Moldovan Medical Journal

8-12

Authors: Мamedgasan Agaev, Tarana Agaeva

Background: The purpose of this study was to assess the effectiveness of the combined use of high doses of heparin, propranolol and monopril with percutaneous coronary intervention (PCI) on eco-endotoxicosis, systolic blood pressure, diastolic blood pressure, heart rate (HR), cardiodynamics and on the clinical course in acute myocardial infarction (AMI) among patients working in environmentally unfriendly conditions. Material and methods: The study was conducted on 42 patients, aged 30 to 70 years (56.7 ± 1.20 years) with acute coronary syndrome (ACS), who were assessed for the anterior Q wave MI and ST segment elevation MI. Of 42 patients, 21 were treated with monopril, propranolol with heparin and PCI (group 1); and 21 patients underwent only PCI (group 2). The degree of eco-endotoxicosis in blood was studied in both groups, whereas the echocardiography and Doppler echocardiography were used to determine the end-systolic volume (ESV), end-diastolic volume (EDV), left ventricular ejection fraction (LV EF), local LV contractile dysfunction, local contractile dysfunction index (LCDI), restenosis via a repeated coronary angiography, echographic study of ST segment elevation and of repeated anginal pain. Results: Patients treated with monopril with propranolol and heparin with PCI exhibited a stabilization of central hemodynamic indices, by a decrease in ESV, EDV, LCDI, and the degree of eco-endotoxicosis, as well as an improvement of LV systolic function by an increased EF. However, one patient from this group had an acute heart failure (AHF) on the 3rd day, whereas one patient experienced a MI relapse. The group of patients who underwent only PCI, revealed 3 cases of MI recurrence, 3 cases of restenosis, 2 cases of AHF and 2 patients died. Conclusions: The combined use of drug and PCI therapy in acute coronary syndrome might lead to positive prognostic outcomes, rather than a separate PCI approach.

19-25

Authors: Tatiana Timbalari

Background: Safe and sustainable supply of tissues and cells for human application is an essential pillar in modern medical assistance and a priority for the health authorities both at national and international level. Material and methods: The study protocol for the needs assessment in tissue and cell grafts for the healthcare system was approved by the Ethic Committee. The survey of 161 surgeons was carried out in 24 institutions, through specially developed questionnaires. In order to validate some data obtained through questionnaires, the analysis of already existing national data and sources was performed. Results: Most surgeons (93.4%) declare that the institution they work at has been provided with a sufficient number of grafts for all patients needing transplantation. Despite this, the estimation of surgeons’ opinion regarding the need for grafts showed that 59.4% of respondents consider that they have enough grafts, 21.7% of respondents deal with exceptional cases of lack of grafts, 13.2% respondents consider that there are sufficient grafts for urgent patients and, sometimes, for non-urgent patients. Conclusions: The study revealed that increasing the number of tissue transplantations will contribute to improve the patients’ life quality and increasing the number of transplanted patients over the next 5 years is a priority measure in the management of the institutions included in the survey.

29-32

Authors: Alina Alsatou

Background: The umbilical cord forms connecting link between the fetus and placenta through which the fetal blood flows to and from the placenta. Its three blood vessels pass along the length of the cord in a coiled or helical fashion (spiral course). The aim of the study was to evaluate umbilical cord coiling abnormalities and determine its relationship with maternal and perinatal outcomes. Material and methods: The study included 190 patients divided into 2 groups: L1 – 95 patients with UC abnormalities and L0 – 95 with normal UC. The umbilical cord index was measured after delivery of the adnexal complex, which was defined as the total number of coils divided by the total length of the cord in centimeters. Results: The hypo- and hypercoiling umbilical cord suggests the high risk of fetal distress (p <0.0001), instrumental vaginal deliveries, the admission of the newborn in the neonatal intensive care (p<0.0001) and perinatal morbidity, which demanded a transfer to other medical facilities (p<0.05). UC torsion was associated with insufficiency of placental circulation, IUGR, fetal hypoxia and fetal mortality (p<0.05). The straight cord had significant correlation with maternal infections, antenatal mortality and preterm labor in anamnesis, placental insufficiency, IUGR and neonatal morbidity (p<0.05). Conclusions: Umbilical coiling index was found to be an important predictor of adverse maternal and perinatal outcomes. To conclude, abnormal umbilical coiling index is associated with an increased rate of adverse antenatal and neonatal features. The association shows wide variations in the numerous studies done so far.

39-43

Authors: Mihaela Burac, Natalia Corolcova, Valentin Friptu

Background: Structural transformation of the endometrium during the menstrual cycle is a genetically determined process and is provided by complex molecular-biological interactions aimed at the onset and development of pregnancy. Sex steroid hormones play a key role in endometrial morphogenesis, which mediate or directly affect angiogenesis and immunogenesis. Conclusions: The primary function of the endometrium is to provide an immuno-privileged site for embryo implantation and to provide a nurturing environment for the fetus during pregnancy. The cyclic differentiation of the endometrium depends on the actions of steroid hormones that act through specific down – stream mechanisms involving complex molecular signaling. The endometrium undergoes repetitive episodes of proliferation, secretion, and menstruation, up to 400 times during a woman’s life, without apparent signs of aging. The human endometrium undergoes complex and dynamic changes during the menstrual cycle. Thus, the combination of molecular, endocrine, biochemical, immunological factors leads to a complete transformation of the endometrium during the menstrual cycle. Secretory transformation of the endometrium with an appropriate ratio and distribution of estrogen and progesterone receptor expression, complete angiogenesis and immunological balance determine implantation, placentation and pregnancy development.

52-58

Authors: Olga Ignatov, Oleg Pascal, Viorel Nacu

Background: Peripheral nerve trauma remains a major cause of motor disability, at the same time functional restoration after treatment continues to show modest results. Acupoint embedding therapy is a type of acupuncture treatment in which different biodegradable materials are inserted into specific points for long-term stimulation. It has a good analgesic effect in chronic pain, and it is considered a cure for many diseases. Different biodegradable materials have been developed and widely used. Catgut has a good biodegradability and low price, but it could cause infections and having unstable chemical properties had been limited in clinical use. Such synthetic materials as polylactic acid and polyglycolic acid present low-cost, good biodegradability and biocompatibility compared with the catgut. However, their poor hydrophilicity and cell adhesion limited their therapeutic efficacy. The ideal embedding materials are required to be safe, non-toxic, biocompatible, and to have excellent swelling and biodegradation behaviors. Acupoint embedding therapy can be a promising treatment method of peripheral nerve disorders. Conclusions: Acupoint embedding therapy is an invasive treatment which can prolong point stimulation, reduces the frequencies of pain and psychological fear of patients. It seems to be a promising method of neuropathy treatment. The properties of the filaments for acupoint embedding therapy can be improved by surface modification technologies.

64-74

Authors: Oleg Arnaut, Dan Croitoru, Ion Grabovschi, Serghei Sandru

Background: Worldwide, traumas represent an actual theme of discussion. The recognition and interpretation of severe traumas are essential for choosing the right treatment strategy. There are two approaches to mark the patients with a high risk of unfavorable evolution and death. First, to use the terms as “major trauma”, “severe trauma” and “polytrauma”, without ability to stratify the patients according the severity of lesions inside categories mentioned above. Second, to implement the trauma scoring systems (anatomical, physiological or mixed), when a doctor uses a mathematical algorithm/model to calculate the risks for each trauma patient. At the same time, according to the articles found on PubMed/Medline, Web of Science, and EBSCO databases, there is no international consensus concerning the most accurate traumatic score. This article’s goal was to revise the existing trauma scoring systems to highlight the potential scoring systems that in perspective can be validated in the Moldovan medical system. Conclusions: Different traumatic scores are used worldwide (different continents, countries or regions) to estimate the severity of trauma patients in relation to the anatomical, physiological or combined criteria. All of them could be potentially validated for the Moldovan medical system. A part of these scores could be validated and compared to identify those ones that have the best determination, calibration and discrimination abilities to predict the outcomes for the local medical system. As a result, the coefficients from the mathematical equations belonging to the scores could be adjusted to the conditions of the national medical system of the Republic of Moldova.