Moldovan Medical Journal

10-14

Authors: Adrian Cociug, Olga Macagonova, Valeriu Cusnir Jr, Vitalie Procopciuc, Valeriu Cusnir Sr, Viorel Nacu

Background: The complexity of cryopreservation and its potential to damage the endothelium make it so that it is rarely used in routine eye banking, except for occasional, clinically urgent transplants, where the main objective is to save the eye. The culture medium was the method of choice in the Eye Bank. Material and methods: The study group was divided into 3 subgroups. For penetrating keratoplasty and anterior lamellar keratoplasty, corneas taken up to 24 hours, with a number greater than 2000 endothelial cells per mm2 , are preferably used. Results: In the first group we found: weakly edematous epithelium; thin, transparent stroma; thin Descemet’s membrane; transparent endothelial layer, endothelial cell density greater than 2800 cells/mm2. The corneas of the second group presented: edematous, but with uncompromised integrity epithelium; slightly edematous, transparent stroma; slightly folded Descemet’s membrane; intact endothelial layer and an average of 2600 cells/mm2. Corneas of the third group: evidently edematous epithelium, with exfoliations in some areas and Bowman’s membrane detachment; considerable edema of stroma in all layers; pronounced folds of Descemet’s membrane; interrupted endothelial layer along the outline of the folds. Conclusions: The age of the donor and the preservation time are important factors that influence corneas in culture media and determine the state of endothelial cells. Although the number of endothelial cells usually decreases with age, there are still many corneas from donors over 80 years of age who meet the minimum criteria for transplantation.

18-20

Authors: Oleksandr Slobodian, Anna Prodanchuk

Background: This investigation is important to reveal hard palate ontogenetic transformations in fetal and early neonatal periods, which is important for the facial surgery in fetuses, newborns. Material and methods: Investigations have been performed in 53 cadavers of fetuses from 4 to 10 months of development, and in 9 cadavers of newborn children of both genders, who died of the reasons not connected with digestive system diseases or anomalies, and were without external signs of anatomic deviations or abnormalities, and were without evident macroscopic deviations of skull structure. Adequate anatomic methods have been used for investigation: macropreparations, topographic anatomical sections, morphometry, and statistical analysis. Results: Variants of the hard palate shapes during fetal and early neonatal periods of ontogenesis are the following: trapezium (15%), square (10%), and ellipse (7%) shapes. The shapes of the trapezium were detected in most cases in 6-7-month fetuses (20%), and in equal percentage proportion in early and late fetuses (12%). The square form is a characteristic variant form in early fetuses (17%), with fetuses age increase this form was detected in less cases, in 6-7-month fetuses – in 10%, in late (8-10 month) fetuses – in 8%, and within the newborn period the square form was not observed. The form of the ellipse was observed in larger percentage proportion in late fetuses and in newborns (12%), in less proportion (5%) – in 6-7-month fetuses, in early fetuses this form was not detected at all. Forms of the ellipse and of the trapezium were observed in equal number of cases in 8-10-month fetuses and newborns. With fetuses development the hard palate form in sagittal and frontal planes changed from arcuate to flat one. Conclusions: An ascertainment of typical and variant anatomy of hard palate forms and types would promote implementation of the new methods of major and reconstructive surgical invasions in face and skull.

25-28

Authors: Liliana Profire

Background: Infection of the pregnant women in advanced period of pregnancy with any of the virus serotypes represents a danger not only for the developing fetus (e.g. fetal intrauterine retardation, fetal distress, oligoamniosis, etc.) but also for the pregnant woman who may develop respiratory and cardiovascular deficiency. We are interested to determine the peculiarities of the clinical evolution, of the flu diagnosis in pregnant women. Material and methods: The general study group consisted of 189 pregnant women which was divided into 2 clinical subgroups: L1, which included pregnant women with confirmed flu (n1 =42) A(H1N1) and subgroup L2 of pregnant women with seasonal flu (n2 =147). Results: The results of the examination of pregnant women for the flu virus’s DNK confirmed high frequency of pandemic flu in 2009, P0.05. The study of laboratory investigations of women with the flu demonstrates the presence of similar changes in the both groups: iron deficiency anemia 93 (49.2%); leukopenia 84 (44.4%); leukocytosis with neutrophilia 4 (2.1%); lymphocytosis 42 (22.2%), P>0.05. The most frequent complications of the pregnancy in pregnant women with the flu were premature delivery (early/late periods of pregnancy) – 15 (33.3±7.27) in L1 and in L2 – 35 (17.7±3.15), p<0.05, followed by intrauterine fetal infestation syndrome (fetal hypoxia, intrauterine fetal development retardation, oligoamniosis, placental dysfunction) – 33 (17.4%), p<0.05. Conclusions: Molecular methods of diagnosis to determine the virus serotype underlie the establishment of the definitive diagnosis of the flu. The risk of pregnancy disruption at various terms, premature birth, intrauterine fetus infestation syndrome are the most common complications in pregnant women with the flu in the study.

36-41

Authors: Оlga Yepanchintseva, Оleg Zharinov, Elena Onishchenko, Borys Тоdurov

Background: Diabetes mellitus (DM) is one of the most crucial risk factors for morbidity and mortality from coronary heart disease (CAD) in the contemporary world. The prevalence and rapid progression of atherosclerotic lesions leading to worse survival is a defining feature of the course of CAD in patients with DM. Clinical manifestations of CAD often call for revascularization in patients with DM. The contemporary data regarding efficacy of the coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with CAD and concomitant DM are summarized in the review. Conclusions: Worse survival prognosis in case of CAD with concomitant DM is associated with systemic atherosclerosis, presence of a number of concomitant risk factors, as well as masked clinical manifestations of ischemia and myocardial infarction common for the patients with DM. The combination of CAD and DM once again proves the benefit of the long-term use of drugs for the secondary prevention of cardiovascular events. From the standpoint of evidence-based medicine the optimal method of revascularization in CAD patients with multivessel coronary artery disease and concomitant DM is CABG surgery. In FREEDOM study surgical myocardial revascularization reduced the number of endpoints compared to PCI. In the case of PCI it is advisable that eluting stents reducing the likelihood of restenosis and the need for repeated revascularization be used.

46-51

Authors: Oleg Cobileanschi, Elena Condratiuc, Ion Cazacu, Diana Popusoi

Background: Pharmacological management of patients with epilepsy is still a very challenging approach for the best outcome of these patients. When considering the appropriate treatment choice for patients it is necessary to take into account several factors that can influence the effectiveness and quality of life. Cancelling or changing treatment suddenly can lead to uncontrolled seizures. After a short period without seizures, many patients are tempted to abandon treatment. Cessation of treatment can be discussed after a seizure-free period for at least two years. Treatment should be discontinued gradually by reducing the dosage and constant supervision of the physician. This paper analyses briefly the general pharmacological and treatment methods in several forms of adult epilepsy. Conclusions: Management of epilepsy means more than observing the medication prescribed by the specialist. It is also important for the patient to maintain his general health status, monitor the symptoms of epilepsy and response to treatment and take care of his safety. Involvement in the management of one’s own affection can help the patient to control his condition and to continue his routine in usual manner. The objective of antiepileptic treatment is to reduce epileptic seizures to zero without intolerable side effects. New treatments should focus not only on reducing the frequency and intensity of seizures but also improving the quality of life of patients.

10-14

Authors: Cristina Postaru, Victoria Malkina, Natalia Pankratova, Mihail Postnikov

Background: The aim of the study included interdisciplinary efficiency in treatment children with class II Angle malocclusions in association with osteopathy problems. Material and methods: there were examined 30 patients of the 6- 12 years old with class II Angle malocclusion in association with osteopathy problems. The patients were divided into two groups, the main group consists of children, who have complex treatment, and in the control group they have just orthodontic treatment. Results: The results show that patients with complex treatment have potentially positive contributions in anthropometric changes as well as in facial appearance and postural problems. The orthodontic treatment of patients, from the control group, was 1.5 times longer than in the main group. So complex treatment of patients combined with postural problems is much shorter and have a positive influence on musculoskeletal disorders than in the control group. Conclusions: Efficient complex treatment of children with malocclusion and osteopathic problems influences the duration of orthodontic treatment of class II malocclusion conditioned by distal position of mandible.

24-30

Authors: Sergiu Vetricean

Background: Over the past decades, there have been a multitude of reports on the effectiveness of various techniques for the reconstruction and obliteration of the mastoid cavity. Material and methods: A comparative study on the meatotympanoplasty effectiveness using the auto osteomatrix forte autograft associated with temporal fascia and mastoid obliteration with pediculated musculoperiosteal flap in 58 patients after total tympanomastoidectomy and 59 patients after revision surgery of the evidation cavity. The patient batches were similar according to age, gender and living environment. Results: 12 months postoperatively, in all patients of both study groups was determined: significant decrease of complaints, ameliorated anatomical outcomes (small, clean and dry evidation cavity), eradication of the evidation cavity pathology, improvement of the auditory functional results (statistically significant increase in the perception of voice on whispering and speech, airway and bone conduction), improvement of the vestibular function and life quality. Conclusions: Meatotympanoplasty with the use of the auto osteomatrix forte autograft when associated with the temporal fascia and the mastoid dislocation with pediculated musculoperiosteal flap is a feasible and safe technique for pathology eradication involving the evidation cavity. The use of the autologous bone for reconstruction is effective for the stability of the external auditory canal and for the tympanic membrane. It preserves and / or restores hearing, and has a lot of advantages: is immediately available in primary and revision surgeries, is economical, does not cause inflammation processes in the body, contributes to the growth of the new bone, reduces the risk of infection, resorption and subsequent degradation and improves life quality.

39-46

Authors: Ludmila Sidorenko, Ivan Diaz-Ramirez, Victor Vovc, Gert Baumann

Background: The heart rate variability (HRV) analysis is a well-known method demonstrating its value over the years in different medical fields. However, it still has its known limitations. Material and methods: The new approach to HRV analysis is based on a complementary HRV standard analysis with new cardiophysiological biomarkers. The biomarkers are assessed on cardiorhythmograms obtained by a 5-minute ECG recording using a specialized hardware (Polyspectrum-HRV-device, Neurosoft). Results: A possible applicative value of the biomarkers is shown on examples of how a prognosis for recurrence of atrial fibrillation (AFib) could be made. When in a rest-state cardiorhythmogram are observed LF drops and are followed by a pathological counterregulation, prognostically, recurrence of atrial fibrillation is expected. When in a cardiorhythmogram LF drops are observed and are followed by a physiological counterregulation, prognostically, sinus rhythm is expected. Physiological background of the biomarkers: increased central modulation of the heart in rest state of a patient, a sympathetic overflow of the heart in calm state and insufficiency of compensatory parasymphatetic counteractivation. Limitations of the paper: this is a methodological paper without description of patients. This paper will be followed by a clinical paper in which we are going to describe the validation of these cardiophysiological biomarkers on patients with AFib. Conclusions: Complementary to the standard HRV analysis, cardiophysiological biomarkers should be assessed: LF drops and HF counterregulation could be used for prognosis construction in cardiology.

53-56

Authors: Victor Ghicavii, Ecaterina Stratu, Ianos Coretchi

Background: Approximately 91% of drugs are imported, some of which are quite expensive and unaffordable for the majority of the population. The process of drug development, i. e. the pathway from synthesis of active substance to drug, its implementation in the clinic, is quite complicated and long-lasting, of great responsibility and particularly costly, requires enormous investment. The manufacture and implementation of the medicine in the medical practice creates great difficulties in starting it. Pharmaceutical manufacturing companies from the country with modest profitability are unable or unwilling to invest financial resources in scientific research – an important stage in the development of medicines and in ensuring the beneficial activity of the concerned institutions. Conclusions: National industry must be focused on the modern manufacturing medicine, competitive and effective medicines from local raw material and first of all on the needs of the health system in the country. The situation requires insistence and can only be improved by a joint activity of specialists in many fields (production, distribution and rational use) and strengthening the research-development and coordination forces of the scientific activities in the country for research, development and implementation of new native original drugs, mainly based on local raw materials. Thus, in finalizing the analysis of the role of the pharmaceutical industry in the economic development of the state, it is necessary to mention the important social aspect of it, the close interrelation with other branches of industry, as well as the high innovation and investment capability.

63-67

Authors: Оlga Yepanchintseva, Natalia Ivanyuk, Yulia Borkhalenko, Оleg Zharinov, Borys Тоdurov

Background: Coronary artery disease (CAD) dominates in the contemporary world among the causes of left ventricular dysfunction (LVD). Prognosis of survival and the course of heart failure (HF) are worse in patients with CAD than in many kinds of non-ischemic cardiomyopathy. Development of cardiac surgery technologies and formation of the relevant evidence base have significantly expanded the role of revascularization in patients with CAD and reduced left ventricular ejection fraction (LVEF). The possibility and expediency of coronary artery bypass grafting (CABG) for improving left ventricular ejection fraction (LVEF), clinical course of HF and survival are evidence-based. Stenting is less effective than coronary artery bypass grafting (CABG) regarding the influence on primary endpoints but improves the quality of life of patients with CAD and ischemic LVD. Conclusions: In patients with ischemic LVD, surgical revascularization can ensure an improvement in the pumping function of the heart, provided there is a sufficient amount of viable myocardium. From the standpoint of evidence-based medicine, the effectiveness of CABG surgery in patients with multivessel lesion of the coronary bed and LVD has been proven for correction LVEF, improvement of the course of the disease and prediction of survival compared with the optimal drug therapy. Percutaneous intervention is inferior to surgical revascularization in terms of its effect on endpoints, but it can make an improvement in the quality of life of patients with ischemic LVD. Evaluation of myocardial viability may be of additional importance for the decision on the feasibility of CABG in the presence of multivessel coronary artery disease combined with a sharp decrease in LVEF.

9-16

Authors: Obreja Galina, Raevschi Elena, Penina Olga

Background: Excessive salt intake is associated with noncommunicable diseases, especially with hypertension, cardiovascular disease and stroke. Implementation of comprehensive and effective strategies can reduce salt intake and related disease burden. The aim of the present research was to analyse the current situation and existing evidence to inform national salt reduction strategy. Material and methods: An analysis of current status of national salt reduction initiatives and hypertension prevention, as well as of scientific publications and governmental websites was done to identify the most effective interventions applicable in the Republic of Moldova. Results: Four out of 10 individuals have raised blood pressure in the Republic of Moldova and the prevalence of hypertension and hypertension linked disease has tripled over the last 15 years. There is a strong link between salt consumption and hypertension. Currently, salt consumption in almost every country is too high. Three out of nine targets on noncommunicable disease prevention and control, which were internationally and nationally assumed, provide the baseline to reduce the salt intake in the Republic of Moldova. The main strategies applied in different combinations at the international level to reduce salt intake are regulations, food reformulation, food labelling, colour coding based on salt content, taxation and education campaigns. Conclusions: The biggest reduction in salt consumption can be achieved by comprehensive multicomponent strategy involving legal measures, mandatory reformulation, nutritional labelling, efficient enforcement and a good leadership.

21-23

Authors: Boscaneanu Natalia

Background: The pathogenesis theories of preeclampsia (PE) include inappropriate trophoblast invasion and incomplete remodeling of spiral uterine arteries. This is followed by a reduced utero-placental perfusion; ischemia is the cause of oxidative stress activation. The imbalance between the oxidant and antioxidant components in favor of pro-oxidation, induce endothelium activation and / or dysfunction with the occurrence of clinical and laboratory manifestations. Material and methods: It was proposed a comparative prospective study including 105 pregnant women with preeclampsia in comparison with 367 pregnancies without preeclampsia. Pro-oxidant and antioxidant status and its correlation with systolic blood pressure values and classical laboratory marchers were analyzed. Results: In preeclampsia there is an excess accumulation of pro-oxidants comparing to control group p<0.001. Malondialdehyde and Advanced Oxidation Protein Products are most implicated in hypertensive syndrome r 0.7, p<0.001. Inflammatory diseases of uro-excretory tract accompanying preeclampsia, demonstrate excess accumulation of Advanced Oxidation Protein Products and AGE verprelizine-like and AGE pentozidine-like r 0.7, p<0.001. Modified ischemic albumin did not get the modified value in the research group. Conclusions: Excess accumulation of pro-oxidants in preeclampsia plays an important role in pathogenesis pathway, clinical and laboratory manifestation of preeclampsia.

28-37

Authors: Bazeliuc Iurii, Gugava Vahtang, Bour Alin

Background: It has been more than 130 years since Reginald Fitz described for the first time the pathomorphological changes of the acute appendicitis and after the first appendectomy that was performed by H. Hancock, in the case of acute appendicitis, but the problem remains to be actual till now. Despite of the acute appendicitis is the most common abdominal emergency, there still are some compartments of this problem that need to be studied, starting with particularities of etiology of acute appendicitis and ending with particularities of clinical picture, differential diagnosis, and treatment. The article describes anatomy and physiology of the appendix. Authors presented data on history, epidemiology, etiology, pathophysiology, classifications, complications, management, treatment and prognosis of acute appendicitis. Also the article reflects characteristics of acute appendicitis in children, elderly patients and pregnancy and clinical signs depending on anatomical position of appendix. Conclusions: Earlier diagnostics and an early surgery performance in patients with acute appendicitis are the key to success, and lead to significant reduction in number of postoperative complications. We hope that our article will be useful for medical students, family doctors, and for young surgeons.

43-50

Authors: Cojocari Lucia, Sandul Alexandru

Background: Fungal rhinosinusitis is a major clinical problem which should be considered in all patients and immunocompromised patients with chronic rhinosinusitis. It may be non-invasive or invasive with five main subtypes. Acute invasive fungal rhinosinusitis affects immunocompromised patients, usually with poorly controlled diabetes. Orbital and intracranial invasions are common, and mortality is high, except in cases of early detection and aggressive treatment. Chronic invasive fungal rhinosinusitis and chronic granulomatous fungal rhinosinusitis are characterized by a prolonged clinical course with slow progression of the disease, frequent invasion of the orbit and skull. Allergic fungal rhinosinusitis is a disease of young atopic individuals. There are usually involved all the sinuses with mucosa thinning and specific secretions. Fungus ball appears in one sinus, most frequently in the maxillary sinus, and affected individuals are not usually atopic. Anatomical and physiological interactions of the nose and paranasal sinuses form a dynamic system. Mucus is the first line of defense against inhaled irritants and pathogens. The hygiene of a normal airway is maintained by the mucociliary clearance. The immune system includes nasal epithelial surface properties, or non-specific innate immunity and specific acquired immunity. Conclusions: The detailed knowledge of anatomical, histological and immunological properties of the nasal and sinus mucosa is essential for understanding the pathophysiology of sinus diseases, treatment planning and surgical approach in order to obtain a favorable result.

63-66

Authors: Martynchuk Аlexander, Popovich Sergei

Background: In the article it is considered the essence and possibilities of the bioregulatory approach in the therapy of osteoarthrosis/osteoarthritis (OA) that is realized with the help of the use of complex bioregulatory medications (CBM) of the German company Biologische Heilmittel Heel GmbH. It is described in detail the composition and characteristics of the CBM Zeel T – the chondroprotective compound with a bioregulatory action. Zeel T is registered in the Republic of Moldova as a solution for injections, sublingual tablets and cream. Zeel T contributes to the restoration of the disturbed metabolic and reparative processes in the articular cartilage. There are considered important distinguishable moments of the mechanism of Zeel T action from the traditional chondroprotective compounds and its advantages. It should be noted that Zeel T has more than 40 years research history and it is widely used in more than 30 countries. Every year almost one million patients worldwide are treated with Zeel T. In the article it is presented the overview of clinical studies on the use of Zeel T at OA that demonstrate that Zeel T has comparable clinical efficacy with various traditional medicinal products (MP). Conclusions: It has also a good tolerability, does not cause characteristic for NSAIDs and corticosteroids (CS) side effects, and therefore can be used for a long time. The medicine is well combined with other medicinal products that increases the effectiveness and reduces the duration of the treatment course of OA.

8-12

Authors: Maniuc Mihail, Ababii Polina, Danilov Lucian, Ghinda Serghei

Background: Determination of the general immune status and the effectiveness of the complex treatment with local immunostimulation (autologous mononuclear cells) of chronic rhinosinusitis in children. Material and methods: The general immunity status and the effectiveness of the complex treatment with local immunostimulation were examined by the application in the maxillary sinuses of activated autologous mononuclear cells in 19 children with chronic rhinosinusitis and 116 healthy children. Results: The presence of allergic reactions by increase in IgE and CD4/CD8 index was determined in patients examined. The sensitization to streptococcal antibodies was assessed by the cell sensitization data and the presence of streptococcal antibodies according to ASL-0 data. The inhibition of the T-cells was functional decrease of T-lymphocytes in the TTBL test with phytohemagglutinin and tendency towards a decrease of the T-CD-3 lymphocytes titer. The compensatory activation of the B-cells (increase in the IgA titer) was determined. The objective follow-up examination of the patients over one year revealed the absence of hyperemia and edema of the nasal mucosa, while an insignificant nasal obstruction was present in 5 children. The rhinomanometric examination demonstrated an increase in total volume indices and a decrease in the total nasal resistance in all treated children. The new method of local immunocorrection of chronic rhinosinusitis in children proved to be clinically effective. Conclusions: There were determined increased IgE, CD4 / CD-8 index and CIC (PEG-8% with low molecular weight), cellular sensitization to streptococcal antibodies according to TTBL data, inhibition of the T-cells and tendency towards a decrease of T-CD-3 lymphocytes. Also, the compensatory activation of the B-cells (increase in the IgA titer) was determined.

18-23

Authors: Ghicavii Victor, Bacinschi Nicolae, Podgurschi Lilia, Turcan Lucia, Chianu Marin

Background: The rational use of medicines remains one of the most important directions of public health, especially in socio-medical diseases, including arterial hypertension. Material and methods: The study involved 28 cardiologists and 84 internists who, based on a set of questionnaires, expressed their opinion on ambulatory treatment of patients with arterial hypertension. Also 21 internists, 6 cardiologists and 6 obstetrician-gynecologists expressed their opinion on treatment of pregnancy-induced hypertension. Results: Cardiologists and internists recommended angiotensin-converting-enzyme inhibitors (ACE inhibitors) in 28% of cases, diuretics – in 23% of cases, beta-blockers (BB) – in 20, 4% of cases, calcium channel blockers (CCB) – in 13.7% of cases, angiotensin receptor blockers (ARB) – in 13.6% of cases for ambulatory treatment of patients with arterial hypertension. The antihypertensive drugs from other pharmacological groups (with central action, alpha-blockers, arteriodilators, sympatholytics, etc.) were prescribed in only 1.3% of patients. On treatment of hypertension in pregnancy showed that all physicians – 100% recommended as first-line agent for treatment of hypertension during pregnancy centrally acting antihypertensive drug Methyldopa. For second-line treatment they recommended CCB – in 36.36% of cases, alpha-adrenoblockers – in 24.24% of cases, BB – in 21.21% of cases, diuretics – in 12.12% of cases and 3% for ACE inhibitors and ARB. For treatment pre-eclampsia and eclampsia seizures in 84.85% of cases is recommended Magnesium sulfate and 15.15% mention labetalol, hydralazine and sodium nitroprusside. Conclusions: ACE inhibitors, diuretics, BAB, CCB and ARB have been first-line drugs in the arterial hypertension (AHT) treatment. For treatment of pregnancy-induced hypertension physicians recommended centrally acting antihypertensive drug Methyldopa. For second-line treatment they recommended calcium channel blockers (CCB), alpha-adrenoblockers, beta-blockers (BB) and diuretics. As third-choice in treatment of severe hypertension in preeclampsia are selected direct vasodilators as hydralazine, labetalol, sodium nitroprusside, and the most widely used in preeclampsia and eclampsia remains magnesium sulfate.

29-35

Authors: Pantea Valeriu

Background: The functional organization of the service, institution or organization requires adjustment to challenges of the social, economic, and professional environment that intervene development stages of society. This is also true for the Public Health Supervision Service. Material and methods: The results are based on evidence of historical achievements, statistical activity data in public health surveillance, the disease prevention, data on managers’ opinion about ways to streamline institutional work, including some results of the economic activity of the institutions. Results: The diminished activity in the prevention of non-communicable diseases is determined by the scarce budget for public health surveillance activities, the lack of staff and the inappropriate approach of the methodology for monitoring environmental factors in relation to the health of the population. Service overloading 1.2-1.4 times to the functional standard, driven by low wages and as a result of staff exodus, has a negative impact on effective indicators of public health coverage. The current model of non-communicable disease prophylaxis, with a particular focus on increasing healthcare investment, does not contribute to improving the population’s health indicators. Conclusions: The functioning of the Public Health Surveillance Service under the conditions of insufficient budget with dispersion of the existing number of institutions does not contribute to the efficiency of public health surveillance. The results of the study, also the health and economic indicators in the health system point to the need for institutional reform to adjust the public health surveillance and financial support for disease prevention activities under the new conditions.

42-48

Authors: Levco Simion, Scerbatiuc Dumitru

Background: Although the symptoms of oral phlegmon have been described before Hippocrates and Galen, there have been discrepancies in the diagnosis and treatment plan appreciation in patients with phlegmon of the mouth floor until now. Ludwig’s angina accounts for less than 1% of all pathologies of maxillofacial surgery. In the pre-antibiotic era, 50% of patients died. At the moment, the mortality rate is below 10%. If the pathology is not treated, patients die in 100% of cases. Data sources: This study was conducted on specialty literature analysis. We analyzed 45 books and 8 articles. The aim of the study is to compare different sources in which the phlegmon of the oral floor is described. Discussion: The phlegmon of the mouth floor can involve only the unilateral spaces of the mouth floor, and the diffuse phlegmon of the mouth floor, also called Ludwig’s angina, compulsory involves bilateral spaces of the mouth floor. Two bilateral incisions in the submandibular regions and one in the submental region is the most practiced surgical treatment. The infection is poly microbial, with a mixed flora: aerobic alpha and beta hemolytic streptococci, staphylococci and gram-negative bacilli, anaerobic bacteroides and peptostreptococcus. Usually, the flora is from the oral cavity and pharynx. Conclusions: Patient intubation is the method of choice when it is possible. Aggressive antibiotic treatment needs to be taken as early as possible. Surgical treatment is required to be performed as early as possible. The number of incisions and their location are chosen depending on the situation.

55-62

Authors: Cheptanaru Olga

Background: The implant-prosthetic restoration in single missing tooth is a viable treatment option for the functional rehabilitation of tooth loss. Several published studies show that the deadline and the type of functional loading of the implant for single missing teeth is not decisive for the survival and success rate of the implant. Although the conventional protocol is still the “gold standard”, the immediate loading of dental implants in the fresh postextraction socket of the aesthetic area has an excellent prognosis. Immediate functional loading is successfully adopted to minimize the treatment time with immediate and impact benefit on the patient’s quality of life and satisfaction. The aesthetic result is not yet systematically included in the success criteria of the therapy through implant, although a trend for this is more common in recent publications, particularly in publications evaluating the implant prosthetic rehabilitation in the anterior maxilla and mandible. In order to obtain optimal aesthetic results, it is necessary to take into account the other aesthetic parameters, together with the chosen material for the fabrication of the implant-supported single crown and the type of prosthetic abutment. Conclusions: The systematic review of the contemporary specialty literature examines the types of implantations and implant-supported restorations for single tooth replacement, the survival rates of the implant, the survival of the crown on the implant and the successful implant, incidence of biological, technical and aesthetical complications of the implants and prosthetic restorations on implants, the quality of life related to the oral health to patients with implant-prosthetic treatment.

10-13

Authors: Zorina Zinovia, Catereniuc Ilia, Babuci Angela, Botnari Tatiana, Certan Galina

Background: The study of anatomical variability is a component of one of the largest compartments of anatomy and it is a current direction of the modern morphology, conditioned by the nowadays requirements of practical medicine. The presence of anatomical variants is closely related to the abnormal development of the arterial system during intrauterine life, mainly that of the primary axial artery of the upper limb. Those variants do not lead to functional disorders, but they may become fatal under certain circumstances. Material and methods: During the dissection of a 60-year-old male cadaver an unusual arterial variant was found out on the right upper limb, using classical methods of the upper limb arteries dissection. Results: In its retropectoral part the axillary artery was bifurcated into two arterial trunks, the brachioradial and brachioulnar arteries. The brachioradial artery represented the anterior trunk of the axillary artery bifurcation, having a superficial trajectory, while the brachioulnar artery was the posterior and deeply located one. In the specialty references, the brahioradial and brachioulnar arteries are defined as high origin of radial and ulnar arteries, which arise more common from the brachial artery and less frequently from the axillary one. Conclusions: The variants of origin and trajectory of the upper limb arteries are of clinical significance to both imagists and vascular surgeons. The imagists may misinterpret the angiographic images with such vascular patterns and surgeons may encounter difficulties in surgery at that level.

20-24

Authors: Ghicavii Victor, Podgurschi Lilia, Pogonea Ina, Rakovschi Tatiana

Background: The global aging of the population is particularly evident in economically developed countries and has a progressive character, being in the sight of the state, government and of many international organizations. According to statistics, in this period of life, the morbidity is higher in males than females. At the same time, the need to provide medical assistance to the elderly is 50 percent higher than needed for middle-aged people. About 26% of senile patients show complications and side effects due to medications. The reasons may vary: the late doctor attendance, the socio-psychological state, polymorbidity, the chronic outbreaks of diseases, parallel treatment at other physicians’, self-treatment etc. The simultaneous treatment by other physicians, who in their turn, prescribe drugs which might increase the probability of chemical and physical incompatibilities, and especially the pharmacological ones. Self-treatment is a global issue. The patient, quite often, listens to the advice of neighbors, friends, acquaintances who believe they are suffering from the same disease. So appear the different forms of polypragmasia. Conclusions: So appear the different forms of polypragmasia. Polypragmasia is sometimes more dangerous than the insufficient treatment. Anatomicalphysiological modifications of the cardiovascular system of senile patients lead to paradox effects of the administration of some drugs. Before initiating any treatment, it is necessary to determine whether the patient is using any drugs recommended by other specialists, friends, neighbors or drugs, which are not allowed to be prescribed with other drugs, in order to avoid unwanted interactions.

32-37

Authors: Capros Hristiana, Mihalcean Luminita, Porfire Liliana, Surguci Mihail

Background: Postpartum hemorrhage (PPH) is a major public health problem due to complications that have a direct impact on the most important reproductive health indicators: maternal morbidity and mortality. It is a leading reason for peripartum hysterectomy, admission of pregnant women to intensive care units, and massive blood transfusion. In the most severe cases, hemorrhagic shock may lead to anterior pituitary ischemia, occult myocardial ischemia, dilutional coagulopathy. Post-partum anemia increases the risk of post-partum depression. To decrease the incidence of postpartum hemorrhage the conditions that are known to be associated with PPH and these women should be identified. Careful anamnesis and obstetrical examination should be done to screen for risk factors in pregnancy and labor. To assure minimal blood loss during delivery several measures are proposed in international protocols. The knowledge of prophylaxis measures is useful to reduce maternal mortality and morbidity from PPH. Conclusions: The knowledge of prophylaxis measures is useful to reduce maternal mortality and morbidity from PPH. Actually, for prophylaxis of postpartum hemorrhage, evidence based medicine recommend correction of anaemia, use of the partograph in labor and the close supervision first two hours after the delivery.

45-48

Authors: Suman Serghei, Topor Boris, Suman Ala

Background: The neck is divided into two compartments: anterior compartment, which includes the organs with their fascial cellular structures and the posterior compartment, which is constituted of muscles with their fascial sheaths. Study of cervical fasciae represents major difficulties, because the authors did not synchronize over the time a common opinion about the fascia and terminology classification. In the manuals of anatomy in English, French and Russian the same formations are specified differently. Conclusions: The authors of contemporary textbooks and scientific articles describe equally the real anatomy of cervical fasciae in the anterior visceral compartment of the neck, where they are located, what structures envelop, how they delimitate the narrow clefts and large spaces between them, but in the different manner and using different terms for the same fascial leaves. Maybe there is no need to give preference to a concrete classification, of the 3 fasciae as in the official Anatomical Nomenclature or of the 5 fasciae as is in the textbook of V. N. Shevkunenko. It is enough to know the synonyms of the fascial leaves and consider their clinical significance in the spreading of infection, for opening the cervical phlegmons and performing the surgical approaches.