The infection with the new Influenza A(H1N1) virus

Catedra Boli infecţioase, tropicale şi parazitologie medicală USMF „Nicolae Testemiţanu”The Novel Flu in Humans is an extremely contagious respiratory illness, wich is caused by the new Influenza A virus subtype H1N1 and has never been met in people before. This new virus appeared suddenly in human population. It was first dettected in the USA in April 2009. The outbreak intensified rapidly from that time spreading over more and more countries and continents. On 11-th of Juin 2009, WHO General-Director has decided to raise the current level of influenza pandemic alert to phase 6. This article presents the most important data about the infection with the new Influenza A(H1N1) virus. Gripa (porcină) sau de tip nou este o maladie respiratorie acută, extrem de contagioasă, cauzată de virusul gripal de tip A(H1N1), neîntâlnit anterior în circulaţia umană. Acest virus de tip nou a apărut în populaţia umană şi pentru prima dată a fost detectat în aprilie 2009 în SUA. Erupţia epidemică a evoluat vertiginos, răspândindu-se în mai multe ţări şi continente. La 11 iunie 2009 directorul general al OMS a declarat nivelul 6 de alertă pandemică, cauzată de acest virus. Lucrarea actuală aduce o informaţie importantă despre infecţia cu virusul gripal de tip nou A(H1N1)

Впервые выявленный сахарный диабет, осложнённый кетоацидозом. Клинический случай

USMF Nicolae Testemiţanu, IMSP SCM Sfânta Treime, Conferinţa consacrată aniversării celor 40 de ani de la fondarea SCM Sfânta Treime 17 iunie 2016 Chișinău, Republica MoldovaKetoacidosis is a metabolic complication of the Diabetes Mellitus, that appears frequently in the Diabetes type 1, and much more rarely in diabetes 2. The patient, whose case is described represents clinical role of a severe ketoacidosis: weight loss, signs of deshydratation and hypovolemia, Kussmaul breathing, confusion, laboratory abnormalities (metabolic acidosis with pH 6,68 and bicarbonat 1 mmoli/l). Ketoacidosis was shown as an onset of diabetes. This situation required prompt diagnosis and appropriate intensive treatment. Therapeutic course, involves: rebalancing the volume and restoring the capital fluid, correction of dyselectrolytemia, correction of hyperglycemia and ketoacidosis and hyperosmolarity of the serum. Central vascular and hemodynamic monitoring approach was dictated by the degree of hypovolemia, cardiovascular status and pathology of the patient. The correction of hypokalemia was performed before starting the insulin infusion. Bicarbonate administration, continuous intravenous insulin therapy was targeted towards normalization of the anionic hole. Following the principles discussed, in approaching the diagnosis and intensive treatment of diabetic ketoacidosis, patient progress was favorable.Кетоацидоз – это тяжелое метаболическое осложнение, которое чаще появляется при сахарном диабете I-го типа и очень редко у пациентов с диабетом II-го типа. Oписывается клинический случай пациентки с классической картиной тяжелого диабетического кетоацидоза с потерей в весе, признаками гиповолемии и дегидратации, с дыханием Куссмауля, нарушением сознания, с метаболическим ацидозом pH 6,68 и бикарбонатом 1 ммоль/л. Параклинические исследования позволили обосновать диагноз: впервыe выявленный сахарный диабет осложненный диабетическим кетоацидозом. Это тяжёлое осложнение, которое проявилось в начале заболевания, нуждалось в ранней постановке диагноза и экстренном назначении адекватного интенсивного лечения: восстановление и коррекция объема жидкости, гипергликемии, гиперосмолярности крови и кетоацидоза. Внутривенное назначение бикарбоната и инсулина являлось главной терапевтической целью для восстановления анионической „дыры”. Коррекция гипокалиемии была проведена до начала инсулинотерапии

Infecția cu coronavirus de tip nou (COVID-19): protocol clinic naţional (ediția VII) PCN-371

Acest protocol este elaborat și revizuit sistematic de grupul de lucru al Ministerului Sănătății al Republicii Moldova (MS), constituit din reprezentanți ai Comisiilor de specialitate ale MS, angajați ai Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” și Agenției Naționale pentru Sănătate Publică. Documentul nu este unul exhaustiv și se bazează pe recomandările actuale ale Organizației Mondiale a Sănătății privind infecția cu coronavirus de tip nou (COVID-19) și alte date disponibile la acest moment. Protocolul clinic național servește drept referință pentru elaborarea protocoalelor clinice instituționale, reieșind din posibilitățile reale ale fiecărei instituții medicosanitare

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6+/-9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; pPeer reviewe

COVID-19 Barriers to Care for Pregnant Patients in Prolonged Isolation

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the agent responsible for coronavirus disease 2019 (COVID-19), continues to have a devastating impact on healthcare systems worldwide, and many questions remain unanswered. The effect of COVID-19 on the pregnant population is widely debated, and the unique risks in pregnancy have not yet been elucidated. What has been established, however, is the recommendation for healthcare workers to use personal protective equipment (PPE) for both contact and airborne precautions to prevent transmission of the pathogen—adding another barrier to care for vulnerable populations. We report a case of a young woman from Haiti during her first pregnancy, who was admitted to the antepartum service at 22 weeks of gestation with preterm premature rupture of membranes (PPROM) and remained admitted in isolation, though asymptomatic, for over six weeks due to persistent positive SARS-CoV-2 testing. Our case highlights the unique barriers to care that COVID-19 poses to antepartum patients, particularly in the setting of pregnant women with persistent positive testing

Эффективность лечения хронического вирусного гепатита С противовирусны- ми препаратами прямого действия

Catedra de boli infecțioase, tropicale și parazitologie medicală, IP USMF „Nicolae Testemițanu”Rezumat Infecția cu virus hepatic C rămâne o problemă de sănătate publică pe glob. Hepatita virală C acută netratată avansează într-o formă cronică în până la 80% din cazuri, evoluând în ciroză hepatică cu un risc de decompensare hepatică, carcinom hepatocelular și extrahepatic. Scopul tratamentului antiviral cu preparate cu acțiune directă este eliminarea definitivă a virusului și negativarea ARN-VHC timp de 6 luni după finisarea tratamentului. În studiul dat au fost incluși 66 pacienți diagnosticați cu HVC cronică, care au urmat tratament cu preparate antivirale cu acțiune directă Sofosbuvir+Daclatasvir timp de 12 săptămâni. La toți pacienții pe parcursul tratamentului au fost monitorizați indicii clinici, biochimici, seologici, gradul de fibroză hepatică și testele de biologie moleculară. La 12 săptămâni de tratament la toți pacienții ALAT a atins limitele normei, 92,4% pacienți au avut răspuns virusologic și la 24 săptămâni de la inițierea tratamentului 90,9% subiecți au înregistrat răspuns virusologic susținut. Concluzii: Studiul nostru arată o rată înaltă a răspunsului virusologic susținut după tratamentul cu Sofosbuvir și Daclatasvir timp de 12 săptămâni atât a pacienților cu HVC cronică naivi cît și pretratați cu PEG-INF și Ribavirină. Viral hepatitis C infection remains a public health problem worldwide. Untreated viral hepatitis C advances up to 80% of cases, increasing the risk of liver cirrhosis with liver decompensation, hepatocellular and extrahepatic carcinoma. The purpose of anti-viral therapy is to eradicate the virus hepatitis C by the direct action drugs and VHC-RNA negativity for 6 month after the end of treatment. The current study included 66 patients diagnosed with chronic VHC, who had been treated with direct action Sofosbuvir+Daclatasvir antiviral drugs for 12 weeks. All patients were monitored during treatment for clinical, biochemical, serological indices and degree of liver fibrosis and molecular biology tests. At 12 weeks of treatment all the patients reached the normal levels of ALAT, 92,4% of patients had virological response and at 24 weeks 90,0% subjects sustained virologic response after the initiation of treatment. Conclusion: Our study shows a high rate of sustained virological response following the treatment with Daclatasvir plus Sofosbuvir during 12 weeks both for patients with chronic VHC as naive and pre-treated with PEG-INF and Ribavirin. Вирус гепатита С остается проблемой общественного здравоохранения во всем мире. Острый вирусный гепатит С прогрессирует в хроническую форму до 80% случаев, что повышает риск цирроза печени с декомпенсацией, гепатоцеллюлярной и внепеченочной карциномой. Целью противовирусной терапии является элиминация вируса гепатита С и отрицательная РНК-ВГС в течении 6 месяцев после окончания лечения. В наше исследование включено 66 пациентов с хроническим гепатитом С, которые лечились противовирусными препаратами прямого действия Софосбувир + Даклатасвир в течении 12 недель. У всех пациентов до начала лечения были исследованы клинические, биохимические, серологические показатели, степень фиброза печени и молекулярные методы обследования. Через 12 недель лечения все пациенты достигли АЛАТ нормальных уровней, 92,4% пациентов имели вирусологический ответ, на 24-й неделе после начала лечения 90,9% пациентов показали устойчивый вирусологический ответ. Заключение: Наше исследование показывает высокий уровень устойчивого вирусологического ответа после лечения с Даклатасвир + Софосбувир в течении 12 недель у пациентов с хроническим гепатитом С как у первичных, так и у получавших лечение ПЕГ-ИФН и Рибавирином