Moldovan Medical Journal

5-9

Authors: Aliona Nastas

Background: Septic purulent nosocomial infections (SPNI) are one of the most significant healthcare challenges of post-surgical procedures. SPNI are associated with increased morbidity, mortality and admission costs. It is a priority to determine the level of nosocomial infections (NI). This study aims to evaluate the bacterial contaminations after cardiac surgery within the Department of Acquired Heart Defects (DAHD). Material and methods: A cross-sectional study was designed and the medical records of 1189 patients who underwent cardiac surgery within the DAHD of a multiprofile hospital were retrospectively analyzed. The data were collected and stored in a Microsoft Excel spreadsheet. Results: The incidence rate of SPNI following cardiac surgery was 317.57‰ compared to 15.02‰ officially reported (p <0.001). Of the most common infections among the total of 418 cases of SPNI studied, 32.06% were surgical site infections, 23.18% were associations of infections, 19.14% – respiratory tract infections. A patient with SPNI has an average of 22.25 days/bed spent in hospital, compared with the average for a patient without SPNI of 12.27 days/bed. The etiological structure includes 28 species of microorganisms including gram-positive (61.92%) and gram-negative (38.08%). Conclusions: Given the relatively high incidence of the SPNI and its impact, it is imperative to take more serious measures to prevent and control these infections.

17-22

Authors: Diana Guranda, Cristina Ciobanu, Nicolae Ciobanu, Rodica Solonari

Background: Urinary tract infections are the most common urogenital diseases, with an increased incidence in men and older people. Urogenital infections are caused by Gram-negative bacteria, in which Escherichia coli predominates with a share of 80%. The evolution of microbial resistance to preparations used in curative-prophylactic institutions, induces the need of the reintroduction of nitrofurans, noteworthy for their wide spectrum of antibacterial activity. Material and methods: For the study, suppositories with furazidine were prepared by hand rolling and by melting and molding methods. Quantitative analysis was performed spectrophotometrically on a UV-VIS Perkin Elmer Lambda 40 spectrophotometer. All solvents and reagents had the degree of purity ”pure for analysis” and ”chemically pure”. Results: Duble cast method was applied to identify the exact mass of hydrophobic (cocoa butter, suppocire) and hydrophylic (polyethylene glycol mixtures) excipients. All the formulated suppositories were subjected to quality tests and showed acceptable physical characteristics and uniformity of drug contents. The UV-VIS spectrophotometric method for quantitiative determination of furazidine was developed and validated. The validation results showed that the developed method is simple, fast, accurate and robust. Conclusions: Suppositories with furazidine were prepared by classic technological methods. Preparation of the suppositories with furazidine on cocoa butter excipient is a suitable alternative for individual medicinal prescriptions. The UV-VIS spectrophotometric dosing method for furazidine in suppositories was developed and validated.

29-34

Authors: Alexandru Ghetiu

Objectives: To present the survey questionnaire used for the medical assessment of patients requiring alveolar ridge reconstruction as well as the study of concomitant pathologies and their influence on the healing process. Material and methods: The study involved 173 patients aged between 18 and 69 years. All patients have been assessed according to the survey questionnaire developed to determine the patient’s general condition, life anamnesis, and medical history. Results: Out of the total of 173 patients, 72 (41.6%) had no concomitant pathologies, 8 patients (4.6%) had concomitant pathologies that did not interfere with the operation, 40 (23.1%) had pathologies that might affect the outcome of alveolar ridge reconstruction but still were admitted to surgery, and 53 patients (30.6%) had pathologies that could affect the outcome of the reconstruction procedure and were not admitted to bone grafting. Conclusions: Assessment of patients with alveolar ridge defects during preparation and planning of preimplantation bone reconstruction identified a number of concomitant pathologies, more or less noticed by the patient, which may remain unclear due to superficial study of the patient’s condition that is able to influence the surgical treatment outcome. These issues can be both intraoperative and postoperative and lead to failure of surgical treatment and further reoperation.

39-44

Authors: Boris Golovin, Mihail Peștereanu, Tatiana Bicic, Svetlana Lupu, Ludmila Petcu, Nicolae Doni

Background: In the last 2 years, some changes have occurred in the structure of emergencies at the prehospital stage in the Republic of Moldova, being largely influenced by the COVID-19 pandemic. Material and methods: Retrospective analysis of the Prehospital Emergency Medical Service (PEMS) Request Sheets of the National Centre of Prehospital Emergency Medicine (NCPEM) of the Republic of Moldova for the years 2019-2020. Results: According to the nosological profile in 2020 at the prehospital stage, respiratory emergencies were on the first place with 23% of the 761.416 of total number of requests. On the second – cardiovascular (20.6%), on the third – neurological (13.3%), infectious – 3.1%. In 2019, on the first place – cardiovascular with 22.3% of the 845.572 of total number of requests, followed by respiratory – 19.3%, neurological – 13.6%, infectious – 2.2%. In 2020, on the first place were respiratory emergencies, which compared to 2019 increased practically by 4% and the infectious emergencies by almost 1%. The number of endotracheal intubation procedures and medical-assisted transportations practically doubled in y.2020 compared to y.2019. Conclusions: All these changes: increased respiratory and infectious emergencies, intubation procedures, and assisted-medical transportations, have occurred exeptionally due to COVID-19 infection.

50-54

Authors: Daniela Blanita, Chiril Boiciuc, Doina Turcan, Victoria Sacara, Natalia Usurelu

Background: Congenital Disorders of Glycosylation (CDG) are a group of inherited metabolic disorders caused by the defect in various steps in the biosynthesis of glycoproteins and other glycoconjugates. Material and methods: 40 patients under clinical suspicions for CDG at the Institute of Mother and Child were examined by isoelectric focusing of transferrin (IEFT) in collaboration with RadboudUMC, Netherlands and U.S.A. The spectrum of clinical presentations of these patients was multisystem damage, predominantly neurological manifestations. Results: Most of the patients (55%) had early neurological manifestations from the birth, such as hypotonia, psychomotor disability, cerebral MRI abnormalities, seizures (25%), cutis laxa (17.5%), total alopecia (2.5%), abnormal fat pads (2.5%), myopia (7.5%), nystagmus (5%), strabismus (2.5%), stroke-like episodes (2.5.%), ataxia (7.5%), abnormal coagulation (10%), hepatomegaly (35%) and liver cirrhosis (2.5%). Serum samples analyzed by IEFT showed the results: 37 normal, 2 questionable and 1 abnormal patterns. Two samples questionable belongs to the patients with Galactosemia and Fructosemia, which give the false-positive results. The last positive sample is performed additionally for glycomics profiling. In some cases, with IEFT negative profile was performed genetic test and were diagnosed other diseases, mimicking CDG, such as: NARP syndrome, late diagnosed PKU, GSD, Manosidoses, Prader-Willi Syndrome and chromosomal aberrations. Conclusions: The CDG is a rare metabolic disease with multisystem impairment and variety of symptoms which determine overlapping of phenotype with other genetic disorders. The process of diagnosis is very complex and can take several years.

62-65

Authors: Ion Sirbu, Sergiu Matcovschi

Background: It was intended to study the structure of the symptoms in patients suspected of having SARS-CoV-2 virus infection, as well as to find any correlations between the clinical, paraclinical and radiological manifestations in positive versus negative patients, in order to further facilitate the diagnosis and triage of patients. Material and methods: 101 patients seeking medical attendance at the COVID-19 Triage Center in Chisinau have been examined, presenting various respiratory symptoms. The frequency of symptoms and the results of the paraclinical investigations were evaluated based on the results of the PCR tests for SARS-CoV-2 infection and the assessment of correlations (Pearson). Results: Out of 101 subjects, 50 tested SARS-CoV-2 positive, and the remaining 51 – negative. The clinical manifestations of SARS-CoV-2 suspects were as follows: fatigue – 72%, sweating – 54%, chills – 52%, fever – 49%, subfebrility – 39%, myalgias and arthralgias – 37%, cough – 35% (sputum – 17% and hemoptysis – 2%), dyspnea – 34%, chest pain – 23%, anosmia – 12%, headache – 11%, dyspeptic syndrome – 8%. Infiltrates on chest radiography were found in 22% of cases. A weak inverse correlation (R = -0.22, P <0.05) between the leukocyte count and SARS-CoV-2 test results was found. An average direct correlation between the presence of fever (R = 0.36, P <0.05) and a positive COVID-19 test was also noticed. Conclusions: Certain symptoms such as anosmia were more commonly seen in patients with positive COVID-19 tests. The absence of pulmonary infiltrates and the presence of dyspnoea have been negative predictive factors for COVID-19. Leukopenia has been noticed only in SARS-CoV-2 positive patients. Subfebrility has not shown a predictive significance of COVID-19.

69-71

Authors: Lilia Rotaru

Background: Parkinson’s disease (PD) – the most common neuro-degenerative movement disorder – is considered a result of a multifactorial pathogenic process modulated by cumulative and interactive effects of genes and exposures. An environmental exposure could enhance or create dopaminergic neurons vulnerability and increase PD risk. The purpose of the study was to find if excessive exposure to toxic environmental factors may influence clinical pattern of PD. Material and methods: The study was conducted on 111 patients diagnosed with PD, study group being defined as PD exposed to toxins (33 patients), control group including PD patients without toxin exposure (78 patients). General epidemiological data and clinical data were recorded. Results: Toxin exposure was found in 33 patients (29.73%), more of them – men and rural residents. Toxin exposed PD patients had an insignificantly younger age. The most common disease phenotype in the study group was the akinetic-rigid phenotype (64.7%, p = 0.040), bradykinesia being the most common sign at the disease onset (57.6%, p = 0.008). Levodopa equivalent daily dose also was higher in the study group (659.02 ± 232.46, p = 0.042). Conclusions: Excessive exposure to toxic environmental factors may influence the clinical pattern of PD. In this study the akinetic-rigid type was the predominant disease phenotype associated with toxin exposure. Doses needed for treatment were higher in PD patients exposed to toxins, as an indicator of a more severe motor impairment in this group.