SELF-MEDICATION WITH ANTIBIOTICS IN ACUTE RESPIRATORY INFECTIONS

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Automedicația (AM) este o practică răspândită prin folosirea de medicamente depozitate la domiciliu, utilizarea rețetelor vechi și împărtășirea medicamentelor între membrii cercului social. Riscurile AM cu antibiotice (AB) predomină beneficiile potențiale atât pe termen scurt, cât și pe termen îndelungat precum rezistența bacteriană. Scopul studiului. Evaluarea AM și cauzele acesteia în rândul populației urbane. Material și metode. Studiul a cuprins un eșantion de 293 pacienți din zona urbană cu semne de infecții respiratorii acute (IRA). S-a aplicat chestionarul standardizat Happy Audit-2. S-a analizat motivul, sursele de AM; frecvența, complicațiile IRA; cunoștințele despre AB. Rezultate. În IRA 21.5% de respondenți au administrat AB în baza recomandărilor precedente, fără a consulta medicul de familie (MF) sau alt medic și 78.5% au consultat MF. Studiul a constatat că principalul motiv pentru AM a fost în 41.6% de cazuri îngrijorarea agravării IRA. Motive pentru îngrijorare au fost IRA suportată în ultimele 2 luni-29.8% și complicațiile IRA suportate anterior precum: bronșite-59.9%, tonzilite-33.7%, sinusite-24.8%, pneumonii-17.8%, otite-12.7% și tusea cu durata de peste 1 săptămână-25.0%. Motivele AM fost în 15.3% de cazuri dificultățile programării imediate la MF și, în 78.3% -convingerea că AB scurtează durata bolii. Studiul a constatat: 50.0% respondenți au știut că AB au efect asupra bacteriilor și 29.0% au fost convinși că AB au efect și asupra virusurilor. Principalele surse de AB au fost: rezervele casnice-34.0%, AB eliberate fără prescripție-16.0% și AB împărtășite de rude-10.0%. Concluzii. Automedicația cu AB în IRA este frecvent practicată în rândul populației urbane. Fenomenul este susținut de convingerile și cunoștințele despre AB și condiționat de accesul la AB din rezervele casnice și procurarea din farmacii fără rețetă. Fortificarea măsurilor educaționale despre impactul AM sunt necesare în rândurile populației generale.Background. Self-medication (SM) is a widespread practice through using medicines stored at home, using old prescriptions, and sharing medications among the community. The risks of SM with antibiotics (AB) outweigh the potential benefits in both the short and long term such as bacterial resistance. Objective of the study. Assessing the SM and its causes among the urban population. Material and methods. The study included a sample of 293 patients from the urban area with signs of acute respiratory infections (ARI). The standardized Happy Audit-2 questionnaire was applied. It has been analyzed: the causes for SM, sources and knowledge about AB, frequency and complications of ARI. Results. Study showed: 21.5% of respondents administered AB based on previous recommendations without consulting the general practitioner (GP) or other doctor and 78.5% consulted GP. The study found that the main reason for SM was in 41.6% of cases the concern of ARI aggravation. The motives for concern were ARI suffered in the last 2 months - 29.8% and complications of previous ARI such as: bronchitis - 59.9%, tonsillitis-33.7%, sinusitis - 24.8%, pneumonia - 17.8%, otitis - 12.7% and cough lasting over 1 week - 25.0%. The reasons for SM in 15.3% of cases were the difficulties in appointment to the GP and in 78.3% - the confidence that AB shortens the duration of the disease. The study found: 50% respondents knew that AB acts on bacteria and 29.0% were convinced that AB also act on viruses as well. The main sources of AB were household supplies - 34.0%, AB issued without a prescription - 16.0% and AB shared by relatives 10.0%. Conclusion. Self-medication with AB in the IRA is commonly practiced among the urban population. The phenomenon is supported by conviction and knowledge about AB and influenced by AB accessibility from home stocks and procurement from over-the-counter pharmacies. Strengthening educational measures about the impact of AM are needed among the general population

Cunoștințe și practici de utilizare a antibioticelor de către pacienții cu infecții respiratorii acute

Introducere. Creșterea rapidă a rezistenței bacteriene prezintă o problemă de sănătate publică și securitate globală. Consumul excesiv de antibiotice (AB) este asociat cu dezvoltarea rezistenței la antibiotice de la nivel individual până la global. Populația generală are cunoștințe insuficiente despre antibiotice și o percepție greșită a impactului utilizării lor iraționale, a rolului fiecărui utilizator în dezvoltarea rezistenței bacteriene. Scopul. Evaluarea cunoștințelor și a practicilor de utilizare a antibioticelor la pacienții cu infecții respiratorii acute în scopul identificării necesităților pentru elaborarea de măsuri educaționale orientate spre utilizator. Material și metode. Studiul a cuprins un eșantion din 296 de pacienți din zona urbană cu semne de infecții respiratorii acute (IRA) la momentul chestionării. S-a aplicat chestionarul standardizat Happy Audit-2 pentru pacienți cu IRA. Au fost evaluate acuzele la adresare, frecvența suportării IRA, tratamentul antibacterian aplicat, modul de achiziționare a AB, complianța la tratamentul cu AB, cunoștințele referitor la antibiotice și la dezvoltarea rezistenței bacteriene. Rezultate. 50,8% din respondenți s-au tratat fără de AB, 37,2% au administrat tratament antibacterian, iar 12,0% nu au dat un răspuns clar. Tratamentul antibacterian a fost recomandat de medic în 84,4% de cazuri, în 7,3% din cazuri a fost luat de sine stătător de pacient pe baza recomandărilor medicale precedente, în 6,4% din cazuri a fost recomandat de farmacist (7/109) și în 2,7% (3/109) din cazuri de rude. Antibioticul a fost procurat pe bază de rețetă în 84,5% din cazuri, în 8,0% din cazuri –fără rețetă, iar 7,5% din respondenți nu au răspuns. 34,0% din respondenți au utilizat AB din rezervele casnice, dintre care 18,2% l-au folosit în primele trei zile de debut al IRA, iar 81,8% din respondenți după trei zile de la debutul boli. Pacienții cu prescripții medicale pentru AB, au fost complianți la recomandările medicale în 88,7% din cazuri, pe când 11,3% nu au respectat fie durata, fie doza de AB prescrisă. Din numărul total de respondenți (293), 29,2% au considerat că antibioticele sunt eficiente în tratamentul infecțiilor virale, iar 27,9% au dat un răspuns echivoc. 11,6% din respondenți au considerat că AB sunt inofensive pentru organismul uman , 22,2% nu cunoșteau despre efectele nedorite ale AB, iar 30,0% nu cunoșteau despre dezvoltarea rezistenței bacteriene. Concluzii. Cunoștințele insuficiente ale pacienților cu IRA despre efectul antibioticelor și practicile iraționale de utilizare precum automedicația, impune necesitatea fortificării măsurilor de conștientizare. Accesibilitatea și adresabilitatea pacienților către farmacist face necesară colaborarea eficientă interdisciplinară farmacist-medic de familie în scopul utilizării raționale a AB. Datele obținute indică la necesitatea masurilor de fortificare a cunoștințelor pacienților referitor la utilizarea rațională a AB pentru prevenirea rezistenței bacteriene

Knowledge and practices of using antibiotics by patients with acute respiratory infections

Introduction. Excessive and inappropriate antibiotic (AB) consumption is associated with the development of antibiotic resistance (AR). Insufficient knowledge and irrational practices in the use of AB for acute respiratory infections (ARI) by patients contribute to the development of AR. Aim: to assess the knowledge and practices of AB use in patients with ARI to identify educational needs. Material and methods. The study included 393 patients with ARI. The standardized Happy Audit-2 questionnaire was applied. Complaints, the frequency of ARI occurrence, administered AB treatment, AB acquisition method, AB compliance, knowledge about AB, and AB resistance were assessed. Results. AB was used by 40.3% of the patients. Antibiotic treatment was recommended by a doctor in 87.6% of cases, taken independently by 5.6%, recommended by a pharmacist in 5.0%, and recommended by relatives in 1.9% of cases. AB was obtained without a prescription in 6.3% of cases, and household reserves were used in 20.8% of cases. Patients were compliant with antibiotic treatment in 89.7% of cases but 10.3% of respondents did not adhere to the prescribed duration/dosage. 26.7% of respondents believed that AB was effective against viral infections, and 13.8% believed they were harmless to the human body. In 24.1% of cases, respondents were unaware of the adverse effects of AB, including the development of bacterial resistance in 29.7% of cases. Conclusions. Insufficient knowledge about the effects of antibiotics and irrational usage practices, including self-medication, emphasize the need for strengthening awareness and education measures for potential antibiotic users

A comparative clinical picture of dementia

Nicolae Testemitanu State University of Medicine and Pharmacy, Republic of MoldovaIntroduction. The prevalence of dementia is increasing in our population, which is aging at an alarming rate. Due to the heterogeneity of the clinical presentation and the complexity of the neuropathology of the disease, the classifications of dementia remain controversial, and the number of people diagnosed does not correspond, even remotely, with reality. About 47 million people live with dementia globally; by 2050, there will be an almost threefold increase to about 131 million people with dementia. Also, the costs for the diagnosis, treatment and post-treatment surveillance of dementia for the health system and the economy are significant. The clinical picture of dementia is quite diverse. Therefore, it is necessary to learn how to relate its different symptoms and syndromes, characteristics and specificity in different nosologies. Material and methods. The present work studied 42 materials and literature sources from the Medscape, PubMed and EBSCO databases in terms of clinical manifestations, symptoms and syndromes of dementia (2013-2021). Most of the used literature sources refer to the last years of publication (2016-2021). The methods of study were as follows: 1. The clinical-descriptive method of the main symptoms, syndromes, 2. The comparative clinical analysis of the symptoms of dementia, 3. The specific clinical features, 4. The differential diagnosis between different types of dementia, 5. The 4 most common dementia types, 6. Dementia in different nosologies, 7. The most common conditions viz. depression and delirium, should be differentiated from dementia in the first place. Major attention was paid to the comparative characteristics and clinical manifestations of different types of dementia in various pathologies, to the point of specific features of dementia. A comparative clinical picture of deep cognitive changes and development was studied according to the REIBERG scale for dementia. There were applied current classifications of dementia: DSMV, ICD-X, ICD-11. The scientific novelty of the work is provided by the use of ICD-11 in the description of the criteria for the diagnosis of dementia. Results. The paper lists the risk factors, protection factors and pathogenesis of dementia. The study results provided a generalization of specific symptoms and syndromes in the most common 4 types of dementia: 1. Dementia in Alzheimer’s Disease, 2. Lewy Body Dementia, 3. Vascular Dementia, 4. Frontotemporal Dementia, as well as dementia occurring in other nosologies. Comparative differential criteria for the diagnosis of dementia and other underlying conditions which are difficult to differentiate from dementia viz. depression and delirium were also studied. Conclusions. Failure to recognize dementia syndromes remains common. Different types of dementia require different approaches and management. From a long list of differential diagnoses of dementia, four common types should come to mind (Alzheimer's disease, vascular dementia, Lewy body dementia and frontotemporal dementia) just by taking patient’s family history, physical examination and checking the patient’s behavioral status. Dementia should be differentiated from the most common conditions like depression and delirium by nosology, clinical presentation, prevailing symptoms and syndromes

Practices of using antibiotics in acute respiratory infections in primary health care in Republic of Moldova: cross-sectional study

Catedra de medicină de familie, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”, Chișinău, Republica MoldovaRezumat. Introducere. Utilizarea excesivă și neargumentată a antibioticelor (AB) este cauza principală de dezvoltare a antibiorezistenţei microorganismelor. Peste 80% din toate prescripţiile de AB, în special, în infecţiile respiratorii acute, se fac în sectorul de asistenţă medicală primară (AMP). Material și metode. Studiu observaţional, descriptiv, transversal, care a inclus 465 de medici de familie (MF) din diferite regiuni ale Republicii Moldova. Participarea medicilor în studiu a fost benevolă și confidenţială. Practicile de prescriere au fost evaluate prin aplicarea chestionarului Happy Audit 2, propus de BARN (Baltic Antibiotic Resistance Network). Rezultate. S-a demonstrat că infecţiile respiratorii acute (IRA) au fost tratate cu antibiotice în 50,44% din cazuri, dintre care, 32,26% – în primele 3 zile de la debutul manifestărilor clinice. Rata de prescriere a AB în raport cu etiologia IRA, stabilită conform semnelor clinice, a constituit: pentru etiologia bacteriană – 89,9%; mixtă – 84,6%; necunoscută – 56,8%; virală – 19,8%. Dintre medicii participanţi la studiu, 94,9% au prescris antibiotice în IRA, dintre care, 61% – în caz de etiologie virală a infecţiilor respiratorii acute. Cel mai frecvent prescrise au fost: penicilinele semisintetice asociate – 33,2%; cefalosporinele generaţia I, II, III – 21,19%; penicilinele semisintetice cu spectru larg de acţiune – 18,93%. Concluzii. Rezultatele studiului au constatat că practicile de prescriere a antibioticelor în IRA la nivel de asistentă medicală primară sunt conforme recomandărilor ghidurilor naţionale și internaţionale doar în 49,56% din cazuri, fiind asemănătoare cu datele din ţările UE și SUA. Fiecare participant a prescris antibiotice în IRA, cel puţin, o singură dată. Dar, 61% dintre participanţi au prescris antibiotice și în etiologia virală a IRA. Mai frecvent trataţi cu antibiotice au fost copiii preponderent cu vârsta de până la 5 ani, de rutină fiind utilizate antibiotice cu spectru larg de acţiune. Cele expuse susţin ipoteza privind răspândirea largă a practicilor nepotrivite de prescriere a AB în sectorul primar.Abstract. Introduction. Excessive and unjustified use of antibiotics (AB) is the main cause of microorganisms’ resistance development. Over 80% of all antibiotic prescriptions, especially in acute respiratory infections, occur in primary health care (PHC). Material and methods. A transversal, descriptive, observational study involved 465 general practitioners from different regions of Republic of Moldova. Doctors’ participation in the study was voluntary and confidential. Prescription practices were evaluated by applying Happy Audit 2 questionnaire proposed by BARN (Baltic Antibiotic Resistance Network). Results. It has been shown that acute respiratory infections (ARIs) have been treated with antibiotics in 50.44% of cases, 32.26% of which within the first 3 days of onset clinical manifestations. The antibiotic prescription rate in relation to the etiology of an ARI determined according to clinical signs was: for the bacterial etiology – 89.9%; mixed – 84.6%; unknown – 56.8%; viral – 19.8%. Among the doctors participating in the study, 94.9% prescribed antibiotics in ARIs, 61% of which in viral etiology of acute respiratory infections. The most commonly prescribed were: associated semisynthetic penicillins – 33.2%; cephalosporins generation I, II, III – 21.19%; semisynthetic penicillins with broad-spectrum of action – 18.93%. Conclusions. The results of the study found that antibiotic prescription practices in ARIs in primary care correspond to the recommendations of the national and international guidelines only in 49.56% of the cases, being similar to the data from EU and US countries. Each participant prescribed antibiotics in ARIs at least once, but 61% of the participants also in their viral etiology. Children predominantly up to 5 years of age were treated more frequently with antibiotics, routinely broad-spectrum antibiotics being used. In the context of the above, the hypothesis regarding the spread of inappropriate antibiotic prescribing practices in primary sector is supported

Practices of antibiotic consumption in acute respiratory infections at the primary health care level in the Republic of Moldova

Introduction. Antibiotics (AB) rank among the most frequently prescribed drugs globally, and their usage continues to rise. Excessive use is recognized as a major contributor to the development of antibiotic resistance. Primary Healthcare (PHC) practitioners are responsible for over 80% of all antibiotic prescriptions, primarily for respiratory tract infections. Inappropriate antibiotic prescriptions by healthcare practitioners stem from various factors, including diagnostic uncertainty due to the absence of rapid diagnostic tests, influenced prescribing knowledge and behaviors, and practice settings. Aim. The undertaken study aimed to assess the consumption of antibiotics for acute respiratory infections at the level of Primary Health Care Units in the Republic of Moldova. Material and methods. A total of 12,948 records of patients with respiratory infections (RI) were analyzed, as consulted by 429 family physicians (FP) in both rural and urban areas of the Republic of Moldova (RM) between November and March 2015-2016. Each participating physician documented data on patients with acute respiratory infections (ARI) over a consecutive 2-week period, with a minimum of 30 patients each. The participants utilized the "Happy Audit 2" questionnaire, as proposed by the Baltic Antibiotic Resistance Network (BARN). Results. The prescription rate of antibiotics by family physicians (FP) for respiratory infections in the Republic of Moldova was found to be high, at 53.4%. The combination of Amoxicillin with β-lactamase was prescribed in 33.1% of cases, followed by Cephalosporins at 21.3%, Amoxicillin at 18.8%, and Macrolides at 16.0%. Elevated prescription rates were particularly noted for acute tonsillitis (93.6%), acute bronchitis (89.1%), acute otitis media (85.6%), and acute sinusitis (78.2%). Antibiotic prescribing in urban areas accounted for 49.5% (±0.01), while in rural areas, it was 58.2% (±0.01). Across geographical regions of the Republic of Moldova, antibiotic prescription rates were registered as follows: 61.3% (±0.02) in the North, 56.1% (±0.02) in the Center, and 52.5% (±0.03) in the South. Self-medication with antibiotics before consulting a family physician was noted in 2.7% of respondents. The average self-medication rate for the stud-ied sample was 2.1% (±0.6), which included rates for urban areas (2.5% ± 2.1) and rural areas (1.67% ± 0.8). Conclusions. The antibiotic prescription rate for Acute Respiratory Infections (ARI) in the Republic of Moldova is notably high at 53.4%, and this prevalence is more pronounced in rural areas. The antibiotic consumption practices for ARI in the country closely mirror those observed in Southeastern European nations. The extensive use of second-line antibiotics such as Amoxicillin clavulanate and Cephalosporins by Primary Healthcare (PHC) practitioners for ARI treatment contradicts both national and international recommendations. Self-medication with antibiotics is more commonly practiced among the urban population in the Republic of Moldova compared to rural areas. It is imperative to implement robust educational measures to curb irrational antibiotic consumption and pro-mote responsible antibiotic use

Loco-regional analgesia in oncology. Influence on cancer recurrence rate. Literature review.

Introduction. A major role and, at the same time, a question mark, both for patients and doctors, is the possibility that drugs and anesthetic techniques influence cancer metastasis. Cancer is the leading cause of death worldwide. This trend will continue in the future. Most of the deaths of cancer patients are due to complications arising from metastases. The metastasis process of a tumor depends on its intrinsic properties and interaction with the host. The treatment of tumors by performing a surgical intervention, radical or palliative, has a significant impact. For these reasons, the rate of survival and migration of cancer cells in the perioperative period is studied quite insistently and complexly. Thus, surgical intervention and anesthetic support in cancer patients becomes of great importance, because it represents the vulnerable link, both from the point of view of the operation itself, as well as the possibility that drugs, anesthetic techniques may or may not influence tumor metastasis. Material and methods. Primary scientific studies published from 1996 to 2021 dedicated to loco-regional anesthesia and its influence on the perioperative period and on cancer metastasis were studied. To achieve the proposed goal, scientific sources PubMed, Medscape, SCOPUS, MEDLINE were researched. Keywords used for searching: loco-regional anesthesia, fascia plane anesthesia, metastasis. More than 80 reference sources were identified, 67 were selected for analysis. Results and discussions. The surgical procedure, itself, performed for curative purposes, also known as tumor resection – is a risk factor for metastasis by creating an environment with high potential for tumor cell survival. This stimulates tumor growth and angiogenesis, can remodel lymphatic pathways, allowing metastasis of tumor cells. Hemotransfusion is associated with increased risk of metastasis. Regional anesthesia could reduce cancer recurrence through several mechanisms. Conclusions. Regional anesthesia could reduce cancer recurrence by reducing the need for opioids or inhaled anesthetics, or by reducing the stress response during surgery. There is scientific in vitro evidence of a protective effect of systemic lidocaine on recurrent cancer, although relevant clinical data are limited

Gripa la adult: protocol clinic naţional PCN-370

Acest protocol a fost elaborat de grupul de lucru al Ministerului Sănătăţii, Muncii și Protecției Sociale al Republicii Moldova (MSMPS RM), constituit din specialiştii Catedrei de boli infecţioase, tropicale şi parazitologie medicală şi Catedrei de boli infecţioase, Catedra de medicină de familie, Agenția Națională pentru Sănătate Publică. Protocolul naţional este elaborat în conformitate cu ghidurile internaţionale actuale privind gripa la adulţi şi va servi drept bază pentru elaborarea protocoalelor instituţionale, în baza posibilităţilor reale ale fiecărei instituţii în anul curent. La recomandarea MSMPS pentru monitorizarea protocoalelor instituţionale pot fi folosite formulare suplimentare, care nu sunt incluse în protocolul clinic naţional