu, Eugen Cerevan

Background: Arteries have a very variable origin, diameter, path, correlation, branching and terminal pattern. An honorable mention is necessary for the individual anatomical variations of the axillary artery branches, because this is a spot of frequent vascular lesions that are the result of blunt weapon traumas, proximal humerus traumas and glenohumeral dislocations. Material and methods: The morphologic variability of the posterior circumflex humeral artery was studied on a male adult cadaver, on 10 angiographies and 9 ultrasonographies of the upper limb arteries which also constituted the study poll. The origin variations were identified in 3 cases. Results: In correlation with gender, and the body part that is taken into consideration, the posterior circumflex humeral artery morphological variations are found more often in the male gender, predominantly on the right upper limb. Conclusion: The posterior circumflex humeral artery has a wide range of anatomical variations. More frequently the anatomical variations are found on the right upper limbs of male gender. The obtained data will become useful in the approaches of the axillary artery during arteriographies and also in choosing the right surgical intervention tactic on this topographical region.

13-17

Authors: Greta Balan

Background: Infections that are difficult to treat might lead to high morbidity and mortality rates. In some infections, however, despite a proper antibiotic therapy, microorganisms might persist, under certain circumstances, and produce recurrent or chronic infections. It is a well-known fact that the persistence of microorganisms might influence their viability within the macro-organism, whereas the suppression of the microbial persistence via drug preparations might greatly reduce therapeutic duration. This study is aimed at assessing the antibiotic sensitivity and some factors, contributing to persistence of Gram-negative bacilli strains isolated from trophic ulcers. Material and methods: Data were collected and examined from 128 samples of patients with trophic ulcers. The bacteriological examinations, factors determining the persistence and the antibiotic susceptibility of the isolated strains were carried out in accordance with the current method. Results: 211 microbial strains were isolated. The identified microorganisms revealed a high taxonomic diversity, whereas Gram-negative bacilli made up 50.2%. Isolates showed multiple resistances to antimicrobial drugs in 76.4% of cases, 43.4% strains showed hemolytic, 88.7% – anti-lysozyme and 93.4% – anti-complementary activities, whereas 70.8% strains produced a detectable biofilm. The strains isolated from mixed infections exhibited a higher percentage of pathogenicity factors compared to those isolated from monoinfections. Conclusions: Gram-negative bacteria showed great resistance to the antimicrobial drug tests and multiple persistence factors. The results of the study proved that trophic ulcers are difficult to treat, thus being a major problem, which requires coherent monitoring and control.

24-27

Authors: Oleg Cobileanschi, Tatiana Prospit, Ion Cazacu, Alexandru Dandara, Dorel Jelaga

Background: The brain controls how the body moves by sending small electrical signals along the nerves to the muscles. Seizures occur when abnormal signs in the brain change the way the body works. Seizures vary from person to person. Some people only have light handshakes and do not lose consciousness. Other people may become unconscious and experience violent whole body trembling. The article focuses on the cases of the seizure, order and behavior during and after the epileptic crisis, the child’s febrile convulsions and recommendations. Conclusions: Our knowledge about the causes of epileptic seizures increases the chance of preventing them. Correct actions in the crisis, follow-up of the crisis particularity minimize the risk of traumatization and ensures correct therapy of the pathology that causes the crisis. Correct treatment and cognition of contraindications reduce syncope repetition. Correct informing people about the crises particularities allows understanding the seriousness of the consequences of a crisis.

38-43

Authors: Elinor Paz, Angela Babuci, Elena Stepco

Background: The bone loss, tooth loss and gingival inflammation are the most common harmful factors that might cause pathologic tooth migration. Taking into consideration that miniscrews implants are used in orthodontic treatment of both pathologic and physiologic tooth migration, we were interested to mark out the advantages and disadvantages of miniscrew usage. Conclusions: Development of implants industry and particularly miniscrew anchorage has been rapidly increased in the recent years, but nevertheless there still are some risk factors of miniscrews use and success of treatment depends a lot on techniques of miniscrew insertion and stability elements. The anchorage control during tooth movement is one of the main factors for ensuring successful orthodontic treatment and the most important keys for achievement of success in clinical orthodontics. The advantages of miniscrews, in comparison with other methods of orthodontic treatment might be resumed to: lower costs, easy placement, no need for patient cooperation, high quality and efficiency of treatment. Among the most undesirable side effects of miniscrews use can be marked out the screw fracture, screw-root proximity, damages of soft and hard tissues, displacement under orthodontic loading, etc.

48-51

Authors: Lior Shoev, Eugeniu Simionica

Background: Janus kinase-signal transducer and activator of transcription (JAK-STAT) is a family of intracellular, nonreceptor tyrosine kinases that transduce cytokine-mediated signals. In the beginning of 20th century, it was named “just another kinase” but by some reasons ultimately it was published as “Janus kinase”. The name Janus was taken from the two-faced Roman god of beginnings, endings and duality, because the Janus kinases (JAKs) possess two near-identical phosphate-transferring domains, one domain exhibits the kinase activity, while the other negatively regulates the kinase activity of the first one. The article describes JAK-STAT in many aspects such as general definition, mechanism of action, biochemical qualities and the relation to cancer. Eventually the article will explain the role of JAK-STAT pathway in carcinogenesis and summarize the article through future direction in clinical medicine and research. Conclusions: Understanding JAK-STAT pathway can help physicians, medical students and teachers apply this into clinical practice. By discovering more about the JAK-STAT pathway, many cancer diseases could be halted or treated due to their connection to cancer therapy.

59-66

Authors: Ilarion Draguta, Anatolie Mustea, Constantin Popescu, Cornel Iurcu, Ghenadie Gorincioi

Background: The latest studies highlight the importance of a holistic bioelectric field in the development of tumor diseases. According to some researchers, carcinogens prevent formation of a single morphogenetic field and lead to the creation of separate bioelectric fields. It has been experimentally proved that the development of a tumor in a certain part of the body depends on the bioelectric state of the distant regions. Water is one of the important links between the morphogenetic field and molecular substrates. Due to the presence of hydrogen bonds in the aqueous media, specific structures can be formed that can receive, store and transmit information. Intracellular structured water can serve as a “transformer” of various types of energy for use in the life processes of cellular structures. It was found that normal biological tissues could be distinguished from hyperplastic and malignant ones by means of magnetic resonance image scan based on recording diverse reactions of water protons. Conclusions: the importance of a holistic bioelectric field in the development of tumor diseases is probably paramount. The development of a tumor in a certain part of the body depends on the bioelectric state of the distant regions. It is possible that carcinogens prevent formation of a single morphogenetic field and lead to the creation of separate bioelectric fields. A more in-depth study of the bioelectric and water constituents in patients with oncopathology will probably open up new facets of oncogenesis.

3-6

Authors: Svetlana Lozovanu, Ion Moldovanu, Victor Vovc, Andrei Ganenco, Andrei Blajevschi, Tudor Besleaga

Background: The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has included major and radical changes in the personality disorder (PD) diagnosis method, from categorical to dimensional one. It includes Alternative Model for Personality Disorders (AMPD). This model explains that personality disorders are characterized by impairment in personality functioning and presence of pathological personality traits. The current study consists in the validation and cultural adaptation of the Russian version of the Personality Inventory for DSM-5 (PID-5), respecting the stages of intercultural adaptation specific to the medical, sociological and psychological fields. Material and methods: The PID-5 questionnaire translated into Russian was used by 30 Russian-speaking subjects living in the Republic of Moldova that use English in the specialized activity. After a 30 minute break, all of these subjects were asked to fill out the original questionnaire in English. Results: After comparing the answers to the 220 items, we obtained the following results: 26 persons, representing 86.7% of the total number of participants, responded identically to all 220 items, one person (3.3%) admitted only one difference in test responses, 3 persons (10.0%) admitted a different response in 3-4 items. Conclusions: The result of the presented work is the Russian-language version of the PID-5 questionnaire, which proposes a methodical evaluation of the Russian speaking people with a mental health problem, the residents of the Republic of Moldova.

11-15

Authors: Tatiana Lozan

Background: The aim of this study was to estimate overall prevalence of primary headaches and prevalence of migraine (MG) and tension-type headache (TTH) among adolescents in the Republic of Moldova. Metetial and methods: In total there were 3389 adolescents whose age ranged from 10 to 19 years, recruited from urban and rural areas of the country. This school-based study was conducted during the academic year 2015-2016. The information was collected with the use of self-administered questionnaire based on the criteria of International Classification of Headache Disorders: ICHD-2 (2004) and ICHD-3 (2013). Primary headaches were classified, according to the type of headache and after the frequency of headache attacks within the month. Results: The overall prevalence of primary headaches in Moldovan adolescents is 38.75% (girls – 49.7%, boys – 27.8%), and it is higher in urban area (48.23%) than in rural (30.05%). The prevalence of MG is 19.7%. The prevalence of MG is higher in girls (27.5%) than in boys (12.1%). The prevalence of migraine is higher in urban adolescents (27.1%) compared to rural ones (13.0%). The prevalence of TTH is 7.9%. The prevalence of TTH is almost equal in both sexes (8.0% in girls and 7.7% in boys). The prevalence of TTH in urban adolescents is 10.2% and it is more than 1.7 times higher compared to the recorded level in rural areas – 5.8%. Conclusions: The present study is the first Moldovan survey on epidemiology of headaches in adolescents. It is very important to continue developing different aspects of epidemiology of adolescents’ headaches in the Republic of Moldova.

20-25

Authors: Iuliana Feghiu, Sergiu Cobiletchi, Sergiu Sandru

Background: Administration of propofol and fentanyl for induction of general anesthesia is often associated with cardiovascular instability. This effect can be caused by changes in the cardiac autonomic tonus induced by the drugs. In the literature there is no consensus regarding the effect of propofol and fentanyl on sympathetic or parasympathetic balance of the heart. Material and methods: There was performed a randomized prospective study which was approved by the Ethic Committee. Written informed consent was signed by all patients. The study group involved 47 patients scheduled for surgical intervention, anesthetic risk ASA I-II. The analysis of heart rate variability and the changes in cardiac autonomic tonus was performed with Holter ECG at rest, after premedication with fentanyl solution and after induction of general anesthesia with propofol and fentanyl. Results: After administration of fentanyl in doses of 1.0 mkg/kg for premedication there were not significant changes of heart rate variability and autonomic heart tonus. Administration of propofol 2.5 mg/kg combined with fentanyl 1.0 mkg/kg for induction of general anesthesia leads to significant changes in heart rate variability. There was a considerable reduction of heart rate variability. The LFun (marker of sympathetic heart tonus) has enhanced by 6.8% compared with previous stage (67.1 (95% CI 63.1-71.1) vs 72.0 (95% CI 67.9-76.1) (p=0.004). The HFun (marker of parasympathetic cardiac tonus) has reduced by 19.8% (32.9 (95% CI 28.9-36.8) vs 26.4 (95% CI 20.4-34.3) (p=0.007). After administration of propofol and fentanyl for induction of general anesthesia the LFun/HFun ratio has enhanced by 30.8% (2.7 (95%CI 2.1-3.4) vs 3.9 (95%CI9 2.9-4.8) (p=0.003), signaling an enhanced sympathetic heart tonus. Conclusions: Administration of fentanyl solution in doses 1.0 mkg/kg for premedication is not associated with significant changes of autonomic tonus of the heart. Administration of propofol 2.5 mg/kg in combination with fentanyl 1.0 mkg/kg for induction of general anesthesia leads to significant enhanced sympathetic cardiac tonus.

29-32

Authors: Oleg Popadyuk, Roman Kutsyk, Maryana Voloshyn

Background: Experimental and clinical studies show that wound healing cannot be evaluated as optimally effective today. For the treatment of wounds today, various methods and means are used. Wound dressing was developed from both natural and synthetic materials. However, polymeric biodegradable materials, saturated with various active drugs, which are effective, easy to use, have insignificant disadvantages and need further study. The aim was to study the effectiveness of the use of biodegradable polymeric film “biodén nano” in the treatment of suppurable postoperative wounds of the skin in the experiment. Material and methods: The research was carried out on 45 guinea-pigs of the species “Murchaky” in the clinical and biological base (Vivarium) of the Ivano-Frankivsk National Medical University, in accordance with the requirements for the maintenance and handling of laboratory animals. The pelvic wounds were simulated after staphylococcus aureus 2.0*108 KU/ml infection. Results: The change in the wound area of the group IV and group V decreased slightly up to the third day, and after 7 days the area of the wound surface was reduced by 7% and 13.6% respectively. During the observation period, 14 days, the wound area in relation to the initial area was 35.5% in group IV and 43% in group V. Conclusions: The biodegradable polymeric film “biodep nano” demonstrated high antimicrobial and wound healing properties in an experimentally simulated peptic cutaneous wound of the skin.

38-43

Authors: Maria Iacubitchii, Eugeniu Bendelic, Suleiman Alsaleim

Background: Being analogous to a blood surrogate, the aqueous humor has an important role in the regulation of the homeostasis of the ocular tissues. It has many functions: provides nutrition, removes excretory products, transports neurotransmitters, stabilizes the ocular structures, influences the intraocular pressure, and participates in the immune response against invading pathogens and inflammation. Aqueous humor’s unique composition (electrolytes, proteins, biologically active substances, and organic solutes) is required to maintain adequate functionality of the ocular system. Its secretion is a complex biochemical reaction that gives specific properties and makes the difference from other human fluids. Different factors (traumatic, physical, chemical, pharmacological) and eye pathologies influence its composition, modifying its physiological properties, and cause pathological conditions in the anterior segment. In the last decade, it was made massive progress in the characterization of the composition of aqueous humor in different pathologies (glaucoma, myopia, keratoconus, age-related macular degeneration, branch retinal vein occlusion, etc.). It determined the biomarkers for eye’s pathologies and identified the progression of the disease. Conclusions: The detailed knowledge of biochemical and physiological properties of aqueous humor is necessary in understanding the pathophysiology of eye’s diseases. The significant variations in the differentially abundant changes in human aqueous humor may be relevant for future diseases treatment in order to get favorable outcomes in patients. Specific markers for pathologies represent nowadays an important field of research. These markers are necessary for early diagnosis and selecting the proper treatment for each individual case by stopping the clinical disease progression.

51-55

Authors: Gheorghe Guzun, Radu Turchin

Background: The complete diagnosis of pathomorphological disorders in case of diseases of the spine determines the choice of effective treatment, pathogenetically argued in various diseases which, according to modern classifications, do not have a direct link with it. Continuous improvement of diagnostic and treatment methods in some pathologies, both surgical and therapeutical requires a more detailed study of clinical anatomy and spinal biomechanics. Thus, perhaps even revising concepts are well-rooted in the consciousness of scientists and modern practitioners. As we will try to analyze the anatomical-clinical component of the appearance and recovery of antero-lateral abdominal wall hernias, we will limit ourselves to some analysis and discussion of one of the predisposing factors, namely the lack of resistance or insufficient resistance of the abdominal muscles. This is closely related to the condition of the constituent elements of the abdominal wall, and in particular depends on the innervation and vascularization of the musculoaponeurotic layers, which determine the strength and muscle tone. Conclusions: One of the causes of inguinal hernias is the decrease in the tone of the abdominal muscles. It depends on several factors: the elasticity of the muscular tissue, state of neuro-muscular transmission, the state of peripheral nerve fibers and motor neurons in the spinal cord, superior motion control centers. Thus, the causes of muscle tone decrease can be both muscular in origin and generated by pathology of the nervous system at different levels. Because the causes are multiple, the treatment is different at certain stages of hernia development. In this way, our treatment – qualitative nutrition, vitamins, special exercises, spinal region work, paravertebral muscles massage fit perfectly into hernia etiology and pathogenesis. This treatment is physiologically accessible and can be performed and supervised by physicians with non-surgical specialties in stationary or outpatient settings, after prior consultation with the surgeon.

3-8

Authors: Evelina Lesnic

Background: Cytokines are the regulators of the immune response in tuberculosis: TNF-alpha and CXCL8 (IL-8) are involved in the granuloma formation, IL-10 inhibits the inflammation; some chemokines increase the liver production of the acute phase proteins (APPs). The aim of the research was to assess the serum level of IL-8, TNF-alpha, IL-10, C-reactive protein (CRP), ceruloplasmin and fibrinogen in patients with drug-sensitive and multidrug resistant tuberculosis (MDR-TB). Material and methods: A prospective case-control study, which included 51 patients, distributed in 2 groups: the 1st study group (N=24 new cases with drug-sensitive TB) and the 2nd study group (N=27 new cases with MDR-TB) according to sex and age were compared with the control group (N=36 healthy individuals). Results: Serum concentration of IL-8 was elevated up to 13 times, TNF-alpha up to 4 times and IL-10 up to 2 times in study groups, compared with the reference value of the control group. Fibrinogen concentration was elevated up to 2 times in study groups compared with the control group and CRP up to 3 times compared with conventional value. Ceruloplasmin was statistically higher in the drug-sensitive TB and mildly elevated in MDR-TB group. Conclusions: Proinflammatory biomarkers are more elevated than the anti-inflammatory response, without differences among groups regarding drug sensitiveness.

13-16

Authors: Mariana Jian, Vitalie Cobzac, Victoria Vartic, Viorel Nacu

Background: Currently hepatocytes obtaining is prerequisite to create the necessary conditions for medical research, because it is an important tool in developing of new strategies in tissue engineering domain, which represents obtaining functional organs in laboratory conditions. Material and methods: The study was made on adult Wistar rats liver with body weight 274.66± 2.52 g (n=3) which were used for hepatocytes extraction by perfusion through the upper cave vein with combination of type II collagenase and type I dispase and Hank’s 0.9 mM MgCl2, 0.5 mM EDTA and 25 mM HEPES (HiMedia, India). Results: The cells were counted with trypan blue 0.25% in hemocytometer and cultured in William’s E medium (HiMedia, India) with 2 mM L-glutamine, 5% fetal bovine serum (Lonza, Belgium), antibiotic antimycotic solution (HiMedia, India), 100 nM dexamethasone and 100 nM insulin, with 2.5 x 105 cells per well in 12-well plates. After isolation were obtained 324, 48 ± 1, 25 x 106 hepatocytes, with a viability of 94.7 ± 0.9 % which indicates a high yield of cells viability. Conclusions: The hepatocyte isolation method by liver perfusion with the combination of collagenase-dispase is feasible for obtaining a large amount of functional hepatocytes intended for the recellularization in vitro of decellularized liver scaffolds. The yield and viability of hepatic cells could be increased by enzymatic digestion of liver tissue using combination of collagenase/dispase solution due to the less cytotoxic effect.

24-27

Authors: Ecaterina Carpenco

Background: Cancer research was focused on the studying of proper tumor cells for a long time. Despite the huge progress, there are still a lot of questions, that’s why new molecular markers must be identified. These could reveal new information about tumorigenesis. Material and methods: 15 cases of ductal invasive breast carcinomas have been analyzed and researched on tumor associated macrophages via immunohistochemistry. CD68 was used as a macrophage marker and CD68+ cells were evaluated in tumor nest and peritumoral area, as well as hormone receptors (ER, PR) and HER2 protein. Results: Most of tumors (10 cases out of 15/ 66.7%) were moderately differentiated (G2). The mean and std. error of mean of intratumoral CD68+ cells were 2.0±0.2, of peritumoral CD68+ cells – 1.4±0.2. Intratumoral CD68+ cells registered higher scores than those located in the peritumoral area. Conclusions: CD68+ cells are more likely to be present in the tumor nest rather than in the peritumoral area. This research did not establish any significant correlations between intratumoral and peritumoral CD68+ cells and patients’ age, tumor grade, expression of ER and PR. The content of peritumoral CD68+ cells inversely correlated with the number of HER2+ carcinoma cells.

31-34

Authors: Eugenia Bogonovschi, Ion Bologan

Background: Failure to provide antenatal information for pregnant women as well as to complete the perinatal medical records at each visit may have negative effects on the child development. Material and methods: A retrospective documentary review study was carried out, which included 100 women of fertile age. The questionnaire included 80 questions within the following rubrics: personal information about the patient, obstetrical-gynecological medical history, and perinatal medical card. Results: The patients were divided into the following age groups – 2 patients (2.0%). The recommended weight gain range is ≤12 kg, whereas 59 patients (59%) reported the highest weight gain ≥ 20 kg and others showed a mean range of 12-20 kg. The assessment of parity’s effects on fetal weight proved that multiparous women give birth to heavyweight newborns. Women in their second pregnancies make up 62%. Vaginal and cesarean births were registered in 88% and 12% of cases, respectively. Spontaneous abortions were reported in 20%, abortions on demand – 21%, and premature births in 5% of cases. The perinatal medical records were fully completed in 49.0% and partially – in 51.0% of cases. Conclusions: The amount of perinatal medical card fulfillment has reached the lowest level, including the ”gravidogram” that refers to the fetal growth charts.

41-45

Authors: Angela Babuci

Background: Interest in anatomical variability and individual specific features of the extracranial branches of the facial nerve, taking into consideration that nowadays, people are so concerned about their physical look, the knowledge of facial nerve peripheral branching is of high clinical significance. Even, if it is hardly difficult do discover something new, or unusual at the macromicroscopic level, we believe that reading this paper oncologists and oromaxillofacial surgeons will be surprised by anatomical variations of the peripheral braches of the facial nerve. Material and methods: Our research project was carried out on 52 cadaveric semiheads that previously were fixed in 10% formalin solution: 36 male and 16 female; 25 of those samples were right and 27 left side semiheads. The bilateral pattern of dissection was carried out on 30 semiheads and unilateral dissection – on 22 semiheads. The dissected samples were photographed. Some samples were marked out with black papers for better contrast. Results: The facial trunk on its exit from the sylomastoid foramen was descendent in 32 cases (61.54%), in 9 cases (17.3%) it ran horizontally and in 5 cases (9.62%) it had an ascending course, but in 6 cases (11.54%) the branches derived directly from the trunk in a fan-like fashion. According to the known classification of the facial nerve peripheral branching, the following percentage for each type was established: Type I (23.1%); Type II (7.7%); Type III (1.9%); Type IV (38.5%); Type V (7.7%); Type VI (9.7%). Few intermediate types have been marked out such as: Type II-III (3.8%); Type III-IV (3.8%), Type V-VI (3.8%). When dissecting the facial nerve we observed that the trunk in 37 cases divided into two primary braches and in 15 cases there were marked out diffuse types of branching. Conclusions: A significant characteristics of the facial nerve is its variability and individual specific features. Among the well known classified types of peripheral branching of the facial nerve, there are intermediate types of its extracranial divisions.

50-56

Authors: Elena Cirjau, Emilia Behta

Background: About one century ago, was found and described a new virus, which, due to its particular way of damaging cells, was called cytomegalovirus. Human is the only natural source of cytomegalovirus infection. The relevance is that it is a widespread pathology, and due to its ability to “disguise” in the human body, remains unnoticed until the “defect” appears in the body’s immune system. It is especially dangerous for pregnant women, children and people with immunodeficiency. It is one of the most common infections that cause pathology in the fetus and newborns, which, in turn, leads to serious consequences, from disability to child death. There are many ways of cytomegalovirus transmission: airborne, parenteral, domestic contact, sexual and vertical (transplacentally, with aspiration of secretions from the birth canal and natural feeding). The virus is able to have a direct and indirect effect on the body. It is able to independently induce immunosuppression. The article describes the epidemiological data, pathogenesis, clinical manifestations, and modern methods of diagnosis, treatment and prevention of cytomegalovirus infection. Also, some diagnostic problems in immunosuppressive organisms are described. Conclusions: Due to its consequences, namely, children`s disability, death and immunosuppressed people, cytomegalovirus has become a demographic problem. A high infection frequency indicates a low level of social development of the population. More public awareness is needed on the transmission and possible consequences of cytomegalovirus infection.