Moldovan Medical Journal

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.