Moldovan Medical Journal

12-15

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

Introduction: Status epilepticus (SE) is a life-threatening neurological emergency requiring immediate medical intervention and is associated with high mortality and morbidity. The aim of this research was evaluation of clinical and etiological profile of refractory status epilepticus (RSE) among children aged between 1 month and 18 years. Material and methods: The study was done between January 1, 2017 and December 24, 2019. All children with the age limits mentioned above, who presented convulsive SE, subsequently with development in refractory status epileptic (RSE), were included in the study. Patients were investigated and evaluated according to a standard protocol. Subsequently, the characteristics of children with RSE and those without an evolution in RSE were compared. Results: 55 children, out of whom 32 boys with SE were enrolled in the study, of which 20 children (36%) developed RSE. Central nervous system (CNS) infections were the most common causes of SE and development of RSE (51% in SE and 53% in RSE, p > 0.05). Noncompliance of antiepileptic medication served as the second cause for evolution of RSE. The overall mortality rate was 10.9%, the chances of death in RSE (20%) being higher than in SE (5.7%). The unfavorable prognosis was seven times higher in children with RSE, compared to children who developed SE. Conclusions: In the management of CNS infections, pediatricians should be aware of the high risk of developing RSE. In addition, the possibility of developing RSE should be considered and promptly managed in an intensive care unit in order to reduce the risk of mortality and morbidity of this severe neurological condition.

21-25

Authors: Oleg Arnaut, Ion Grabovschi, Serghei Sandru, Gheorghe Rojnoveanu, Ruslan Baltaga

Background: Trauma remains a medical-social problem, still having high lethality rate. Indirect lung injury (ILI) occurs in trauma due to systemic neutrophils activation and proteases release into primarily intact tissues. There are no data in the literature regarding ILI predictive models in trauma. Material and methods: In the experimental study (19 traumatized male rabbits), the proteases, antiproteases and the pulmonary morphological changes, assessed according to the SAMCRS score (Semiquantitative Reflected Qualitative Changes Assessment Scale) were followed. There were used two statistical instruments – correlational analysis and multivariate linear regression. Results: Initially, a correlational analysis between the values of the SAMCRS score and the proteases/ anti proteases was performed. The null hypothesis was rejected (F = 7.017, p = .002). The correlation coefficient of the predicted results and the real values of SAMCRSlungs was .854, the determination coefficient being .626. The final model included the following parameters: constant (B = 9.427; 95% CI 7.341, 11.513; p <.001); α2-macroglobulin0 (B = -4.053; 95% Cl -6.350, -1.757; p = .002); AEAMP0 (B = .002; 95% CI .000, .004; p = .075); AEAMP24 (B = -. 006; 95% CI -.010, -.002; p = .003); AECG2 (B = .081; 95% CI .040, .122; p = .001); AEE0 (B = -. 026; 95% CI -.040, -.011; p = .002). Conclusions: In this research, a predictive model for indirect lung injury in experimental trauma was developed, the predictors being some elements of the proteases/antiproteases system. This, in turn, allows the hypotheses emission regarding the pathophysiology, prophylaxis and treatment of ILI.

33-36

Authors: Artur Colta

Background: The purpose of the study was to diagnose possible chronic nonbacterial prostatitis (CNP) and chronic pelvic pain syndrome (CPPS) among patients, as well as differentiate between the inflammatory (category IIIA) or non-inflammatory (category IIIB) types in selecting and optimizing differential drug treatment of this category of patients. Material and methods: The study was conducted on 43 patients diagnosed with CNP/CPPS. The control group included 10 healthy men. Both the production of nitric oxides (NO) by phagocytes, as well as prostate secretion and ejaculate were determined according to the procedure described by Metelyskaya B.A., which was modified by Gudumac V, et al. Results: There was a 39.0% (p <0. 05) decrease in NO production by induced NO-synthase (iNOS), determined in the blood of 11 patients (from the main group – 2) with CNP/CPPS and a 115% (p <0.05) increase was determined in 32 patients (from the main group 1) if compared to the same indices in the control group. The prostatic secretion and ejaculate showed a higher macrophage iNOS activity by 80% (p <0.05) and 75% (p <0.05) if compared to the same parameters from the control group. The iNOS activity in prostatic fluid and split-ejaculate fractions from the main group – 2 did not differ from that of the control group. Conclusions: The assessment of NO production, prostate secretion and ejaculate allows to somewhat establish the main diagnosis of CNP and category III types (A – inflammatory and B – non-inflammatory prostatitis), which will significantly contribute to the optimization and selection of an appropriate differential treatment based on the drug action mechanisms.

42-48

Authors: Tatiana Timbalari, Oleg Lozan, Igor Codreanu, Viorel Nacu

Background: Numerous studies focusing on public attitude towards organ donation have been performed at the international level, but very few highlight public attitude towards tissue and cell donation and transplantation. Material and methods: We conducted a survey among a representative sample of the general adult population (N=427). The questionnaire was developed on the basis of previous study and included reuse of some items from the earlier survey to facilitate historical comparison. The analysis of the data was carried out using SPSS, 2011 and focused on descriptive statistics. Results: The vast majority of our respondents (81.0%) agreed with the tissue and cell donation and only every 10th respondent did not accept this. The fewer respondents (68.1%) would agree to have tissues and cells transplanted from other people compared to those who were willing to donate tissues and cells (81.0%). Finally, most of the respondents (85.0%) expressed interest in receiving more information, and were very similar to those in receiving more information on organ donation and transplantation (88.0%) Conclusions: The study revealed the respondents’ positive attitude towards tissue and cell donation and transplantation and demonstrated a remarkable growth in the public positive attitude towards donation. Furthermore, as the vast majority of our respondents wanted to receive more information on these issues, it seems to be a clear opportunity to develop educational and promotional strategies to improve awareness and enhance donation rates in our country.

53-57

Authors: Roman Chornopyshchuk

Background: High mortality and disability of patients with critical and supercritical burns, long-term treatment, unsatisfactory aesthetic and functional results lead to the search for ways to provide assistance aimed at counteracting the formation of a mass of necrotic tissue, which is crucial for life or death of the victim. Material and methods: The experimental study was performed on 60 sexually mature Wistar rats, which were on a regular diet and weighed 150-160 g. The experimental animals were divided into the main and control groups and were used to simulate burns with boiling water of IIb degree. Results: The traumatic effect of hyperthermic exogenous and endogenous damage factors of the animals in the main group were immediately neutralized by a gauze napkin soaked in water at a temperature of 18-20 ° C immediately after the simulation of burns, the duration of which became the criterion for dividing them into subgroups. In animals of subgroup 1 the time of application of a wet wipe to the burn area was 1 min., in the 2nd subgroup it was 5 min., 3rd subgroup – 10 min., 4th subgroup – 15 min., 5th subgroup – 20 min. The application napkin was changed when it was heated to 34 °C. Such applications were not performed to the animals of the control group. Conclusions: The conclusion was made on the necessity of prompt neutralization of traumatic action of hyperthermic exogenous and endogenous damage factors as the main elements of burn wound depth. For a broader understanding of action mechanisms of the suggested technology of self-help and mutual first aid as well as the nature of the impact of neutralization directly on the tissues, it is advisable to supplement the research with morphological methods.

65-69

Authors: Ivan Vladanov, Alexei Plesacov, Vitalii Ghicavii

Background: Transurethral resection of the bladder (TURB) tumor was first described by Stern and McCarthy in 1931, and is still considered the gold standard in diagnosis and treatment of non-muscle-invasive bladder cancer. The quality of TURB affects accuracy of histopathologic evaluation, and subsequently impacts the risk of recurrence and patient outcome. New methods that aim to improve the effectiveness of TURB are reviewed, and recent studies are discussed, including resection methods and image enhancement techniques. Material and methods: Between January 2016 and April 2019, within the Urology Clinic of Nicolae Testemitanu State University of Medicine and Pharmacy 108 patients were surgically treated with bladder tumor pathology. Patients were divided in two groups: En-bloc resection group which includes 51 patients and transurethral resection group with 57 patients, the obtained data were comparatively analyzed. Results: Tumor analysis showed that the majority of the patients’ tumors were localized on lateral urinary bladder walls, single bladder tumors were detected in 64 (59%) cases, tumor sizes up to 3 cm were detected in 74 (69%) patients included in the study. Detrusor muscles were detected in 49 (96%) cases of En-bloc group and 45 (79%) cases of TURB group. Most recurrences occurred in patients with high-grade histological result, recurrence rate in En-bloc group occurred in 18% and in TURB group in 37%. Conclusions: The En-bloc resection technique of non-muscle-invasive bladder tumor proved to be a safe and effective method compared to the conventional transurethral resection technique (TURB). This method provides more favorable results for obtaining better quality tumor samples (present of detrusor muscle) that allow to establish correct diagnosis and staging of the disease and reduces the number of recurrences.

79-86

Authors: Olga Macagonova, Doina Risnic, Adrian Cociug, Viorel Nacu

Background: The extracellular matrix plays an important role in the promoting the tissue regeneration and repair. Decellularization or removal of the cells from the complex mixture of the structural and functional proteins that constitute the extracellular matrix (ECM) can be done by the physical (agitation, sonication, freeze and thaw), chemical (alkaline orchids, ionic detergents, nonionic, tri-n-butyl phosphate (TBP), hypotonic or hypertonic treatments, chelating agents), and enzymatic methods (trypsin or protease inhibitors). However, complications associated with the use of the decellularized skin have been reported, which are widespread and poorly understood. In this synthesis have been included publications, identified by the Google Search engine, National Bibliometric Tool (NBT), Pub Med databases, Web of Science, Springer, Elsevier, Wiley Online Library, Science Direct and Biosience, Biotechnology and Biochemistry. The results of the decellularization were reported in terms of the number of cells remaining in the collagen fibers depending on the duration of exposure to chemical agents. Conclusions: The natural matrix is more widely used than synthetic material, because it has the natural structure and composition of the ECM, it naturally stimulates cell development and allows the incorporation of the growth factors and other proteins increasing cell proliferation.The assessment of the quality of decellularization techniques is done by evaluating the necrosis of the extracellulare matrix, the depletion of the collagen fibers and the remaining amount of genetic material.