Transplant of faecal microbiota - priority area in the agenda to eradicate clostridium difficile infection

Department of Microbiology, Virology and Immunology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young DoctorsIntroduction: Fecal transplant or transplant of fecal microbiota (TFM) is an innovative technique of transplantation of fecal bacteria from a healthy person to a sick one. For the first time it was used by experts from the University Hospital "Hadassah"(Ierusalim) to treat certain intestinal diseases, especially the ones caused by the bacterium Clostridium difficile. This microorganism is found in intestines of people of different ages, but the increasing number of these bacteria inhibits the normal micro-flora of the intestinal tract inside healthy people. When the optimum balance in the gut is disrupted (often as a result of antibiotic treatment), there is a rapid increase of Clostridium difficile, which leads to diseases.C.difficile is estimated to be responsible for at least one fourth of antibiotic-Associated diarrheas in hospitalized patients. Studies that have been done in this field have contributed to the progress in getting known the TFM. The recovery of patients were successful in more than 90% after the manipulations which were performed, these being recognized as the most important scientific achievements of 2012. Material and methods: The presentation represents an extensive literature review based on previously completed research; we have conducted its own study and concluded the benefit of this procedure for the treatment of patients with intestinal diseases. The result of discussion: There are three antimicrobial drugs most commonly implicated in infection with C.difficile, clindamycin, ampicillin and the cephalosporin. First-line antimicrobial drugs for C. difficile treatment are metronidazole and vancomycin; however, recent data suggest that metronidazole is losing its efficacy and expert suggests to use more radical methods for treatment such as transplant of fecal microbiota. Transplantation can be provided through a variety of methodologies, either to the lower proximal, lower distal, or upper gastrointestinal tract. A research conducted in 2008 by T. Brodie, an Australian gastroenterologist, and other scientists, allowed to extend the list of indications for TFM. In addition to the treatment of intestine pathologies, faecal transplant was used to treat diseases like Parkinson's disease, diabetes mellitus, and insulin resistance, rheumatoid arthritis, obesity, and multiple sclerosis. Conclusion: Unfortunately C.difficile infection increases incidence, severity and recurrence rates, particularly in the last several years. From 1996 to 2010, the reported incidence of CDI cases in acute care hospitals in the U.S indicates an increase from 139,000 to 349,000. Up to now the intestinal microbiota has been generally inaccessible to scientific researches because most of them were hardly cultivated in the laboratory. The transplant of fecal microbiota proves to be an inexpensive and very effective intervention in intestinal diseases treatment. According to literature data, about 90% of patients are cured, so this procedure represented a real success in modern medicine. Key-words: Fecal microbiota, Clostridium difficile, recurent infection, intestinal disease

Atrial fibrilation in Brugada syndrom

Department of Internal Medicine, Cardiology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Atrial fibrilation is the most common cardiac arrhythmia with the worldwide prevalence of more than 33.5 million people and is a subject with increased interest in clinical trials. The reason is the awareness of the high risk of embolic events that in 75 % are complicated by cerebrovascular accidents. It is estimated that the number of patients with AF in 2030 in Europe will be 14–17 million and the number of new cases of AF per year at 120,000–215,000. In approximately 80% of patients, atrial fibrillation is associated with organic heart disease including valvular heart disease (mostly mitral valve disease), coronary artery disease, hypertension, hypertrophic or dilated cardiomyopathy. In 20% of cases, atrial fibrillation occurs in the absence of organic heart disease. Besides the danger of embolic events, atrial fibrillation is the most common atrial arrhythmia found in Brugada syndrome which is associated with malignant ventricular arrhythmias and sudden cardiac death. Aim of the study. The purpose of this study was to review data about characteristics and management of atrial fibrillation in Brugade syndrome. Materials and methods. The source of information was represented by articles published in the online databases: PubMed, HINARI, SCOPUS, EMBASE Results. Current evidence revealed that the prevalence of AF in patients in BrS vastly differs among publish studies, ranged from 6% to 39%. The only genetic mechanism of arrhythmias is related to the mutation of the SCN5A gene that encodes cardiac sodium channels. However, as this sodium channel is found not only in the ventricular tissue, but also in the atria, this could lead to reentrant tachyarrhythmias in the atrium. Nevertheless, management of BrS with AF remains a difficult task, as medication for AF, such as sodium channel blockers, confers their risk owing to their proarrhythmic effects in patients with BrS. In addition, other than quinidine and disopyramide cannot be used because they block sodium channels and cause ventricular arrhythmias. Recent evidence suggested that catheter ablation could be utilized as a first‐line therapy for paroxysmal AF in BrS patients. For the last 2 decades, ICD therapy has been considered as the cornerstone therapy of patients with documented ventricular tachyarrhythmia, but recent studies has been associated ICD therapy with a significant rate of complications, and should be avoided in asymptomatic patients. The most common of these complications are inappropriate shocks, which cause pain, and can produce psychological trauma. Pulmonary vein isolation (PVI) is an effective method for controlling paroxysmal AF. The literature indicates that the success rate of PVI is 79.8% in the long term in patients with brugada syndrome. Conclusions. According to studies, PVI has been shown to have minimal risk of complications and is considered one of the most effective long-term methods in the control of atrial fibrillation and brugade syndrome. This treatment method could be considered the first line of treatment for atrial fibrillation and in brugade syndrome

Thyrotoxic cardiomyopathy: a case report

Department of Internal Medicine, Cardiology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Background. Heart failure (HF) is the final common pathway of many cardiovascular diseases. It imposes significant socio-economic and health care burden to both patients and healthcare systems. Although the most common cause of HF is ischemic heart diseases, other less common causes such as hyperthyroidism (thyrotoxicosis), severe anemia, arrhythmia should also be considered during diagnosis to improve overall clinical management of HF. Case report. The 42-year-old man was admitted to cardiology department with mixed (inspiratory and expiratory) dyspnea at moderate effort, palpitations, fatigue, the loss in weight of about 15 kg during 9-10 months. Anamnesis: general condition worsened the last 2 months when appeared generalized edema and mixed dyspnea. During this time did not address to doctor, any treatment has not received. Physical examination revealed swelling in the legs, ankles, ascites, an irregular pulse, at a rate of 130 beats/min, BP- 110/70mmHg. On ECG - atrial fibrillation with rate - 120-57 b/min, electric axis of heart is normal. Signs of left ventricular hypertrophy. The chest X-ray -pulmonary congestion, bilateral pleural effusion. The abdominal X-ray – fluid levels with air on the left. On TTE- thickening of the walls of the aorta and valve apparatus. Dilatation of all heart chambers, significant dilatation of the right atrium and right ventricle, and moderate dilatation of the left atrium and the left ventricle. Contractile function of the left ventricular myocardium is moderately reduced. Ejection fraction = 42%. The second degree mitral regurgitation and third-fourth -degree tricuspid regurgitation. Moderate pulmonary arterial hypertension (PASP= 52mmHg). Sheets of the pericardium are thickened. Fluid in the pleural cavity up to 11 millimeters in the region of the right atrium. Bilateral pleurisy - inhomogeneous fluid with floating elements on the left - about 1,000 milliliters, to the right - about 800 milliliters. Сytological analysis of fluid from pleural cavity pointed to the inflammatory etiology of the effusion. On the ultrasound examination of the thyroid gland – fourth –degree hyperplasia, multiple diffuse changes.On the ultrasound examination of abdominal cavity - ascites, bilateral pleuritic, diffuse changes in the parenchyma of the liver. The glycemic profile -7-00: 4.7 mmol/l, 13-00: 6.3 mmol/l, 17-00: 10.6 mmol/l, glycated hemoglobin - 5,6%. Analysis of thyroid hormones- free Triiodothyronine – 17,22 Pmol/l, free Thyroxine – 79,52 Pmol/l. TSH – ‹ 0, 05 uIU/ml; anti TPO- 144 IU/ml. Tumor marker CA 19-9 - <3.0 U/ml. During hospitalization was consulted by endocrinologist, surgeon. After 11 days of complex treatment with diuretics, anticoagulants, beta-adrenoblockers, antithyroid drugs, cardiac glycosides, corticosteroids, histamine-2- receptor blockers - the general condition improved: dyspnea and general swelling disappeared, general weakness was reduced.Conclusions. The incidence and prevalence of thyrotoxic heart failure (THF) provide a wide variation from 12% to 68% in hyperthyroid patients. Up to 90% of patients with thyrotoxicosis may develop Atrial Fibrillation, 47% Left Ventricle systolic dysfunction and 1% dilated THF and a third of these cases are reversible. Mortality in THF patients is 1.2 higher than in patients with hypertension, valvular heart disease or coronary artery disease, and 1.4 higher than in the general population. Hyperthyroidism is a potentially reversible and curable cause of THF, so it should be excluded in every new patient with HF, especially in young patients and in the absence of coronary artery disease and other structural heart diseases