Correlations of myocardial bridges with left ventricle myocardial hypertrophy and prepontin coronary atherosclerosis

Background: Of particular interest are the studies researching the correlations of myocardial bridges with hypertrophic cardiomyopathy and correlations of thick myocardial bridges with the development of coronary atherosclerosis in the proximal to the bridge arterial part. Material and methods: Assessment of the correlation between myocardial bridges, coronary atherosclerosis, and the degree of hypertrophy of the left ventricle was performed by retrospective analysis of 6168 coronary angiography protocols (2012-2019) and echocardiographic data from patients’ clinical records. Results: Moderate systolic compression predominated, and the number of patients detected with severe under the bridge systolic coronary stenosis was double as in patients with nonsignificant coronary atherosclerosis. From the total number, patients with myocardial hypertrophy and myocardial bridges were twice less when compared with the patients with the normal myocardial thickness. The comparative research did not show any interdependence between the degree of vascular compression and the degree of left ventricular myocardial hypertrophy. Proximal to the bridges atherosclerosis was detected in 32% of cases without correlation with the force of the myocardial bridge. Conclusions: The study showed the absence of the correlation between the degree of arterial stenosis caused by the bridge and the degree of hypertrophy of the ventricular myocardium as well as the degree of proximal to the bridge atherosclerosis. Important finding was that the degree of coronary systolic compression is higher in patients with moderate and severe proximal to the bridge atherosclerosis.

The use of the constrained prosthesis in the difficult primary knee arthroplasty

Background: The constrained knee prosthesis has the basic indication in revision arthroplasty, but the latest literature reveals that it takes place also in primary total knee arthroplasty in cases of knee osteoarthritis associated with major deformities. Material and methods: Present study is based on the surgical treatment, using the constrained knee prosthesis in the primary total knee arthroplasty, during 2019-2021, of 28 patients with knee osteoarthritis associated with severe deformities in varus or valgus, in the Big Joint Replacement Department, Clinical Hospital of Traumatology and Orthopedics, Chisinau. Results: In this study, the following criteria were evaluated: the type of deformity – valgus (10 cases) and varus (18 cases); the degree of deformation – for varus knees was on average 300 , and for valgus knee – 250 ; bone attrition – 11 cases with bone defects where it was necessary to use augmentations; affected side – in 19 cases the right knee was affected and 9 cases the left one; the women/men ratio was 4/1; the mean age of the patients was 67.5 years; average duration of the intervention – 140 minutes; in 5 cases a lateral para-patellar approach was performed, of which 2 cases with tibial tuberosity osteotomy; complications – 1 case with intra-operative periprosthetic fracture and 2 cases with superficial infections of the operated joints. Conclusions: Osteoarthritis of the knee progresses rapidly, leading to severe deformities, significant bone defects and joint instability, which are indications to use the constrained prosthesis in the primary total knee arthroplasty, long-term follow-up is necessary to obtain the last conclusion, but from this study the constrained knee prosthesis like primary implant for special indication had promising results.

The peculiarities of patients with COVID-19 infection

Background: The surge demand and decreased availability of the health workers determined the designation of the Clinical Municipal Hospital of Phthisiopneumology (CMHP) into a hospital for the case-management of COVID-19 patients during the period of December 2020 – April 2021 for the treatment of the mild cases. The aim of the study was to assess the main peculiarities of the patients with COVID-19 through a cross-sectional study developed during the period February-April 2021 in the CMHP. Material and methods: A cross-sectional, analytical and prospective study was realized, which included 145 patients with COVID-19 hospitalized in the CMHP during February-April 2021. The inclusion criteria were: patient older 18 years, COVID-19 infection diagnosed by the pulmonologist with the positive polymerase chain reaction result for SARS-CoV-2 (COVID-19) and signed informed consent. Results: The peculiarities of patients with COVID-19 were dominated by the female sex, age over 60 years, residence in the urban districts of Chisinau and the infection acquired in the Republic of Moldova. Common clinical manifestations were: high temperature, profuse sweats, asthenia and headaches, productive cough, dyspnea, loss of smell or taste, and sore throat. The typical radiological findings such ground-glass pattern or consolidation with bilateral multifocal involvement were most frequent. Were cured most of the patients and the death rate was low. Conclusions: Peculiarities and clinical manifestations of the patients admitted in CMHP were typical for the COVID-19 infection. These findings did not show the real outcome of the standard case-management of the COVID-19 due to the restricted admission criteria.

The effect of diabetes mellitus on evolution and outcome of tuberculosis in a prospective study

Background: In the Republic of Moldova almost 5% of the cases with tuberculosis are diagnosed annually among diabetic patients. The aim of this study was to assess the impact of diabetes mellitus on the evolution and anti-tuberculosis treatment effectiveness in a prospective study. Material and methods: A prospective, longitudinal and case-control study, which included a total number of 252 patients diagnosed with pulmonary tuberculosis and distributed in a study group, consisting of 93 patients diagnosed with diabetes mellitus and a control group, consisting of 159 patients without glycemic disorders, was performed. Results: This study identified that one half of the group with diabetes was detected by active screening and one third received anti-tuberculous treatment before actual episode. A similar rate of diabetic and non-diabetic patients was microbiologically positive, as well confirmed with drug-resistance. The anti-tuberculous treatment effectiveness was lower in diabetic patients, the death rate and the low treatment outcome (lost to follow-up and failed) were higher than in non-diabetic patients. The main causes of unfavorable evolution were: glycemic disorders (hyperglycemia), diabetes complications and the history of the anti-tuberculous treatment in the anamnesis. Conclusions: The individualized approach and a tight follow-up should be performed regularly in all patients with glycemic disorders and tuberculosis for the improvement of the disease outcome.

Sonographic approach to the tumours of retroperitoneal space

Background: Timely diagnosis of primary retroperitoneal tumours is one of the current challenges of clinical oncology. This is due to the rarity, polymorphism and diagnostic difficulties of primitive retroperitoneal tumours. Material and methods: The study is cross-sectional, prospective and retrospective. The study group is represented by 118 patients with abdominal and retroperitoneal space tumours. Using the receiver operating characteristic (ROC) analysis curve and calculating the average quality of the diagnostic model, the informativeness of ultrasonography in the diagnosis of primary retroperitoneal tumours (PRT) was appreciated. Results: For tumour localization, the ultrasonography (USG) as a diagnostic model demonstrated an appropriate use criteria (AUC) of 0.641 (95% CI 0.541, 0.740, p <0.001), and the mean quality of the diagnostic model was 0.54. Following the statistical analysis, was found a partial correlation between the size of the tumour and the dimensions estimated at USG of 0.540 (95% CI 0.295, 0.737, p <0.001), which represents a high positive correlation. To determine the uni- or multicentric character of the tumour, the USG demonstrated an integrative value of sensitivity and specificity of 0.644 (95% CI 0.415, 0.873, p <0.001. In assessing the proximity ratio of retroperitoneal tumours, the highest AUC was recorded in the assessment of the ratio of tumour to pancreas – 0.838 (95% CI 0.705.0.971, p <0.001) and kidney – 0.861 (95% CI 0.699, 1.024, p <0.001). Conclusions: Ultrasonography is a fairly informative imaging diagnostic method in the diagnosis of retroperitoneal tumours. The characteristics of the tumours obtained after the ultrasound examination provide indirect information about the malignant or benign nature of the primitive tumour, which allows the assessment of the next stages of diagnosis and treatment.

Impact of targeted treatment in non-Hodgkin’s lymphoma with primary lymph node involvement

Background: Non-Hodgkin’s lymphomas (NHL) are malignant tumors that develop from lymphoid tissue. Primary lymph node (LN) involvement is the most common localization (52-70%). The integration of Rituximab (R) in the NHL treatment represented a turning point. The aim of this study was to evaluate the therapeutic impact of the use of R in combination with conventional polychemotherapeutic (PChT) in the treatment of nodal onset NHL. Material and methods: A descriptive cohort study was performed on 80 patients diagnosed with NHL. Results: In the study participated: men – 39(48.8%), women – 41(51.2%). The mean age of the patients was 56.09 ± 13.6 years. The onset of NHL occurred in peripheral l/n in 85.0% of cases, in mediastinal LN – 7.5%, and abdominals in 7.5%. Stages I-II were identified in 21(26.2%) patients, stages III-IV in 59(73.8%) cases. Aggressive NHLs were diagnosed in 54(67.5%) patients, indolent NHLs in 26(32.5%) cases. In 61(76.3%) patients, first-line R+PChT treatment was applied – group 1(G1), and in 19(23.8%) cases conventional PChT was applied – group 2(G2). The overall response rate (ORR) in G1 was 86.8%, in G2 – 63.1%. Complete remissions (CR) were obtained in G1 in 63.9% of patients, in G2 – 47.3% of cases. Progression-free survival (PFS) in G1 had a median of 20 months, and in G2 the median was 12 months (p <0.05). Conclusions: The use of Rituximab increased the ORR rate (86.8% vs 63.1%), the frequency of CR (63.9% vs 47.3%) and PFS (20 months vs 12 months (p <0.05).

Erythrocytic antioxidant system in the administration of new coordination compounds thiosemicarbazide derivatives

Background: Currently, there is a growing interest in new local coordination compounds (CC), which demonstrated antitumor properties, but their influence on the erythrocyte antioxidant system has not been studied. The aim of the study: to study the effects of CC, thiosemicarbazide derivatives –TIA-160, CMT-67 and CMJ-33 on indices of the antioxidant system indicators in erythrocytes peripheral blood in vivo experiments. Material and methods: The action of CC on superoxide dismutase, catalase, total antioxidant capacity was evaluated on a group of 34 white rats, randomly divided into 4 groups: the first control group was injected subcutaneously with saline. The other groups (2 – TIA-160, 3 – CMT-67 and 4 – CMJ-33) were given subcutaneously 3 times a week for 30 days, 0.1µM / kg CC. Results: It was established that the TIA-160 compound demonstrated the highest capacity to induce the expression of erythrocyte catalase that exceeded the control level of 1.8, which did not correlate with the enzymatic superoxide dismutase (SOD) activity. Thus, this study showed that there are differences in the mechanisms of action of thiosemicarbazone derivatives. Conclusions: The influence of tested CC on the indices of the antioxidant system is selective. This selectivity may be the base to their strong selective antiproliferative and cytotoxic action on tumor cells, but not on healthy ones.

Assessment of teachers' health in relation to working conditions

Background: Teaching in schools has been defined as the profession with the most diverse risk factors that affect health. With almost 48000 people currently working in educational institutions, teachers make up the largest occupational group in the Republic of Moldova. Material and methods: The study involved 519 teachers from pre-university educational institutions. For the self-assessment of the health status, a questionnaire was created which was applied online. The subjective assessment was performed by researching the entries in the medical cards. Results: The majority of respondents were women (91.4%), with a mean age of 45.6±7.5 years and a working experience of 22.9±3.2 years. In 75.7% of them health is satisfactory, only 3% have serious health problems and would require hospitalization. In 35.8% of cases, the presence of chronic diseases is registered, their top being led by diseases of the gastrointestinal tract (33.8%), the cardiovascular system (29.2%) and endocrine (27.2%). The most common risk factors mentioned were: high levels of stress (53.5%); increased number of tasks (23.4%); lack of support from family and colleagues (22.9%). Conclusions: The health of teachers is influenced by a variety of risk factors. There were no correlations between the type of institution and the subject taught, which highlights the importance of studying the influence of factors in the occupational environment and the development of prevention measures.

In vivo experimental study of the arterial supply of the rabbit posterior limb

Background: The use of bone graft has been a successful step in the treatment of a large number of diseases of the osteoarticular system. But a massive bone defect remains a dilemma for modern reconstructive surgery. Present methods used have a high level of morbidity and complication. Literature indicates the absence of an optimal solution in massive bone defects healing. The aim of this study: to perform an in vivo preliminary study of vascularization of the hind limb in the rabbit model, for obtaining a graft able for further inclusion in the host blood circulation, without immunosuppression by decellularization. Material and methods: The study was performed on the 12 laboratory rabbits. After euthanasia of the rabbit, the femoral and tibiofibular bone was collected without soft tissue, only with the vascular pedicle, and keeping the passage through the vessels. In the abdominal aorta was injected contrast material, with the subsequent preparation of the arterial vessels, succeeded by anatomical, morphological, radiography, and microangiography study of this vascularized bone segment. Results: The principal nutrient artery of the rabbit femur springs from the lateral circumflex femoral artery. The optimal segment for vascularized allografting (the rabbit model) was determined the upper third of the femur with the up to the level of the internal iliac artery. So, it could be used as a bone graft for further conservation and decellularization. Conclusions: The vascularized allogeneic bone without immunosuppression would be a perfect alternative in the treatment of the massive bone defects.

Aspects of frailty syndrome, nutritional status and comorbidities in the elderly

Background: Frailty syndrome is one of the most important multifactorial medical syndromes, which is characterized by a decrease in functionality of many systems and organs. Material and methods: In order to establish the nutritional determinants that contribute to the onset of frailty syndrome, a study was performed on a group of 50 patients, aged ≥65 years with chronic pathologies and geriatric syndromes. All participants were examined according to clinical features (history, clinical examination), Mini Nutritional Assessment and of the Complex Geriatric Assessment, which included: the data of the frailty tools, age category, Vulnerable Elders Survey, Charlson Comorbidity Index, autonomy – Activity Daily Living, Instrumental Activity Daily Living, Tinetti scale, psychoaffective status – by memory test Mini-Mental State Examination and the Geriatric Scale of Depression in the context of nutrition in the elderly. A clustered analysis (k-means method) of nutritional status showed that the most relevant indicators that separated the clusters were: age category, gender, clinical scale of frailty, comorbidities and polymedication. Results: Frailty through the multidimensional aspects that it meets has an increased prevalence among the elderly with an unfavorable prognosis. Following the proposed study, it was revealed that insufficient nutrition and comorbidities can lead to the weakening of the institutionalized age. The results obtained by evaluating the bio-psycho-social aspects characterize the profile of the institutionalized elderly and can be used as a basis for the development of effective strategies aimed at reducing physical, cognitive and social frailty. Conclusions: The comparative evaluation between both groups of elderly people by gender, showed a normal nutritional status with a higher share in women in the group of 75-84 years, compared to older men, and malnutrition was practically manifested equally in both groups in the study (men/women)