Moldovan Medical Journal

11-15

Authors: Vitalie Iacubitchii, Alexandru Betisor, Nicolae Erhan

Background: The constrained knee prosthesis has the basic indication in revision arthroplasty, but the latest literature reveals that it takes place also in primary total knee arthroplasty in cases of knee osteoarthritis associated with major deformities. Material and methods: Present study is based on the surgical treatment, using the constrained knee prosthesis in the primary total knee arthroplasty, during 2019-2021, of 28 patients with knee osteoarthritis associated with severe deformities in varus or valgus, in the Big Joint Replacement Department, Clinical Hospital of Traumatology and Orthopedics, Chisinau. Results: In this study, the following criteria were evaluated: the type of deformity – valgus (10 cases) and varus (18 cases); the degree of deformation – for varus knees was on average 300, and for valgus knee – 250; bone attrition – 11 cases with bone defects where it was necessary to use augmentations; affected side – in 19 cases the right knee was affected and 9 cases the left one; the women/men ratio was 4/1; the mean age of the patients was 67.5 years; average duration of the intervention – 140 minutes; in 5 cases a lateral para-patellar approach was performed, of which 2 cases with tibial tuberosity osteotomy; complications – 1 case with intra-operative periprosthetic fracture and 2 cases with superficial infections of the operated joints. Conclusions: Osteoarthritis of the knee progresses rapidly, leading to severe deformities, significant bone defects and joint instability, which are indications to use the constrained prosthesis in the primary total knee arthroplasty, long-term follow-up is necessary to obtain the last conclusion, but from this study the constrained knee prosthesis like primary implant for special indication had promising results.

21-26

Authors: Mihail Tasnic, Valeriu Revenco, Ilia Catereniuc

Background: Of particular interest are the studies researching the correlations of myocardial bridges with hypertrophic cardiomyopathy and correlations of thick myocardial bridges with the development of coronary atherosclerosis in the proximal to the bridge arterial part. Material and methods: Assessment of the correlation between myocardial bridges, coronary atherosclerosis, and the degree of hypertrophy of the left ventricle was performed by retrospective analysis of 6168 coronary angiography protocols (2012-2019) and echocardiographic data from patients’ clinical records. Results: Moderate systolic compression predominated, and the number of patients detected with severe under the bridge systolic coronary stenosis was double as in patients with nonsignificant coronary atherosclerosis. From the total number, patients with myocardial hypertrophy and myocardial bridges were twice less when compared with the patients with the normal myocardial thickness. The comparative research did not show any interdependence between the degree of vascular compression and the degree of left ventricular myocardial hypertrophy. Proximal to the bridges atherosclerosis was detected in 32% of cases without correlation with the force of the myocardial bridge. Conclusions: The study showed the absence of the correlation between the degree of arterial stenosis caused by the bridge and the degree of hypertrophy of the ventricular myocardium as well as the degree of proximal to the bridge atherosclerosis. Important finding was that the degree of coronary systolic compression is higher in patients with moderate and severe proximal to the bridge atherosclerosis.

33-37

Authors: Ivan Vladanov

Background: Transurethral resection of the bladder is one of the essential methods in the diagnosis, treatment and management of non-muscular- invasive bladder cancer. The purpose of the procedure is to remove completely all visually detected tumors with a following establishment of a very precise histological diagnosis. The aim of the study is to compare the results of conventional transurethral endoscopic treatment and the En-bloc resection method using different types of energy sources in the treatment of bladder tumors. Material and methods: A total number of 88 patients underwent endourological interventions. Regarding the distribution, 23 patients had conventional transurethral resection, 22 – En-bloc monopolar resection, 21 – En-bloc bipolar resection and 22 – En-bloc with Thu:YAG laser. Clinical data, intraoperative and postoperative data and also the histopathological examination results were compared. Results: The compared groups were heterogeneous by age, sex, tumor characteristic (size, number, location). No significant differences were observed during the operations, comparing the intraoperative and postoperative complications of the studied groups. The detrusor musculature was detected in 74% of cases after conventional transurethral resection, in 91% of cases of En-bloc monopolar resection, in 95% of cases of En-bloc bipolar resection and in 96% of cases of En-bloc Thu:YAG laser. Conclusions: The En-bloc resection technique of non-muscular-invasive bladder tumors is a safe and effective method comparing with the conventional transurethral resection; it allows more favorable postoperative results and obtaining better quality tumor samples which allow establishing correct diagnosis of the disease.

42-46

Authors: Constantin Toncoglaz, Serghei Toncoglaz, Alina Toncoglaz

Background: Congenital uterine abnormalities result from abnormal formation, fusion or resorption of the Mullerian ducts during fetal life. These abnormalities have been associated with an increased rate of miscarriage, preterm birth, and other fetal adverse outcomes. Material and methods: Was performed a clinical observational retrospective study of uterine malformations, diagnosed in the Republic of Moldova. Pelvic MRI (1.5-3 tesla) with contrast and without were examined, from 01.01.2016 to 20.11.2016. During this time, 190 MRIs were performed according to the program, 167 MRIs were included in the study, 23 MRIs were excluded, having total or partial hysterectomy performed. The age of the examined persons is between 81 years and 6 months. Results: 15 uterine malformations were detected, which represent 11.13%. Among the uterine abnormalities were detected 6 cases of bicorn uterus, 3 cases of didelph uterus, 2 cases of uterine agenesis and septate uterus and one case of arcuate uterus, and unicorn. Conclusions: In this study it was determined that the prevalence of uterine malformations in an unselected population in the Republic of Moldova is 11.13%, and that of the septate uterus is 1.2%, data that are similar and correspond to the international literature.

51-55

Authors: Dumitru Cheptea

Background: Teaching in schools has been defined as the profession with the most diverse risk factors that affect health. With almost 48000 people currently working in educational institutions, teachers make up the largest occupational group in the Republic of Moldova. Material and methods: The study involved 519 teachers from pre-university educational institutions. For the self-assessment of the health status, a questionnaire was created which was applied online. The subjective assessment was performed by researching the entries in the medical cards. Results: The majority of respondents were women (91.4%), with a mean age of 45.6±7.5 years and a working experience of 22.9±3.2 years. In 75.7% of them health is satisfactory, only 3% have serious health problems and would require hospitalization. In 35.8% of cases, the presence of chronic diseases is registered, their top being led by diseases of the gastrointestinal tract (33.8%), the cardiovascular system (29.2%) and endocrine (27.2%). The most common risk factors mentioned were: high levels of stress (53.5%); increased number of tasks (23.4%); lack of support from family and colleagues (22.9%). Conclusions: The health of teachers is influenced by a variety of risk factors. There were no correlations between the type of institution and the subject taught, which highlights the importance of studying the influence of factors in the occupational environment and the development of prevention measures.

62-69

Authors: Iulia Rodoman, Alexandr Dorif, Ina Palii, Victoria Sacara

Background: Standard pediatric cardiology examinations and echocardiography fail to discover when the cardiomyopathy will occur in patient with Duchenne muscular dystrophy (DMD). Noninvasive markers are needed to fill this gap. Material and methods: This cohort study included a total number of 30 children (21 children (70%) with DMD and 9 (30%) healthy children. Blood samples were used for biochemical (level of creatine kinase, creatine kinase-MB, lactate dehydrogenase) and miRNA (presence of miR133a 3p, miR133b 3p, miR206 3p, miR208a 3p, miR208b 3p) analysis. All patients underwent partial conventional echocardiography ECOCG and Speckle Tracking. Results: The children in the working group presented compared to healthy children: FCC values increased by 15 (71%) vs 2 (22%), high levels of CK, CK-MB, LDH, which is characteristic for the disease and reflects its stage. Also, there is a decrease in systolic function indicators in the working group: mean FE 59 ± 3.8 %, and GLS: -16.2 ± 3.1%. MiRNA analyses confirmed the presence of miR133a 3p, miR133b 3p, miR206 3p, miR208a 3p, miR208b 3p in both working and control group. Conclusions: For the first time in the Republic of Moldova, we developed and adapted protocols for RNA extraction from human blood, performing screening of specific miRNA in the serum of patients with DMD and healthy children. Also, altered LV strain notwithstanding a normal or mildly modified LVEF represents an essential viewpoint for prospective pediatric drug trials in DMD-related cardiomyopathy prevention.

76-80

Authors: Maria-Victoria Racu, Ion Romulus Scorei, Iurie Pinzaru

Background: Boron was classified by the World Health Organization as ‘possible essential elements for human health’. It can be found in different forms in the environment, has beneficial effects on bones and its deprivation can impair calcium and magnesium metabolism and bone development, their health and maintenance. Dietary boron supplementation can help prevent and manage degenerative and inflammatory bones and articular diseases, such as arthritis, osteoarthritis, rheumatoid arthritis and osteoporosis. Relevant articles were identified in PubMed, Google Scholar, ProQuest, and Scopus databases published until June 2021, describing the role of boron in the functioning of the osteoarticular system. Conclusions: From organic and inorganic boron forms that can enter the human body, organic plant based boron compounds are highly bioavailable. In the functioning of the osteoarticular system boron acts by regulation of calcium and magnesium metabolism, enhancing the vitamin D activation process and influencing serum steroid hormone levels. A boron intake equal to or higher than 3 mg per day can help prevent/or correct arthritis, osteoporosis and osteoarthritis. Calcium fructoborate can reduce pain, joint discomfort and increase endogenous vitamin D level in patients with osteoarthritis. Boron may play a role in pathophysiology of rheumatoid arthritis and its severity and a supplementation with boron element may be useful.