Moldovan Medical Journal

9-13

Authors: Mihaela Burac

Background: Despite the positive dynamics of global demography, infertility remains one of the current challenges of contemporary gynecology. The endometrium represents the mirror that reflects the state of the pathological processes that occur in the pelvic organs, and the frequency of morphofunctional disorders of the endometrium in infertility is quite high. The aim of the study was to assess the gynecologic history in primary infertility patients. Material and methods: The study included 96 patients divided into 2 groups. The study group - 48 patients with primary infertility and the control group – 48 fertile patients. The patients were interrogated according to a questionnaire that included 130 questions. Results: The evaluation of menstrual function revealed that according to the following criteria: age of menarche, duration of menstruation, study groups were homogeneous. The age of onset of menarche was within the normal range in 97.9% (n = 47) of patients in both groups and averaged 12.77±1.27 years. Patients in the study group had regular menstrual cycle in 70.8% (n = 34) of cases, and those in the control group in 93.8% (n = 45) of cases, c2 = 8.649; p = 0.003. The duration of the menstrual cycle averaged 35.23 ± 12.54 days in Study group (L1 ) versus 28.33 ± 3.09 days in Control group (L0 ), p <0.001. The duration of menstruation was between 2 and 7 days in both groups with a mean of 4.35±1.12 in the study group and 4.73±1.12 in the control group, p = 0.1. Conclusions: Patients in the study group reported more often an irregular menstrual cycle and a prolonged interval between menstrual periods, hypomenorrhea, intermenstrual and postcoital bleeding, algodysmenorrhea, dyspareunia, premenstrual syndrome indicating the existence of endometrial dysfunction at the basis of infertility pathogenesis.

21-28

Authors: Diana Turlacova, Ianos Coretchi

Background: Iron deficiency anemia (IDA) is a hematologic syndrome characterized by the deregulation of hemoglobin synthesis due to iron deficiency. During pregnancy, there is an increase of about six times of iron. A correlation between body mass index (BMI) and hemoglobin (Hb) in pregnant women with IDA during the treatment with “Sorbifer Durules” (SD) was evaluated. Material and methods: A retrospective, cohort study. 40 medical cards of pregnant women diagnosed with IDA during the pregnancy and who were treated with SD: one tablet 2 times per day, were studied. The BMI and Hb levels were assessed in each trimester of pregnancy. The dynamic of Hb values was determined: ΔHbII-I – the difference between Hb values of the 2nd and of the 1st trimesters, ΔHbIII-II – the difference between Hb values of the 3rd and of the 2nd trimesters. Statistics: Pearson’s correlation coefficient. Results: IDA was diagnosed in 15 out of 40 pregnant women in the 1st trimester of pregnancy (IDA1), in 19 – in the 2nd trimester (IDA2), in 6 – in the 3rd trimester (IDA3). 7 pregnant IDA1 with normal body weight (BMI = 18,5-25 kg/m2 ) had ΔHbII-I=14,28 g/l, 8 pregnant IDA1 with grade I obesity (BMI=30-35 kg/m2 ) had ΔHbII-I=26,12 g/l. Pearson correlation coefficient between BMI in the 1st trimester of pregnancy and ΔHbII-I in pregnant IDA1: r=+0,617, p=0,014. The associations between BMI and ΔHb in pregnant IDA2 and IDA3 were negligible. Conclusions: There is a substantial and significant association between BMI in pregnant women who developed IDA in the 1st trimester and Hb increase during the treatment with SD.

36-38

Authors: Greta Balan

Background: Recently, a particular attention has been drawn to the study of the microbial persistence properties and their correlation with the rate of elimination from the source of infection, as well as the prognosis of the disease progression. Material and methods: There were examined 44 samples taken from patients with trophic ulcers. The bacteriological examination, as well as tests on determining both the persistence factors and the antibiotic susceptibility of the isolated strains were carried out according to the current method. Results: There were determined 80 isolated bacterial strains. Two and more strains were isolated in over half of these cases (52.3%). The most commonly involved strains were the genus Staphylococcus, followed by Enterobacter spp., Pseudomonas spp., Candida spp., and enterococci. Both gram-negative and gram-positive species exhibited a high-level antimicrobial resistance. The study of the persistence factors revealed that the strains isolated in mixed culture showed a higher rate of virulence (1.0-1.5 times higher) compared to isolates in pure culture. Conclusions: The main bacterial strains isolated from trophic ulcers are the genus Staphylococcus and the Enterobacteriaceae family. Isolated strains showed higher level of antimicrobial resistance and multiple persistence factors. The study results proved that treatment of trophic ulcers is still a major problem, requiring rational monitoring and management strategies.

45-48

Authors: Andrei Ganenco

Background: The purpose of the respiratory biofeedback method is to change the dysfunctional respiratory pattern to the normal one, and to decrease the patient’s general anxiety, as biofeedback training can influence the parameters of the respiratory pattern and the level of anxiety. Material and methods: 12 subjects (3 men and 9 women), mean age 21.9 ± 1.1, with high level of trait anxiety, were selected for recording the respiratory pattern and respiratory biofeedback (RBF). Respiratory minute volume (MV), tidal volume (TV), duration of inspiration (Ti), duration of respiratory cycle (Tt), respiratory drive (TV/Ti) and ratio of inspiration (Ti/Tt) were measured. Breathing was recorded under the following conditions: resting breathing, paced voluntary hyperventilation, the recovery period after hyperventilation, voluntary apnea and recovery period after voluntary apnea, anticipatory stress. Respiratory biofeedback consisted of 12 sessions of abdominal, deep, 10 breaths/min, visually guided by the route on the computer screen. Results: After biofeedback, trait anxiety scores decreased in 11 subjects. TV, TV/Ti and MV after biofeedback have been decreased in all phases of research. Tt during the rest and hyperventilation periods did not change, but it was extended in all subsequent phases. RBF did not substantially change the Ti and Ti/Tt in all recording phases. Conclusions: RBF had a greater impact on volume parameters (TV, TV/Ti, MV) and little or no impact on time parameters.

56-60

Authors: Liliana Profire

Background: The activity in the hemostasis system is determined by two opposite processes that function simultaneously – blood clotting (fibrin clot formation) and fibrinolysis (the process of fibrin clot breakage). A normal balance between the processes of coagulation and fibrinolysis produces neither coagulation nor lysis, and vice versa, the imbalance of these processes is potentially dangerous in the development of coagulopathic or lytic events. Both systems (coagulation and fibrinolysis) undergo substantial changes in the physiological pregnancy, changes in an increase of coagulation factors concomitant with a decrease of anticoagulants and suppression in the fibrinolysis system. The predominance of prothrombotic activity gives the pregnancy a hypercoagulable status, with an increased risk of intravascular thrombi formation and thromboembolic complications (e.g. venous thrombosis, DIC syndrome). On the other hand, physiological hypercoagulation during pregnancy contributes to preventing the loss of blood during the immediate postpartum period by providing hemostasis in placental wounds and birth pathways. Conclusions: The hemostasis system in pregnant women is marked by an increase in coagulation at each stage (from endothelium to circulatory factors of coagulation) which presumes the risk of thrombo-embolic complications, and the inhibition in the fibrinolytic system prevents peripartum bleeding.

70-75

Authors: Mariana Avricenco

Background: Hepatitis C virus (HCV) infection has a significant worldwide impact. Patients with hepatic cirrhosis with HCV have an annual risk of decompensation of 3-5%, a risk of developing hepatocellular carcinoma between 1.4-6.9% and a risk of mortality of 2% / year. Therefore, the treatment of chronic HCV infection is a priority for patients with severe hepatic fibrosis and cirrhosis. The emergence and approval of direct-acting antivirals (DAA) in recent years have revolutionized antiviral therapy, especially for patients with liver cirrhosis. Following numerous studies it has been found that, this treatment is well tolerated by these patients. The combination of DAA from different groups has a potent enhancing effect, and the sustained viral response (SVR) rate reaches up to 85-98% in patients with liver cirrhosis. In general, the chance of performing SVR with DAA in patients with compensated cirrhosis (Child-Pugh A) is comparable to non-cirrhotic patients. However, there is a risk for decompensation and acute liver failure during and after treatment. Patients with decompensated liver cirrhosis and advanced liver fibrosis may have greater benefit from antiviral therapy after liver transplantation. Conclusions: The data obtained from the analyzed studies suggest that DAA antiviral therapy prevents the progressive evolution of the disease towards hepatocellular carcinoma or decompensation. At the same time, a correct therapeutic approach and a permanent monitoring of these patients can improve the quality of life, significantly prolonging the years of life.