Moldovan Medical Journal

8-12

Authors: Maniuc Mihail, Ababii Polina, Danilov Lucian, Ghinda Serghei

Background: Determination of the general immune status and the effectiveness of the complex treatment with local immunostimulation (autologous mononuclear cells) of chronic rhinosinusitis in children. Material and methods: The general immunity status and the effectiveness of the complex treatment with local immunostimulation were examined by the application in the maxillary sinuses of activated autologous mononuclear cells in 19 children with chronic rhinosinusitis and 116 healthy children. Results: The presence of allergic reactions by increase in IgE and CD4/CD8 index was determined in patients examined. The sensitization to streptococcal antibodies was assessed by the cell sensitization data and the presence of streptococcal antibodies according to ASL-0 data. The inhibition of the T-cells was functional decrease of T-lymphocytes in the TTBL test with phytohemagglutinin and tendency towards a decrease of the T-CD-3 lymphocytes titer. The compensatory activation of the B-cells (increase in the IgA titer) was determined. The objective follow-up examination of the patients over one year revealed the absence of hyperemia and edema of the nasal mucosa, while an insignificant nasal obstruction was present in 5 children. The rhinomanometric examination demonstrated an increase in total volume indices and a decrease in the total nasal resistance in all treated children. The new method of local immunocorrection of chronic rhinosinusitis in children proved to be clinically effective. Conclusions: There were determined increased IgE, CD4 / CD-8 index and CIC (PEG-8% with low molecular weight), cellular sensitization to streptococcal antibodies according to TTBL data, inhibition of the T-cells and tendency towards a decrease of T-CD-3 lymphocytes. Also, the compensatory activation of the B-cells (increase in the IgA titer) was determined.

18-23

Authors: Ghicavii Victor, Bacinschi Nicolae, Podgurschi Lilia, Turcan Lucia, Chianu Marin

Background: The rational use of medicines remains one of the most important directions of public health, especially in socio-medical diseases, including arterial hypertension. Material and methods: The study involved 28 cardiologists and 84 internists who, based on a set of questionnaires, expressed their opinion on ambulatory treatment of patients with arterial hypertension. Also 21 internists, 6 cardiologists and 6 obstetrician-gynecologists expressed their opinion on treatment of pregnancy-induced hypertension. Results: Cardiologists and internists recommended angiotensin-converting-enzyme inhibitors (ACE inhibitors) in 28% of cases, diuretics – in 23% of cases, beta-blockers (BB) – in 20, 4% of cases, calcium channel blockers (CCB) – in 13.7% of cases, angiotensin receptor blockers (ARB) – in 13.6% of cases for ambulatory treatment of patients with arterial hypertension. The antihypertensive drugs from other pharmacological groups (with central action, alpha-blockers, arteriodilators, sympatholytics, etc.) were prescribed in only 1.3% of patients. On treatment of hypertension in pregnancy showed that all physicians – 100% recommended as first-line agent for treatment of hypertension during pregnancy centrally acting antihypertensive drug Methyldopa. For second-line treatment they recommended CCB – in 36.36% of cases, alpha-adrenoblockers – in 24.24% of cases, BB – in 21.21% of cases, diuretics – in 12.12% of cases and 3% for ACE inhibitors and ARB. For treatment pre-eclampsia and eclampsia seizures in 84.85% of cases is recommended Magnesium sulfate and 15.15% mention labetalol, hydralazine and sodium nitroprusside. Conclusions: ACE inhibitors, diuretics, BAB, CCB and ARB have been first-line drugs in the arterial hypertension (AHT) treatment. For treatment of pregnancy-induced hypertension physicians recommended centrally acting antihypertensive drug Methyldopa. For second-line treatment they recommended calcium channel blockers (CCB), alpha-adrenoblockers, beta-blockers (BB) and diuretics. As third-choice in treatment of severe hypertension in preeclampsia are selected direct vasodilators as hydralazine, labetalol, sodium nitroprusside, and the most widely used in preeclampsia and eclampsia remains magnesium sulfate.

29-35

Authors: Pantea Valeriu

Background: The functional organization of the service, institution or organization requires adjustment to challenges of the social, economic, and professional environment that intervene development stages of society. This is also true for the Public Health Supervision Service. Material and methods: The results are based on evidence of historical achievements, statistical activity data in public health surveillance, the disease prevention, data on managers’ opinion about ways to streamline institutional work, including some results of the economic activity of the institutions. Results: The diminished activity in the prevention of non-communicable diseases is determined by the scarce budget for public health surveillance activities, the lack of staff and the inappropriate approach of the methodology for monitoring environmental factors in relation to the health of the population. Service overloading 1.2-1.4 times to the functional standard, driven by low wages and as a result of staff exodus, has a negative impact on effective indicators of public health coverage. The current model of non-communicable disease prophylaxis, with a particular focus on increasing healthcare investment, does not contribute to improving the population’s health indicators. Conclusions: The functioning of the Public Health Surveillance Service under the conditions of insufficient budget with dispersion of the existing number of institutions does not contribute to the efficiency of public health surveillance. The results of the study, also the health and economic indicators in the health system point to the need for institutional reform to adjust the public health surveillance and financial support for disease prevention activities under the new conditions.

42-48

Authors: Levco Simion, Scerbatiuc Dumitru

Background: Although the symptoms of oral phlegmon have been described before Hippocrates and Galen, there have been discrepancies in the diagnosis and treatment plan appreciation in patients with phlegmon of the mouth floor until now. Ludwig’s angina accounts for less than 1% of all pathologies of maxillofacial surgery. In the pre-antibiotic era, 50% of patients died. At the moment, the mortality rate is below 10%. If the pathology is not treated, patients die in 100% of cases. Data sources: This study was conducted on specialty literature analysis. We analyzed 45 books and 8 articles. The aim of the study is to compare different sources in which the phlegmon of the oral floor is described. Discussion: The phlegmon of the mouth floor can involve only the unilateral spaces of the mouth floor, and the diffuse phlegmon of the mouth floor, also called Ludwig’s angina, compulsory involves bilateral spaces of the mouth floor. Two bilateral incisions in the submandibular regions and one in the submental region is the most practiced surgical treatment. The infection is poly microbial, with a mixed flora: aerobic alpha and beta hemolytic streptococci, staphylococci and gram-negative bacilli, anaerobic bacteroides and peptostreptococcus. Usually, the flora is from the oral cavity and pharynx. Conclusions: Patient intubation is the method of choice when it is possible. Aggressive antibiotic treatment needs to be taken as early as possible. Surgical treatment is required to be performed as early as possible. The number of incisions and their location are chosen depending on the situation.

55-62

Authors: Cheptanaru Olga

Background: The implant-prosthetic restoration in single missing tooth is a viable treatment option for the functional rehabilitation of tooth loss. Several published studies show that the deadline and the type of functional loading of the implant for single missing teeth is not decisive for the survival and success rate of the implant. Although the conventional protocol is still the “gold standard”, the immediate loading of dental implants in the fresh postextraction socket of the aesthetic area has an excellent prognosis. Immediate functional loading is successfully adopted to minimize the treatment time with immediate and impact benefit on the patient’s quality of life and satisfaction. The aesthetic result is not yet systematically included in the success criteria of the therapy through implant, although a trend for this is more common in recent publications, particularly in publications evaluating the implant prosthetic rehabilitation in the anterior maxilla and mandible. In order to obtain optimal aesthetic results, it is necessary to take into account the other aesthetic parameters, together with the chosen material for the fabrication of the implant-supported single crown and the type of prosthetic abutment. Conclusions: The systematic review of the contemporary specialty literature examines the types of implantations and implant-supported restorations for single tooth replacement, the survival rates of the implant, the survival of the crown on the implant and the successful implant, incidence of biological, technical and aesthetical complications of the implants and prosthetic restorations on implants, the quality of life related to the oral health to patients with implant-prosthetic treatment.