Moldovan Medical Journal

5-12

Authors: Valeriu David, Vergil Petrovici, Lilian Saptefrați, Veaceslav Fulga, Ecaterina Carpenco, Elena Frant

Background: The molar and non-molar lesions are determined during histomorphological examination and treated as inconclusive. The establishing of a marker by immunohistochemical investigations could influence the accuracy of the morphopathological diagnosis. The aim is evaluation of p57 immunoexpression in the trophoblastic germ compartment in molar and non-molar pregnancies. Material and methods: Abortion products from 15 patients with hydatidiform mole, 18 pregnancies solved on social indications and 16 short-term disordered pregnancies were evaluated depending on the immunoexpresion of p57. Results: The hydatidiform mole was classified based on anti-p57 immunoexpression into: complete hydatidiform mole – 8 cases (negative immunoexpression or expression in ˂10% of villous cytotrophoblast) and partial hydatidiform mole – 7 cases (positive expression in ˃10% of the villous cytotrophoblast). Basal deciduous and extravillous cytotrophoblasts were positive in 100% of cases and served as internal control. Hepatocytes were used as negative control. In the control group, the positive immunoexpression was attested in >10% of cases in the villous trophoblast. Conclusions: Differential immunoexpression of p57 protein in the germinal cytotrophoblast allows subclassification of molar pathology into complete and partial forms, while not allowing the differentiation between partial hydatidiform mole and non-molar lesions. Immunohistochemical evaluation of p57kip2 protein in molar and non-molar pathology is useful in differential diagnosis as a complementary method.

20-29

Authors: Vitalie Cobzac, Mariana Jian, Tatiana Globa, Viorel Nacu

Background: The existing surgical techniques used to regenerate articular cartilage fail. Utilisation of hierarchical, biphasic structures obtained from osteochondral tissue, through demineralisation, decellularization, longitudinal perforation and combination with chondroprogenitor cells, presents a high potential in cartilage defects regeneration. Material and methods: The research was performed on 36 rabbits, separated equally in two experimental and one control group. In the experimental groups, the experimental osteochondral defects of 4-4.5 mm in depth, were performed with a 3.7 drill bit at the level of weight bearing surface of the medial femoral condyle. In the 1st group the defects were treated with grafts combined with autologous chondrocytes, and in the 2nd group with grafts combined with autologous mesenchymal stem cells. In the control group, cartilaginous defects were treated by transferring the osteochondral plugs taken from the trochlear groove. The rabbits were removed from the experiment at 6 and 12 weeks. The results were evaluated by Unified Histological Score of Regenerated Cartilage (UHSRC). Results: At 6 weeks, according to UHSRC, the 1st group had 28.33±1.53 points, the 2nd group –27.67±2.08 points and the control group –26.33±1.53 points (p˃0.1; p˃0.2). At 12 weeks the 1st group had 18.68±5 points, the 2nd group –14.89±3.76 points and the control group –17.22 ±4.84 points (p˃0.5; p˃0.2). Conclusions: According to UHSRC, the experimental groups don’t show a significant difference compared to the control group at 6 and 12 weeks, also the quality of regenerated cartilage is poor.

36-40

Authors: Olga Macagonova, Adrian Cociug, Viorel Nacu

Introduction: Decellularized biomaterials derived from the biological tissues are ideal for tissue engineering applications because they mimic the biochemical composition of the native tissue. The physical and structural properties of the scaffold are important in the fields of tissue engineering and regenerative medicine. Material and methods: Study material was 20 decellularized dermal grafts. 10 samples were obtained from piglets slaughtered in the slaughterhouse. Other tissues (n=10) were received from the donor from the Human Tissue and Cell Bank of the Republic of Moldova. Extracellular matrices were obtained by decellularization with 0.5% sodium dodecyl sulfate/0.1% EDTA solution. The evaluation of the structural characteristics was carried out by the histological examination with hematoxylin and eosin, scanning electron microscopy and the quantification of the amount of deoxyribonucleic acids. Assessment of the physical characteristics included analysis of extracellular matrix volume porosity, density, and swelling rate. Results: Histological examination revealed fewer cells in decellularized tissues compared to non-decellularized ones. More than 80.5% of nucleic acids were removed from porcine matrix and 82.5% of genetic material – from decellularized human dermal structures. A mean correlation and inverse dependence of -0.43 was shown between porosity and swelling rate of decellularized dermis. Conclusions: The decellularization process significantly (P<0.05) removed the cellular components while preserving the connective three-dimensional structure of the dermal matrices clearly shown by quantification of the amount of DNA and microscopic examination of the structures.

47-50

Authors: Chiril Voloc, Aliona Rotaru, Alexandru Voloc, Eliane Kamgaing Kuissi, Joel Fleury Djoba Siawaya, Simon Jonas Ategbo

Background: Vitamin D plays an important role in the prevention of many diseases. More than 1 billion people worldwide suffer from vitamin D deficiency. Vitamin D deficiency can contribute to the development of 16 types of cancer (breast, colon, prostate, etc.), cardiovascular diseases, stroke, autoimmune diseases, periodontal pathologies, transplant failure in endo-alveolar surgery, etc. There are several risk factors that would prevent the achievement of treatment objectives. The national protocol for deficiency rickets prevention privileges vitamin D 2 versus vitamin D 3 , which creates a medical risk factor compromising oral health in both children and adults. The article provides sufficient arguments in favour of vitamin D3 vs vitamin D2 prescription for prophylactic and treatment purposes. Conclusions: Considering that vitamin D deficiency is currently a global public health problem, it can be proposed to declare vitamin D deficit/deficiency a priority public health problem at the national level. Vitamin D3 should be elective in preventing deficit. Taking into account the multitude of acute and chronic diseases related to vitamin D deficiency, in order to improve the status of vitamin D in all population categories, it is necessary to include vitamin D3 in the list of molecules fully subsidized by the state and distributed free of charge at least to children under the age of 5 years and adolescents in the period of intensive growth.

59-63

Authors: Daria Ribacova, Olga Cheptanaru, Diana Uncuta

Background: The dysfunction of the temporomandibular joint (TMJ) becomes a significant and serious problem for modern society. TMJ disorder is the pathology of the stomatognathic system that is encountered more and more often every year, because the etiology is different and the pathogenesis is not well investigated. This disease is the result of the action of many factors that are constantly related to each other and over time can intensify and aggravate each other. A large number of studies have been done, articles and scientific papers have been published on the subject to establish the degree of prevalence and severity of this disease. Every year there are more and more patients with this pathology, which would mean that an effective solution in solving this problem has not yet been found and the topic remains relevant to this day. Insufficient knowledge of the mechanisms of this disease is one of the main reasons for the ineffectiveness of the treatment methods used. The objective of the work was to identify the clinical relevance of temporomandibular joint diseases. Conclusions: TMJ dysfunction is a topic that does not lose its relevance, because it is still a problem to identify the causes of pathologies of the TMJ and their treatment. TMJ pathology can be caused by various factors, the identification of this problem should be approached with all seriousness, taking into account all diagnostic methods and a high-quality anamnesis taken from the patient.

5-9

Authors: Olga Penina, Galina Obreja, Elena Raevschi

Background: Disregarding the recent rise in life expectancy in Moldova, the gap with Western countries is very high. The aim of the study is to identify the causes of death and the age groups responsible for excess mortality in Moldova in relation to the European average model in 2001-2019. Mortality beyond the European model set as a threshold was considered excessive. Material and methods: Data were retrieved from the Human Cause-of-Death Database and the WHO mortality database. Multiple decrement life tables by cause were computed for Moldova and the model (Germany, England and Wales, Czech Republic, Poland). Results: 27% of all deaths in males and 13% of all deaths in females under the age of 70 are excessive compared with the model. 80% of excess deaths were attributable to cardiovascular and digestive diseases (both males and females) and external causes (males). Excess deaths were mainly concentrated between the ages of 40 and 70 in men and 50 and 80 in women. Over the study period, cardiovascular diseases contributed the most to the decline in excess mortality in females, but not males. For the latter, excess mortality increased because of the cardiovascular component, completely compensating for moderate progress in external causes of death. Conclusions: Narrowing the life expectancy gap between Moldova and Western countries should be possible through better control of the key risk factors behind the identified causes of death. Key words: causes of death, excess deaths, life expectancy, cardiovascular component.

16-23

Authors: Victoria Verejan, Eugeniu Bendelic, Jana Bernic

Background: Visual disturbances may result in a long-term complication after mild traumatic brain injury (mTBI) in children. These problems may affect both near work and reading, and thus affect activities of daily life and the child’s return to school activity. The purpose of the study was to assess the visual acuity disturbances and refractive status in children with persisting symptoms after mild traumatic brain injury. Material and methods: Forty-eight patients with persisting symptoms after mild traumatic brain injury and anomalies of visual acuity were included. Visual symptoms and refractive status were assessed during the eye examination. Results: Thus, in the mTBI group the visual acuity for the right eye was of 0.09-0.5 in 83.7% (40 patients), in 16.3% (8 patients) – right eye 0.6-0.8, comparing to the control group, where 62% patients had the visual acuity ranged almost in 1.0, just 14% (7 patients) ranged 0.09-0.5 and in 24% (12 patients) – 0.6-0.8. The visual acuity for the left eye in the research group was of 0.09-0.5 in 89.8% (43 patients), in 10.2% (5 patients) – for the left eye was 0.6-0.8, comparing to the control group, where 66% patients had the visual acuity ranged almost in 1.0, just 24% (12 patients) it ranged 0.09-0.5 and in 14% (5 patients) – 0.6-0.8. Conclusions: Visual acuity (VA) is affected primary after head trauma although it has big chances to get better with a vision therapy in a time period ranged between 3 and 6 months after the trauma. In most of the cases, we speak of a blurred vison in the near work and relative unclear perception at far. Autorefraction data usually will reveal a slight hyperopia with a possible astigmatic component ranged between 1D to 3D, and in 4.1%-8.2% of cases a slight myopia referring to the spherical compound and 18.4%-32.7% astigmatic compound, also ranged between 1D and 3D.

31-35

Authors: Andrei Scureac, Serghei Cumpata, Evghenii Gutu

Background: Gastroesophageal reflux disease (GERD) is nowadays a highly prevalent, chronic condition, with 10% to 30% of Western populations affected by weekly symptoms. The patient who does not respond to the empiric antisecretory treatment, with alarming symptoms, or referred to surgery should undergo an esophagogastroduodenoscopy (EGD). Material and methods: This was a retrospective and descriptive study of patients with GERD admitted for antireflux laparoscopic surgery from 2012 to 2019. All endoscopic data were analyzed with the following variables: age, gender, reflux esophagitis and its severity, esophageal ulcers and strictures, Shatzky’s ring, Barrett’s esophagus (BE), incompetence of the esogastric junction; hiatal hernia. Results: A total of 152 patients were included in the study. The age of the patients ranged from 19 to 76 years, averaging 52 years. Among them, 97 (63.8%) were women and 55 (35.38%) men. A wide variety of endoscopic features has been found: non-erosive GERD (6.57%); reflux esophagitis (Savary-Miller) – I (21.05%), II (44.07%), III (23.68%); esophageal ulcer (1.31%), BE (1.97%). The majority of patients present axial hiatal hernia (92.76%) corresponding to Hill grade IV incompetence of the flap valve. Hill grade III was present in 4.6% of cases, grade II – 2.63%. Conclusions: The patients with GERD may have a wide range of endoscopic features (from normal to esophagitis, hiatal hernia, strictures and EB). Considering the multitude of data provided by endoscopic examination in patients with GERD, it can be certainly stated that EGD is one of the most important investigations in these patients, and is mandatory in those selected for surgical treatment.

40-47

Authors: Mihail Popovici, Lucia Ciobanu, Ion Popovici, Victoria Ivanov, Mihaela Munteanu, Ion Ion Popovici, Tatiana Danila, Valeriu Cobet

Background: Coronary thrombosis is the key pathogenic mechanism of acute heart attack, including non-ST segment elevation (NSTEMI). Given that, the detection of reliable markers of hemostasis disorders is important in the process of optimizing the diagnosis of NSTEMI. Material and methods: The study was conducted on 54 patients with NSTEMI (average age 69.7±1.5 years). In 60% of cases, 3-vessel disease was noted; 56% of patients had ejection fraction >50%, and Killip class I of heart failure was revealed in 78% of patients. With the help of the STA-Liatest (France) equipment, the blood tests determined the following hemostasis markers: fibrin monomers (FM), thrombotic complex activity of factors II, VII and X. Additional markers like Procoag, the coagulation indicator dependent on circulating phospholipids or SPA, D-dimers, as well as factors C, S and antithrombin III were appreciated. The values of these markers determined by the same method in 20 healthy persons (control group) were used as normal values. Results: Circulating level of FM on admission was increased twice, while the values of Procoag and SPA were significantly decreased by 35.3% compared to the control. Factors C, S and antithrombin III were 54-80% of the control value range, and D-dimers were within the permissible values. In the acute phase of the heart attack, a deterioration of hemostasis indicators was noted, excepting the D-dimers. The levels of FM determined 24 and 72 hours after revascularization were consistently increased (up to 3.8 times) compared to the control, while Procoag and SPA decreased by 54-57%. Further reduction of factors C, S and antithrombin III accounted for 42-54% of normal indicators. After 5 days, an improvement in hemostasis markers was observed, but a significant difference still remained comparing to the control group. Conclusions: The hemostasis particularities discovered in patients with NSTEMI indicate the features of an activated prothrombotic status, and FM could be an important diagnostic marker of NSTEMI, due to its most significant deviation from the normal value (>100%). It can reliably reflect the thrombin level, which triggers the last enzymatic phase of thrombus formation.

56-60

Authors: Stela Vudu, Gouri Durga Krishna

Background: Hypothyroidism is the deficiency in the production of thyroid hormones to meet the requirements of peripheral tissues. Subclinical hypothyroidism (SCH) is defined biochemically as normal serum free thyroxin concentration in the presence of an elevated serum thyroid-stimulating hormone (TSH) concentration. SCH may be associated with low-grade systemic inflammation (increased high sensitivity-C reactive protein (hs-CRP), one possible explanation may be that TSH in adipocytes promotes the release of interleukin-6 (IL-6). Studies have confirmed inflammatory biomarkers like hs-CRP and IL-6 to be a predictor of cardiovascular (CV) events. However, the treatment of SCH remains subject to debate. Conclusions: It is increasingly evident that SCH has prognostic values and crucial clinical effects, which leads to the view of SCH not being a compensated biochemical change sensu strictu. Even a modest but consistent fluctuation in the circulating thyroid hormone levels can create a response from the human heart. Well-timed treatment should be considered as a precaution to avoid the unfavourable CV diseases. The inflammatory biomarkers, namely CRP and IL-6 are exceptionally robust markers of cardiovascular risk. Thus, using these biomarkers may be helpful in assessing the cardiovascular risk in patients with subclinical hypothyroidism.