ASSESSMENT OF CLINICAL SYMPTOMS IN WOMEN WITH INTRAHEPATIC CHOLESTASIS OF PREGNANCY | Author : Maria CEMORTAN, Irina SAGAIDAC, Olga CERNETCHI, Constantin OSTROFET | Abstract | Full Text | Abstract :Introduction. Intrahepatic cholestasis of pregnancy
(ICP) is a disorder characterized by pruritus and elevated
liver function tests and is associated with
a high incidence of adverse perinatal outcomes.
Multi-disciplinary cooperation is critical for managing
the condition and ensuring better pregnancy outcomes.
The objective of the study was to assess the clinical
symptoms and intensity of cutaneous pruritus in
women with intrahepatic cholestasis of pregnancy.
Material and methods. The study group included
71 women with ICP. The patients were asked about
their symptoms and intensity of itching. The intensity
of cutaneous pruritus was assessed according to two
scales. SPSS 21 software was used to conduct the statistical
analysis.
Results. On the onset of symptoms women had indicate
the intensity of itching at 5.1±2.3 points on average,
according to visual analog scale. 53.5% women
indicated the symptom to be occasional or discontinuous.
By the moment of the survey, 66.2% women
indicated the intensity of the pruritus more or equal
to 8 points, being continuous in 52.1% of cases. In
the post-partum period, the intensity of the pruritus decreased, being assessed on the third day after delivery
as less or equal with 5 points in 93.1% of cases,
being occasional or discontinuous in 90.1% of cases.
Conclusions. Pruritus is the most prevalent clinical
sign of ICP and it should not be ignored, being considered
as a call for follow-up. |
| QUALITY OF LIFE – AN IMPORTANT ENDPOINT OF TREATMENT IN PATIENTS WITH HEART FAILURE | Author : Camelia C. DIACONU | Abstract | Full Text | Abstract :Heart failure (HF) is a heterogeneous syndrome,
with progressive evolution and negative impact on
quality of life and mortality of patients. The incidence
of HF in Europe and the United States of
America varies between 1 to 9 cases per 1000 inhabitants,
depending on the population studied and the
diagnostic criteria used1. Currently, it is estimated
that approximately 64.3 million people suffer from
HF world-wide2.
One of the most important therapeutic goals for
patients with HF is represented by maintaining and
improving the quality of life. Many patients value
functional status and quality of life more than longevity.
The most important predictors of the quality
of life in HF are the presence of symptoms and their
severity, functional status and depression3. Current
guidelines recommend the combined use of medical
and behavioural interventions to improve the functional
status of these patients3. |
| FETAL ANATOMICAL VARIABILITY OF MUSCLES AND NEUROVASCULAR BUNDLES OF THE ANTERIOR BRACHIAL REGION | Author : Tatiana V. KHMARA, Oleksandr A. KOVAL, Vitalii V. ILIKA, Mariana I. KRYVCHANSKA | Abstract | Full Text | Abstract :Introduction. Performing surgical manipulations
and interventions on neurovascular bundles located
in the anterior brachial region of human fetuses and
newborns requires comprehensive knowledge of their
topographical and anatomical features.
The objective of the study was to establish the fetal
topography peculiarities of both nerves and vessels in
the anterior brachial muscle region.
Materials and methods. The study was carried out
on 32 human fetuses of 4-8 months with 81.0-310.0
mm crown-rump length (CRL) using macro microscopic
dissection, vascular injections and morphometry.
Results. We describe the main and additional sources
of muscle blood supply and innervation of the
anterior brachial region in human fetuses. Two to 4
branches of the musculocutaneous nerve take part in
the innervation of both coracobrachialis and brachialis
muscles, as well as the biceps brachii muscle. Some
fetuses possess additional sources of innervation: for
the coracobrachialis muscle there is a branch of the
lateral bundle of the brachial plexus, the biceps brachii
muscle has median nerve and for the brachialis muscle
there is radial nerve. The largest number of arterial
and nerve branches goes to the proximal and middle parts of the coracobrachialis and brachialis muscles, as
well as the biceps brachii muscle.
Conclusions. The established neurovascular correlations
and features of the fetal anatomy of the anterior
brachial muscle region determine the presence of relatively
favourable conditions for cutting muscle flaps
that are well innervated and supplied with blood. |
| THE RISK FACTORS OF SEVERE LEPTOSPIROSIS IN THE TRANSCARPATHIAN REGION OF UKRAINE – SEARCH FOR „RED FLAGS” | Author : Pavlo PETAKH1, Vitaliia ISEVYCH, Vasilij GRIGA, Aleksandr KAMYSHNYI | Abstract | Full Text | Abstract :Introduction. Leptospirosis is a re-emerging illness
with a wide spectrum of clinical manifestations, from
asymptomatic or moderate to severe and lethal results.
Leptospirosis can be adequately treated if detected
early; however, comparable clinical presentations with
various other febrile illnesses or co-infections, as well
as laboratory diagnosis problems can result in misdiagnosis,
leading to severe illness. Identifying clinical
predictors for the severe form of the disease is critical
to reduce the disease complications and mortality.
The objective of the study was to establish the risk
factors for mortality in patients with leptospirosis.
Materials and methods. A retrospective study of
102 medical records of patients diagnosed with leptospirosis
in the period from 2009 to 2019 was conducted.
Quantitative variables in the presence of normal
distribution were compared using a paired Student’s
t-test, and in the case of an abnormal distribution, the
Mann–Whitney U test was used. The criterion ?2 was
used for qualitative variables. A two-step cluster analysis
was also performed. Results. The following factors associated with death
from leptospirosis have been identified: oliguria (OR,
13.5; 95% confidence interval [CI], 2.56-71.12), serum
creatinine and urea levels, direct and total bilirubin,
platelets, and white blood cells count.
Conclusions. These „red flag” laboratory and clinical
characteristics will aid medical personnel in rapidly
identifying a patient at risk of death, which is critical
in determining the severity of the condition and the
need for early intensive care and therapy adjustment. |
| RURAL-URBAN DISPARITIES OF MORTALITY AND CAUSES OF DEATH IN THE REPUBLIC OF MOLDOVA | Author : Olga PENINA | Abstract | Full Text | Abstract :Introduction. Evidence on disparities of mortality by
place of residence based on reliable data is needed for
appropriate public health programmes aimed at reducing
high mortality in Moldova.
The objective of the study was to determine changes
in mortality disparities for all causes and major groups
of causes of death between rural and urban populations
of the Republic of Moldova after independence.
Material and methods. The data were analysed by
sex and place of residence for all causes and seven main
groups of causes of death for two periods: 1991-93 and
2017-19. Abridged life tables and standardised death
rates with 95% confidence intervals were computed.
Mortality inequities between rural and urban areas
were analysed in absolute and relative terms.
Results. Cardiovascular diseases and digestive system
diseases in both sexes and external causes and respiratory
system diseases among men accounted for the
rural mortality disadvantage. Cancer mortality had a
negative rural-urban gradient. During independence,
the rural-urban gradient of all-cause mortality declined
among women, but not among men. A more rapid reduction
in mortality from circulatory system diseases
and a more rapid growth of neoplasm mortality in rural areas than in urban areas narrowed the rural-urban
disparities. For external causes and diseases of the
respiratory system, inequalities in mortality between
rural and urban areas increased over the study period.
Conclusions. Public health programmes aimed at reducing
elevated cardiovascular mortality in rural areas
are a key strategy for addressing mortality disparities
between rural and urban populations. |
| THE DRUG APPROACHES AND THE ROLE OF HEALTHCARE PROFESSIONALS IN THE MANAGEMENT OF ALZHEIMER’S DISEASE | Author : Denisa C. MICULAS, Delia M. TIT, Paul A. NEGRU, Alexandra G. TARCE, Alexa F. BUNGAU | Abstract | Full Text | Abstract :One of the most frequent types of dementia is the
Alzheimer’s disease (AD). The fundamental concepts
of pharmacotherapy valid for AD are substances that
increase the cerebral acetylcholine level, intervening in
cholinergic neurotransmission through cholinesterase
inhibition and N-methyl D-aspartate receptor antagonists.
These drugs have the role of slowing down the
further evolution of the disease, providing at the same
time a symptomatic improvement. The effectiveness
of these drugs is clearly limited, both because of several
negative side effects and their inefficiency to cure
the disease. The therapeutic management is therefore
a major challenge in AD, and the non-adherence to
treatment often constitutes a serious barrier to an effective
therapy. Doctors and pharmacists play a vital
role in the pharmacotherapeutic management of AD,
contributing to improved clinical results and quality
of life of the patient. The current review analysed
the challenges in therapeutic management, especially
those related to treatment adherence and pharmacist
involvement. |
| THE CURRENT MANAGEMENT OF END-STAGE HEART FAILURE: TWO CASE REPORTS | Author : Horatiu MOLDOVAN, Oana FRONEA, Claudia NICA, Mihai CACOVEANU, Cristian VOICA, Silvia PREDA, Marian BROASCA, Andra SIBISAN, Robert TIGANASU, Sabina SAFTA, Lucian CALMAC, Ondin ZAHARIA, Liliana MIREA, Camelia C. DIACONU, Horatiu SUCIU | Abstract | Full Text | Abstract :Introduction. Heart failure (HF) is a clinical syndrome
caused by structural and/or functional cardiac
abnormalities, resulting in a reduced cardiac output
and/or elevated intracardiac pressures at rest or during
stress. It is a progressive disease with a high risk of
death in the first 6-12 months after the diagnosis of
end stage HF.
Cases presentation. We present the successful implantation
of a left-ventricular assist device (LVAD)
HEART MATE III in a 54-year-old male with ischemic
cardiomyopathy and end stage HF, and a heart
transplant in a 31-year-old male with non-ischemic
dilated cardiomyopathy and end stage HF. Both procedures
were guided by experienced surgeons and the
overall management Conclusions. HF is one of the leading causes of
death world-wide. The effort to stabilize and effectively
treat patients with ventricular assist devices and/or
orthotopic heart transplant is increasing. One of the
few drawbacks is the complex Heart Team training, a
difficult process that involves each member acquiring
the necessary skills and knowledge. The end stage HF
Team is composed of a large variety of members, such
as cardiologists, cardiac surgeons, anaesthetists and intensive
care doctors, interventional cardiology doctors,
and nurses. |
| ARE MULTIPLE SCLEROSIS PATIENTS PROTECTED AGAINST SOME TYPES OF CANCER? | Author : Titus M. VASILE, Razvan I. DUMITRU, Ionut CALOIANU, Aida M. MANOLE, Florentina C. PLESA, Carmen A. SIRBU | Abstract | Full Text | Abstract :Introduction. The risk factors for multiple sclerosis
(MS) and cancer overlap to a large extent.
The objective of our study was to estimate the prevalence
and risk ratios (RR) of cancers in patients with
MS and to identify which types of cancer have the lowest
frequency.
Materials and methods. We carried out research of
the literature in the PubMed, Medline, and Google
Academic databases, with the aim of identifying
large-scale studies addressing the link between different
cancers and MS. From 411 relevant articles, we selected
13 scientific papers for further analysis, comprising
109,276 patients diagnosed with MS from different
countries.
Results. Of all MS patients, 5.1% were diagnosed
with a certain type of cancer compared to 5.5% in the
general population; the cancers with the lowest incidence
were respiratory, digestive, and blood cancers. Conclusions. The results of our analysis suggested
that MS patients are less exposed to respiratory, digestive,
and blood cancers, but more research is needed
to understand if some disease-modifying therapies play
a role in this regard. |
| EMERGENCY ROOM: THE GERIATRIC PATIENTS WITH SEVERE ANAEMIA – CAUSES AND MANAGEMENT | Author : Bogdan OPRITA, Ruxandra OPRITA, Dragos SCARLAT, Lidia STEFAN | Abstract | Full Text | Abstract :Anaemia is a pathology encountered very often among
geriatric patients and mostly it is secondary to a chronic
disease or an acute/ chronic loss of blood. Therefore,
it should not be considered as a possible physiological
consequence of aging. Anaemia is recognized as a risk
factor for a series of effects with a negative impact on
the subsequent evolution of geriatric patients, such as a
prolonged duration of hospitalization, higher morbidity,
and mortality. In most cases, geriatric patients have
a series of cardiovascular comorbidities which, in association
with anaemia, can further increase the risks.
Most geriatric patients with severe anaemia present to
the emergency room for upper digestive hemorrhage.
This article will focus especially on this pathology,
with a complete description of the causes and treatment
methods in these patients. |
| CONTINUOUS HEMATOSPERMIA FOR 5 YEARS CAUSED BY COITUS RESERVATUS AS A METHOD OF CONTRACEPTION – A CASE REPORT | Author : Petar A. ANTONOV, Atanas S. IVANOV, Pavel E. STANCHEV, Pencho P. GENOV | Abstract | Full Text | Abstract :Introduction. The presence of blood in the semen is
called haematospermia or haemospermia. The condition
is always accompanied by patients’ fear and anxiety
and in most cases is intermittent and on short-term.
In cases when haematospermia is continuing for long
time or associates other symptoms it requires diagnostic
evaluation for the numerous possible causes – inflammatory,
neoplastic, iatrogenic and obstructive.
Case presentation. We present a case of coitus
reservatus – an unpopular practice of sexual intercourse
and a contraceptive method which is clinically
manifested with haematospermia. A 38-year-old male
patient, married, with one 6-year-old child, has been
consulted for persistent haematospermia after each
ejaculation in the last 5 years. The physical, laboratory
and imaging examinations identified the cause of haematospermia
as being coitus reservatus.
Conclusions. Haematospermia is a relatively rare and
typically harmless condition, with a multifactorial aetiology.
The presented case of coitus reservatus is an unpopular practice of sexual intercourse and a contraceptive
method which is clinically manifested with
haematospermia. |
| PLATELET-RICH PLASMA AS A NOVEL TREATMENT FOR LICHEN SCLEROSUS VULVAE: A CASE REPORT | Author : Nikoleta G. TABAKOVA | Abstract | Full Text | Abstract :Introduction. Platelet-rich plasma (PRP) is a novel
treatment of lichen sclerosus vulvae.
Case presentation. We describe a case of lichen sclerosus
vulvae in a 25-year-old woman treated with PRP.
The diagnosis was confirmed by the histological examination.
The patient’s symptoms were evaluated using
Female Sexual Function Index (FSFI) questionnaire.
PRP was prepared using Regen lab Cellular Matrix Kit
and administered every two weeks, three times. The
lesions disappeared at the visual examination.
Conclusions. Our case confirms the effectiveness of
PRP treatment for lichen sclerosus vulvae reported by
other case reports. Nevertheless, future randomized
controlled studies are needed to evaluate the safety of
PRP treatment and to establish effective clinical protocols
for its use in lichen sclerosus vulvae. |
| A CASE OF FEVER AND POLYMORPHOUS RASH IN A PATIENT WITH RECENT SARS-COV-2 INFECTION | Author : Theodoros MICHAILIDIS, Aris LIAKOS, Nikolaos KAKALETSIS, Ioannis AVGERINOS, Stylianos MAMALIS, Sophia ASPRAGATHOU | Abstract | Full Text | Abstract :Introduction. Multisystem inflammatory syndrome in
adults (MIS-A) is a rare but potentially life-threatening
sequel of SARS-CoV-2 infection, requiring early recognition
and treatment. Nevertheless, it is often hard
to distinguish MIS-A from other COVID-19-related
hyperinflammatory complications.
Case presentation. A 74-year-old male presented to
the emergency department with persistent fever, diarrhea,
altered consciousness, polymorphous rash with
oral lesions and erythema of the palms and soles, with
progressive exfoliation. The patient had been hospitalized
for COVID-19 four weeks before and was suffering
from chronic lymphocytic leukemia, diabetes
and hypertension. During his recent hospital stay he
received multiple courses of antibiotics and was discharged
home with instructions to add sitagliptin and
re-initiate therapy with ibrutinib. Upon re-admission,
polymerase chain reaction test for SARS-CoV-2 was
still positive and inflammatory markers were markedly
elevated. Although MIS-A could not be excluded, a
presumptive diagnosis of Stevens-Johnson Syndrome
(SJS) was made, and the patient was treated empirically
with intravenous immunoglobulin and high-dose
methylprednisolone. SJS is usually considered an adverse
drug reaction that affects the skin and mucous membranes. In this patient, MIS-A was also initially
included in the differential diagnosis due to previous
COVID-19, despite the patient’s advanced age and lack
of cardiac involvement or conjunctivitis. The patient
only partially fulfilled current diagnostic criteria for
MIS-A.
Conclusions. SJS results from a dysregulated immune
response and can have a similar presentation to
MIS-A. A better characterization of both conditions is
required particularly in older adults with comorbidities,
to facilitate timely diagnosis and management and
to reduce mortality. |
| NEW-ONSET ISOLATED ACALCULIA AS A CONSEQUENCE OF RIGHT TEMPORO-PARIETO-OCCIPITAL JUNCTION INFARCT | Author : Nataliya NEKRASOVA, Olena TOVAZHNYANSKA, Rhea SINGH, Serhii RUDENKO, Olena RIZNYCHENKO, Kseniia ZUB | Abstract | Full Text | Abstract :Introduction. Acalculia is defined as a form of cognitive
impairment, manifested by the loss of ability to
perform calculations and use arithmetical concepts
because of the damage to some parts of the cerebral
cortex, with a subcortical extension.
Case presentation. We present a unique case of a
74-year-old right-handed patient with isolated acalculia
on a background of ischaemic stroke in the right
parietal lobe. Physical examination, laboratory tests,
and various instrumental and neurological investigations
including electroencephalogram and magnetic
resonance imaging (MRI) were performed. Brain MRI
showed a subacute infarct in the area of the right temporo-
parieto-occipital junction and multiple subcortical
lesions of vascular origin in the frontal and parietal
lobes. The patient was treated with aspirin, enalapril,
and atorvastatin, along with cognitive rehabilitation
therapy. During subsequent follow-up visits, a decrease
in the severity of acalculia was noticed, but complete
recovery was yet to be achieved.
Conclusions. Acalculia is a form of cognitive impairment,
which may either be part of Gerstmann syndrome,
or an isolated symptom of cognitive decline in
stroke, tumours, Binswanger’s disease, several types of dementia, epilepsy, and some other diseases. However,
a subacute isolated presentation is rare. |
| PLASTIC RESTORATION OF A FACIAL DEFECT AFTER SURGICAL REMOVAL OF A LARGE MALIGNANT MELANOMA | Author : Rosen B. TSOLOV | Abstract | Full Text | Abstract :Introduction. Melanomas are the most aggressive
skin carcinomas and a major cause of premature death
from cancer. The risk factors for melanomas are UV
rays, personal or family history of melanoma, large
numbers of naevi, fair complexion, immunodeficiency,
solar-damaged skin, etc. The scars from malignant
melanoma on the face are serious challenge for the
surgeons, so the successful plastic reconstruction of
skin defects is very important for the normal life of
the patient after surgery.
Case presentation. A 82-year-old patient with a large
malignant melanoma of the left cheek was admitted
to the Clinic of Maxillo-facial Surgery, University
Hospital „St. George”, Medical University of Plovdiv,
Bulgaria, for treatment. The preoperative examination
revealed the presence of a sloping heterogonic tumour,
with axial dimensions of 55/28 mm, penetrating and
engaging the dermis, subcutaneous tissue, levator oris
and muscular orbicularis oris. Surgery was performed,
under general anaesthesia. The tumour was removed,
and the defect was repaired using several skin flaps, to
use the adjacent tissues. The final outcome was favourable
and the surgery was functionally successful. Conclusions. This case highlights the importance of
an accurate diagnosis of malignant melanoma, that is
essential for an adequate management and follow-up,
considering its potentially aggressive behaviour. |
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