Moldovan Medical Journal

3-9

Authors: Lesnic Evelina

Background: Tuberculosis represents a social-related disease and for identifying the priority interventions for reducing its impact must be identified the main disparity features of patients. Material and methods: Global Competitiveness Report and Report of the National Centre for Health Management were used. The clinical study was retrospective, randomized, selective, and included 263 new pulmonary TB cases registered in three different Moldovan regions: Chisinau (center), Balti (north) and Cahul (south). Results: Attributable risk identified that in Chisinau compared to Balti predominated patients in economical vulnerable state, without health insurance, GeneXpert MTB/ Rifampicin sensible and those who successfuly finished the treatment. In Balti compared to Chisinau predominated chronic alcohol abusers, co-morbid patients, severe pulmonary tuberculosis, direct addressing to the hospital, patients infected with GeneXpert MTB/Rifampicin resistant strains of Mycobacteria. The major differences between Chisinau and Cahul groups, with predominance in Chisinau were homeless, co-morbid patients and those who successfully finished the treatment course. In Cahul predominated patients with rural residence, direct addressed to the regional hospital and severe forms of tuberculosis. Comparing the Balti and Cahul groups was established the predominance in Cahul of patients with rural residence, in economically vulnerable state and patient’s detection by general practitioner. In Balti predominated co-morbid patients, alcohol abusers, patients with severe forms of tuberculosis. Conclusions: Reduction of health care inequality will be achieved through social assistance of vulnerable groups and improvement of the general public life.

17-22

Authors: Lacusta Victor, Fala Valeriu, Romaniuc Dumitru, Bordeniuc Gheorghe, Fala Paula

Background: Caffeine is one of the most widely-used psychoactive substances, having multiple stimulating effects. Caffeine is being considered as eliciting a dose-dependent effect on sleep bruxism. Material and methods: There were investigated 100 patients with primary sleep bruxism. Patients were clinically examined, there were given several questionnaires, and they underwent a series of investigations: sleep bruxism recording; surface electromyography, occlusal reflex determination, jc.SSR (jaw clenching sympathetic skin response) recording and masseter muscle ultrasonography. Results: In patients with primary sleep bruxism, there were observed various coffee intake patterns/24 h: “abstinent” group – 32%; “1-3 cups” group – 38.1%; “4-6 cups” group – 19%; “>6 cups” group – 11%. People who consume >6 cups/24 h, have increased the number of nocturnal clenches. Pathological occlusal reflex indices were observed in the “1-3 cups” group (76.3%), “4-6 cups” group (89.5%), “>6 cups” (100% cases), “abstinent” group (50%). Disorders associated with the temporomandibular joint and the bruxism-associated pain reach pathological values in individuals who consume 4-6 or more cups of coffee. Excessive caffeine consumption leads to the increase of the amplitude of the sympathetic autonomous potential (jc.SSR, A2, mV) without significant changes in the central autonomous regulation time (jc.SSR, T, s). Conclusions: There were observed various coffee intake patterns in patients with primary sleep bruxism. Excessive coffee consumption is associated with the stress level. The masseter muscle thickness and dental wear show no statistically significant elevation trends, under the influence of various caffeine doses.

30-33

Authors: Oshurko Anatolii, Oliinyk Ihor, Tsyhykalo Oleksandr

Background: The research aims at identifying new methodological approaches to the study of morphological patterns of prenatal development of the human upper jaw. Material and methods: A working model has been developed and a device has been proposed, reasonable to be used for fixation of the examined object in a vertical position during computed tomography of maxillofacial and craniocerebral regions. For proper operation of the device there was introduced a method of vertical fixation of the examined objects during computed tomography of maxillofacial and craniocerebral regions. Results: In the basis of the useful model lies the task to develop a method of vertical fixation of objects under study during the computed tomography of maxillofacial and craniocerebral regions by holding the examined object of up to 540 mm in size; the object is fixed to the planetable using the right and left retainers that are fixed in vertical openings; the height is regulated with the help of the rack, connecting the planetable with the tripod; swivel mounting is led to the facial part of the examined object and the chin is fixed on the table; then the vertical and horizontal position of the chin is regulated by means of sliding vertical and horizontal mounting; the fixed examined object is then moved to the CT scanner with the help of mobile tripod supports. Conclusions: The proposed method is effective for vertical fixation of examined objects during the computed tomography of maxillofacial and craniocerebral regions in the desired position, that contributes to getting qualitative indicators of the examination and can be used during the spot-film radiography in direct and lateral projections in stable and desired position of the head and at the correct distance without imposing additional densities (shades) to provide accurate diagnostic results.

37-41

Authors: Lesnic Evelina, Kulcitkaia Stela, Niguleanu Adriana

Background: Tuberculosis represents the major threat for the health protection in the military forces. The aim of this retrospective and descriptive study was the evaluation of risk factors, clinical presentation and treatment outcomes of tuberculosis in military recruits. Material and methods: 51 military recruits with tuberculosis diagnosed during 01.01.2010-31.12.2015 in Chisinau military quarters and managed in the Hospital of Pneumophtysiology were assessed. Results: Most of military recruits aged 18-22, were residents of the rural localities, graduated incomplete general school or lyceum and were economically vulnerable. One half of the group consisted of active smokers and every tenth patient abused alcohol. Every fourth patient had tuberculosis in childhood and every tenth had family contact with a tuberculosis-affected person. Disease’s insidious onset was established in one half of the group and the acute onset in every fourth patient. Every tenth patient was diagnosed with tuberculosis within the first 6 months after the enrollment. Only one half of the groups were symptomatic patients, who complained of cough, asthenia and loss of weight. Pulmonary infiltrative tuberculosis predominated among recruits. Extensive infiltrates and involvement of both lungs were identified in a lower proportion. The high rate of successful treatment outcome was endangered by the high rate of lost to follow-up patients, demonstrating poor evaluation and follow-up after the discharging from the hospital. Conclusions: The epidemiological studies among military recruits are limited. The high rate of young, economically vulnerable men with risk factors demonstrates their priority for active screening. Treatment outcomes must be improved by the implementation of the adequate follow-up after hospital discharging.

46-49

Authors: Raevschi Elena

Background: Cardiovascular disease is the leading cause of mortality at the global and national level. Ischeamic heart diseases, cerebrovascular diseases and hypertensive heart disease together identify a highest proportional mortality that defines them as major contribution cardiovascular diseases worldwide. Premature mortality analyzing compared to traditional moves target from classical focus on the occurrence of deaths to focus on the losses caused by these deaths. The purpose of the study is to assess the premature mortality evolution from major cardiovascular diseases among adults in the Republic of Moldova for the period of 2003-2015. Material and methods: the research is a descriptive population study over the time of 13 years. The premature mortality phenomenon was counted in the years of potential life lost (YPLL). Age-adjusted rates were calculated using the direct method of standardization applying WHO World Standard Population Distribution (%) based on world average population between 2000-2025. Results: Overall period from 2003 to 2015, premature mortality rate from ischeamic heart diseases (+10.7%) and hypertensive heart disease (+41%) have registered increasing trends versus premature mortality rate from cerebrovascular diseases with decreasing trend (-23.9%). All together determined the decreasing trend (-2.4%) of major cardiovascular diseases premature mortality rate. When analyzing percentage changes of premature mortality increasing trends by age, the study findings identified the higher percentage changes in younger groups for ischeamic heart diseases premature deaths than hypertensive heart disease. Conclusions: Despite the general decreasing trend of major cardiovascular diseases premature mortality rate, ischemic heart diseases compared to cerebrovascular and hypertensive heart disease identify the most pronounced trends of the deaths event rejuvenation in the Republic of Moldova for the period 2003-2015.

54-57

Authors: Raevschi Elena, Ababii Ion, Vataman Eleonora

Background: Implementation of ongoing behavioral risk factor surveillance system (BRFSS) can improve prevention and control of noncommunicable diseases (NCDs) in the Republic of Moldova. Delphi study regarding the development of ongoing behavioral risk factor surveillance system in the Republic of Moldova contributes to evidence-based credible model of implementation in order to support National Strategy on Noncommunicable Diseases Prevention and Control for the period 2012-2020. The article has highlighted the aspects of designing Delphi survey which should be considered for making sense of consensus. Material and methods: The study used Delphi techniques to achieve in an effective way experts’ consensus in terms of development of ongoing BRFSS in the Republic of Moldova. Results: The research found that Delphi panelists similarly trained and competent in the area of knowledge related to the target issue contributed to achievement of the consensus agreement for all items in discussion regardless the national or international affiliation. Conclusions: Well-designed Delphi panel are important for effective and reasonable survey management in terms of achieving feasible consensus agreement to support effective decision-making for further development.

3-6

Authors: Ciobanu Natalia, Ciobanu Sergiu

Background: Patients with stroke associate a lot of complications; one of the most serious is femoral neck fracture. Nearly 30% of patients who have suffered femoral neck fracture die during the first year, in the survivors persists pronounced pain syndrome and reduced motility in the affected limb, and they become dependent in their habitual activities. Material and methods: The notes of all patients with fractured neck of femur who were admitted to Clinical Hospital of Traumatology and Orthopedics, Chisinau, the Republic of Moldova, between January 2014 and December 2015 were scrutinized. Results: In a series of 67 hemiplegic patients who subsequently fractured their hips, it was found that hip fracture occurred significantly more often on the hemiplegic side. Hip fracture was equally common in right and left-sided hemiplegia, and often occurred within five years of the stroke. Conclusions: Hip fracture after stroke is an increasingly recognized problem. Measures to prevent bone loss and preserve bone architecture have not been part of stroke management thus far. Because rapid bone loss is a risk factor for fracture, we believe that kinesiotherapy in the early phase of stroke rehabilitation is indicated. If a successful prevention program could be worked out in stroke patients, there would be potential saving of lives, suffering, and resources.

13-17

Authors: Railean Silvia

Background: There is no information about cranio-facial asymmetry among school children and the influence of this pathology on the quality of life. Material and methods: The study presents a descriptive analysis of 3923 children ages 7 to 18 years. In this scientific work were involved three types of schools: 421 children from schools with severe neurological disorders; 2157 children from auxiliary schools with special educational needs; and 1345 children from pre-university schools. Buccal examination included the dento-maxillary analysis in three planes (sagittal, vertical, and horizontal) and cranial anatomical shape was examined for all children. Results: In total 3923 children were examined, of which 632 (16%) were determined with cranial asymmetry. Among 2157 children from auxiliary schools for children with special educational needs 18% were detected with cranial deformities. In schools for children with neurological disabilities cranial asymmetries were detected in 44.18%, and in pre-unuversity schools 4.76 % were found with cranial deformities. A high incidence (twice more) of dental alveolar anomalies were found in children with cranial deformities, compared to those without deformities in the sagittal plane, 15.5% of children with cranial deformities were found with dento-alveolars anomalies and 7.84% in children without cranial deformation was (P<0.001). Similar resultswere found in the determination of occlusion anomalies in the horizontal and vertical planes. Conclusions: The high incidence of cranial deformities was found among handicapped children and children from schools with special educationalneeds. A few children with cranial deformities were found among children from pre-university schools. It was proved that a high risk of dento-alveolaranomalies have children with cranial deformities.

22-25

Authors: Olaru Andrei

Background: Vertebral cement augmentation and external beam radiotherapy have become increasingly used techniques for treatment of vertebral compression fractures due to spinal metastatic lesions in the Republic of Moldova. Surgically, the goal of vertebral cement augmentation is to improve the strength and stability of the injured vertebrae, as well as local tumor control. External beam radiotherapy for suppressing tumor or inducing pain relief are performed immediately after vertebral cement augmentation. Usually, local tumor control is occurred by CT or MRI studies. We have studied through the infrared thermography the dynamics of temperature gradient of tumoral foci skin projection. Material and methods: The purpose of this study is to evaluate the local tumoral control, analyzing the infrared thermographic examinations in 33 patients with uncomplicated metastatic vertebral fractures, undergoing combined method of treatment (vertebral cement augmentation + external beam radiotherapy), before the treatment and at 12 months follow-up. Results: We observed an indirect tumor “thermographic field” decrease registered by temperature gradient decrease from an average of 2.03±0.24ºC in preoperatively to 1.28±0.33ºC at 12 months postoperatively follow-up. Conclusions: Combined method of stabilization (vertebral cement augmentation + external beam radiotherapy) in patients with uncomplicated metastatic vertebral fractures is effective in minimal invasive surgery and offering local tumor control.

31-34

Authors: Baltaga Ruslan, Tibirnac Petru

Background: Circulation insufficiency is one of the most common dysfunctions in the patients admitted to the intensive care units (ICU) [1]. These patients need an intravenous (IV) vasoactive drug administration to optimize or support cardiovascular system (CVS). Emergency situations, hard work conditions, difficult devices’ usage and a lot of other specific factors of complex environment of ICU create favorable conditions for the occurrence of medical errors (ME). Material and methods: Within this prospective study were examined the methods of administration and the types of the errors that were found during the administration of the following drugs: epinephrine, noradrenaline, dopamine and dobuthamine. In the period of time May – September 2016, were examined 50 patients from ICUs from 4 different hospitals. The age limits were between 31-100 years old. The data collection was accomplished on the base of a questionnaire prepared beforehand. Results: From all the number of examined patients, 33 (66%) were men and 17 (34%) – women. The body weight was indicated in the medical notes of 21 (42%) patients. To 15 (30%) of them was administrated the adrenaline, noradrenaline had the incidence in 15 patients (30%) and dopamine – 17 patients (34%). Conclusions: Tracked dosage errors in 20% of cases, 4% of them were found at dilution administration of the drugs. The inscription of administered drug in medical notes was lacking in 2 uses.

41-44

Authors: Grib Liviu, Cenusa Octavian, Varvariuc Viorica, Abras Marcel, Grib Andrei, Grajdieru Romeo

Background: Atrial fibrillation (AF) is associated with a 5-fold increase in the risk of stroke and a 3-fold increase in the incidence of heart failure. The increase in AF prevalence can be attributed both to better detection of silent AF, alongside increasing age and conditions predisposing to AF. Nonpharmacological measures aimed at «healing» AF were initially tested in open surgery. Searching for an approach with a greater chance of success led to the development of radiofrequency ablation (RFA). Only recently RFA technique began to be used extensively in people with AF, not being tested in large randomized studies, with establishment of remote results. Conclusions: Catheter ablation is used successfully in patients suffering from symptomatic paroxysmal atrial fibrillation, as an alternative to drug therapy. Performed correctly by a trained and experienced electrophysiolologist, RFA allows us to get remarkable results, being possible suspension of treatment with antiarrhythmic drugs and to avoid its so well known side’s effects. RFA with catheter is superior to antiarrhythmic drug therapy in preventing recurrence in both persistent AF and in the paroxysmal AF. The success rate of RFA in experienced centers for paroxysmal AF exceeds 70% a year. RFA reintervention is necessary in the approximately 9-20% of patients with more modest results. The frequency of major complications related to RFA is less than 5%. The restored sinus rhythm with RFA in patients with heart failure may be associated with significant improvement in left ventricular ejection fraction.

3-9

Authors: Fulga Veaceslav, Ceausu Amalia Raluca, Cimpean Anca Maria, Saptefrati Lilian, Raica Marius

Background: Due to its anti-apoptotic and anti-proliferative contradictory functions, BCL2 role in breast carcinoma progression is not clearly understood. The purpose of this study was to highlight BCL2 expression during metastatic progression of invasive breast carcinoma of no special type (NST). Materials and methods: The specimens, primary tumors and corresponding lymph node metastases (LNM) from 84 patients were immunostained for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor (HER)-2, basal cytokeratin CK5, nuclear protein Ki67 and B-cell lymphoma (Bcl)-2 receptor. Results: BCL2 expression was higher at primary site than in axillary metastases. Its score correlates positively with hormone receptors’ level and negatively with HER2, CK5 and Ki67 at both sites. Switch of molecular profile was determined in 22.62% of cases. BCL2 expression was not influenced by subtypes switch. Changes of BCL2 expression were found in 25% of cases with stable molecular subtype. The Luminal A and Luminal B/Ki67 were encountered in the majority of BCL2 transitions, mainly from positive to negative state. Conclusions: Molecular subtypes and BCL2 expression are not stable during tumor progression and metastatic development. In the present study we established immunohistochemically that BCL2 is not influenced by subtypes’ transitions. BCL2 switches were encountered only in cases with a stable HER2, Luminal A or B phenotypes. We expect a further confirmation of our results by other research groups.

15-19

Authors: Visternicean Elena

Background: It is known that etiological structure of recurrent miscarriage has genetic, anatomical, infectious and immunological factors; however, the cause of recurrent miscarriage in 50-60% of cases is not completely clear. Homocysteine is a sulfur-containing intermediate product in the normal metabolism of methionine. Development mechanisms of vascular complications of hyperhomocysteinemia are currently being intensively studied. Hyperhomocysteinemia affects a number of mechanisms involved in thrombogenesis including coagulation cascade, vessel-thrombocytic section, oxidation-reduction reactions, endothelium, and vascular smooth muscle cells and is associated with an increased risk of adverse outcomes in pregnancy. Materials and methods: The study included 50 women who had experienced the loss of at least two consecutive pregnancies. The level of the total serum homocysteine was measured via the chemiluminescent method. Results: We found that plasma homocysteine concentration < 10 μmol/l was found in 16 patients (32,0%, 95% CI 19,07 – 44,93), 9 patients (18.0%, 95% CI 7,36 – 28,64) had a fasting plasma homocysteine between 10 μmol/l to 12 μmol/l and 25 patients (50.0%, 95%CI 36,15 – 63,85) had significantly high total serum homocysteine values. Among them, 23 patients (46.0%, 95%CI 32,19 – 59,81) had the concentration between 12 – 30 μmol/l and 2 patients (4,0%, 95%CI -1,43 – 9,43) had the concentration > 30μmol/l. The complex of B vitamin supplementation was recommended at least 2 to 3 months before conception. In the current study, 40 women (80.0%, 95% CI 68,92 – 91,08) have become pregnant, passed the critical periods for pregnancy loss and continued the folate intake during the pregnancy. Conclusions: The prevalence of hyperhomocysteinemia was more in unexplained primary early recurrent miscarriages. The complex of B vitamin supplementation was recommended at least 2 to 3 months before conception and 40 women (80.0%, 95% CI 68,92 – 91,08) became pregnant, passed the critical periods for pregnancy loss and continued the folate intake during the pregnancy.

22-25

Authors: Mamadova Farah, Azizova Gulnara, Dadashova Arzu

Background: The aim of this work is to study the markers of apoptosis (granzyme B) and oxidative stress (nitric oxide), as well as indicators of endothelial damage - cystatin C and lipid metabolism in patients with congestive heart failure, and to identify the relationship between these parameters. Material and methods: The study included 114 patients (men and women) with congestive heart failure (CHF), out of which 41 patients with CHF, 39 patients with CHF and diabetes mellitus type 2, and 34 patients with CHF with metabolic syndrome. Biochemical parameters were measured with the help of reagent sets produced by “Human” company (Germany), the contents of granzyme B and cystatin C – with the help of commercial sets produced by “USCN Life Science Inc” company (China), while nitric oxide concentration was determined using a commercial kit by “R&D System”. Results: Analysis of indicators of apoptosis factors and oxidative stress in studied patients revealed a substantial increase in patients with heart failure in the presence of diabetes mellitus type 2, compared to two other groups of patients. The concentration of cystatin 3 in patients with diabetes mellitus type 2 increased significantly with *р <0,05. Conclusions: The studied parameters allow us to suggest that complications in CHF are due to the intensity of oxidative stress, apoptosis and atherogenesis, and are interconnected with biochemical changes in lipid and carbohydrate metabolism.

32-34

Authors: Kramar Hanna

Background: Screening studies have revealed in new 3-(2-R1-6-R2-4-oxyquinoline-3(4H)-yl)alkyl (alkaryl-, aryl) carboxylic acid derivative (PC-66 compound) expressive analgesic properties without any damaging effects on the stomach. Therefore, in-depth study of the pharmacological properties of PC-66 compound as a pain management agent is considered topical. Objective of the study – to evaluate a pain-killing effect of PC-66 compound compared to ketorolac and diclofenac sodium on various rat pain models. Material and methods: In experiments on 101 Wistar male rats (180-210 g) of somatic model (tail-flick) and neuropathic pain model (ligation of the sciatic nerve), and formalin test (5% formalin solution, 0.1 ml subplantarly) we investigated the antinociceptive activity of the PC-66 compound (1.0 mg/ kg) versus ketorolac (2.4 mg/kg) and diclofenac (4.0 mg/kg) administered intraperitoneally. Results: In the tail-flick model, PC-66 compound presented significant growth of PT at Hour 1 and Hour 2 by 40.6% and 50.6%, respectively. The analgesia effect of the test compound was superior to the one of diclofenac sodium, but inferior to ketorolac at Hour 1 and Hour 2, yet surpassed it by duration of action. In the formalin test model, analgesic effect of compound PC-66 was the most evident in the first (central) phase, and slightly changed the latent period and duration of the second phase of the test, while diclofenac mostly influenced Phase II (inflammatory) of the formalin test. In the model of neuropathic pain, compound PC-66 also demonstrated pronounced pain-killing effect: PT of subject rat limb grew on average by 46.7% in 2 hours following intraperitoneal administration. For this activity, PC-66 was slightly inferior to ketorolac, which caused PT growth by 51.9%. Conclusions: new 3-(2-R1-6-R2-4-oxyquinoline-3(4H)-yl) alkyl (alkaryl-, aryl) carboxylic acid derivative (PC-66 compound) presented distinct analgesic effect both in somatic and neuropathic pain models.

39-43

Authors: Bernaz Emilian P., Ciobanu Gheorghe Ch., Tentiuc Elizaveta V., Borovic Eduard I., Vovc Liviu A.

Background: Antibiotics have had a profound impact on humanity’s health, by improving our ability to prevent, cure and reduce the transmission of many infectious diseases. It is widely known, that the unnecessary or inappropriate use of antibiotics, occurs up to 50% of prescriptions only in the United States and Canada. Fortunately all negative impact on the human health can be roughly imagined. Material and methods: For this study we used the data of a six-year (2009-2014) period in the Emergency Medicine Institute and their main subdivisions which show the consumption dynamics of antibacterials use in natural indexes. Results: The total annual medium consumption of antimicrobials was registered as the following: ICD 1796.98 DDD/1000, SSOTD 566.12 DDD/1000 and EMI 584.05DDD/1000, with the parenteral to enteral forms share of respectively 94.67% to 5.33%, 85.62% to 14.38% and 83.52% to 16.48%. Five from nine main groups: beta-lactam antibacterials, penicilins, other beta-lactam, aminoglycoside, other antibacterials and quinolone antibacterials registered around 90% of all antibiotics consumption. Comparatively to Australian hospitals and hospitals other worldwide countries in EMI consumption per DDD/1000 was lower: by 3.39 and 2.22 times for tetracyclines, by 5.1 and 4.63 for beta-lactam and penicilins, as well as by 2.55 and 1.63 for macrolides and lincosamides. Conclusions: The obtained data about the dynamics of antibacterials consumption in EMI and their main departments, in comparison with hospitals from other worldwide countries, represents important arguments and reserves for improving quality treatment, planning, rational prescription and utilization of antibiotics in hospitals.