A case study evaluating the use of clozapine in depression with psychotic features

The purpose of this case study was to use an evidence based medicine approach to work through an unusual way of treating a common problem. We looked at an example of an in-patient with severe refractory psychotic depression who had been resistant to treatment with a combination of antidepressant, antipsychotics, mood stabiliser, and concomitant ECT therapy. We then undertook a literature search for the use of clozapine in a patient with severe refractory depression. Although the resulting evidence was low level and thin, we felt on balance that a trial of clozapine was justified. We used a BPRS inventory to monitor her mood prior to commencing clozapine. Her mood and functional abilities were monitored as her clozapine was titrated upwards. Our patient showed a significant improvement in mood and functional abilities and a reduction in her BPRS score during this period. Her symptoms improved to the point where she was successfully discharged home on a combination of clozapine and an antidepressant. The improvement was sustained for a further two years. We thought this was an important case to highlight the limited evidence in using this successful form of treatment for a common clinical problem and that further research in this area was needed

The results of multicentric study of prostate pathology in some localities of Republic of Moldova

IP USMF "Nicolae Testemiţanu", IMSP Spitalul Clinic Republican, IMSP Spitalul Republican ACSR, IMSP SR Cahul, IMSP SR Edineţ, IMSP SR Drochia, IMSP SR Orhei, Compania farmaceutică Berline-Chemie Menarini, Reprezentanţa în R. Moldova, Al VI-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (21-23 octombrie 2015)Rezumat. în lucrare sunt analizate rezultatele unui studiu multicentric a patologiei prostatei efectuat în baza screening-ului la bărbaţi din 7 localităţi ale R. Moldova. Conform protocolului adoptat au fost examinaţi 508 pacienţi cu vârsta medie de 63,3±9,1 ani. Au fost studiate structura patologiilor depistate (adenom de prostată (HBP), cancer de prostată (CP), prostatită), particularităţile clinice ale HBP, incidenţa CP, metodele de tratament recomandate în dependenţă de rezultatele screening-ului. Cea mai frecventă patologie a constituit HBP - 425 cazuri, sau 83,7%, în 8 cazuri (1,6%) a fost diagnosticat CP, iar prostatita cronică la 62 (12,2%) pacienţi. Majoritatea pacienţilor cu HBP - 76,8% au primit indicaţii pentru tratament conservator, 9,1% din pacienţi pentru prostatită cronică; tratamentul chirurgical a fost indicat la 30 pacienţi (5,9%) pentru HBP, iar tratament specializat pentru CP s-a indicat la 3 pacienţi (0,6%). La 12 pacienţi a fost necesar de efectuat o serie de investigaţii suplimentare pentru diferenţierea diagnosticului dintre adenom şi cancer de prostată.Summary. In article were analyzed the results of a multicenter screening study of the prostate pathology in men from 7 regions of R. of Moldova. According to the adopted protocol were examined 508 patients with a mean age of 63,3 ± 9,1 years. The structure of the identified pathologies (binign prostatic hyperplasia (BPH), prostate cancer (PC), prostatitis, the clinical features of BPH, the incidence of PC, the recommended treatment methods depending on the results of the screening were studied. The most frequent pathology was BPH - 425 cases or 83,7%, PC was diagnosed in 8 patients (1,6%) and chronic prostatitis in 62 (12,2%) patients. Most of the patients with BPH — 76,8% received indications for conservative treatment, 9,1% of patients received treatment for chronic prostatitis. Surgical treatment was indicated in 30 patients (5,9%) with BPH and specialized treatment for PC was indicated in 3 patients (0,6%). In 12 patients it was necessary to perform a number of additional investigations for differential diagnosis of adenoma and prostate cancer

Rhinitis in the geriatric population

The current geriatric population in the United States accounts for approximately 12% of the total population and is projected to reach nearly 20% (71.5 million people) by 2030[1]. With this expansion of the number of older adults, physicians will face the common complaint of rhinitis with increasing frequency. Nasal symptoms pose a significant burden on the health of older people and require attention to improve quality of life. Several mechanisms likely underlie the pathogenesis of rhinitis in these patients, including inflammatory conditions and the influence of aging on nasal physiology, with the potential for interaction between the two. Various treatments have been proposed to manage this condition; however, more work is needed to enhance our understanding of the pathophysiology of the various forms of geriatric rhinitis and to develop more effective therapies for this important patient population

Хирургическое лечение «раннего» рака молочной железы: что изменилось? (опыт международного сотрудничества)

The study included patients with noninvasive cancer and stage T1a-b-cN0M0 invasive breast cancer who were treated between 1985 to 2009 in Russia (at the N.N. Blokhin Russian Cancer Research Center and at the Clinic of the Russian Medical Academy of Postgraduate Training, 1036 patients), and in the Netherlands (LUMC, 560 patients, National Cancer Register, 22196 patients). The comparative analysis of surgery types between countries was carried out. The frequency of organ-preserving surgeries for early breast cancer in Russian and in the Netherlands was identical (53.7 % and 52.5 %). The percentage of organ-preserving surgeries over the past 20 years in Russia was not significantly changed, whereas the decrease in the rate of organ-preserving treatment from 56.2 % to 41.2 % was observed in the Netherlands.This is most likely due to an increase in the number of patients in postmenopause (>60 years) from 53.1 % to 63.8 %. The main type of organ-preserving treatment in Russia is radical resection of the breast. In the Netherlands, lumpectomy with sentinel lymph node biopsy or axillary lymphodissection is the most common form of breast-conserving surgery today.В исследование включены пациентки с неинвазивным раком и раком молочной железы c T1a-b-cN0M0 стадией, получившие лечение с 1985 по 2009 г. в России (РОНЦ им. Н.Н. Блохина РАМН и Клиника РМАПО – 1036 больных) и в Нидерландах (LUMC – 560 пациенток, Национальный Канцрегистр – 22196 больных). Проведен сравнительный анализ типов выполненных операций по странам, а также во временных подгруппах. Частота органосохраняющего лечения при «раннем» раке молочной железы вРоссии и Нидерландах идентична – 53,7 % и 52,5 %. Доля органосохраняющих операций в течение 20 лет в России существенно не изменилась, тогда как в Нидерландах отмечено уменьшение доли органосохраняющего лечения с 56,2 % до 41,2 %, что, вероятнее всего, объясняется увеличением числа пациенток, находящихся в постменопаузе (>60 лет) с 53,1 % до 63,8 %. Основным вариантом органосохраняющего лечения в России является радикальная резекция молочной железы, в Нидерландах – лампэктомия с БСЛУ или аксиллярной лимфодиссекцией, причем БСЛУ и в настоящее время не является «рутинной» операцией во всей стране

ТАРГЕТНАЯ ТЕРАПИЯ ИЛИ ОБЛУЧЕНИЕ ВСЕГО ГОЛОВНОГО МОЗГА ПРИ МНОЖЕСТВЕННЫХ (>3 ОЧАГОВ) МЕТАСТАЗАХ: С ЧЕГО НАЧИНАТЬ ЛЕЧЕНИЕ?

Лучевая терапия (ЛТ) на весь головной мозг является общепринятым стандартом при множественных (более 3-х очагов) метастазах в головном мозге. Но эффективность ЛТ различна  в зависимости от нозологической формы опухолевого заболевания и биологических характеристик опухоли. Так, если при раке молочной железы эффективность (частота полных и частичных регрессий метастазов в головном мозге) ЛТ на весь головной мозг при церебральных метастазах достигает 60%, то при меланоме не превышает 10%. При проведении  ЛТ на весь головной мозг (без противоопухолевой лекарственной терапии) медиана выживаемости колеблется от 1,5–3,0 месяцев при меланоме до 4,0–6,5 месяцев при раке легкого и раке молочной железы. Большинство летальных исходов (до 70–80%) у пациентов с церебральными метастазами связано с системным прогрессированием опухолевого процесса. Следует также учитывать риск когнитивных нарушений при ЛТ на весь головной мозг, который увеличивается у пациентов с более длительной выживаемостью (1 год и более), с относительно хорошим прогнозом. Многие пациенты, получающие таргетную терапию, живут более одного года. В связи с этим остается открытым вопрос о последовательности использования противоопухолевой лекарственной терапии и ЛТ на весь головной мозг у групп больных с относительно хорошим прогнозом, получающих таргетную терапию. Эффективность  таргетной терапии при метастатическом поражении головного мозга по литературным данным, а также по результатам собственных исследований, достигает: 50–66% при HER2-позитивном раке молочной железы с медианой выживаемости больных до 17,5 месяцев, 30–44,5% при меланоме с мутацией V600EBRAF с медианой выживаемости больных до 8,0 месяцев, 76–87% при аденокарциноме легкого с мутациями EGFR с медианой выживаемости больных до 18–22 мес., 55–69% при аденокарциноме легкого с транслокацией ALK с медианой выживаемости от 15 мес. до 49,5 мес. На основании данных этих исследований можно предложить проведение таргетной терапии в качестве первой линии лечения как одну из возможных опций в лечении больных с множественным метастатическим поражением головного мозга. Необходимы дальнейшие исследования по изучению таргетной терапии у пациентов с церебральными метастазами

The cellular and humoral immunity assay in patients with complicated urolithiasis

Department of Urology and Surgical Nephrology, “Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chişinău, Republic of Moldova, Clinic of Urology, Clinical Republican Hospital, Chişinău, Republic of MoldovaAbstract. Especially complicated, renal lithiasis contributes to the general inflammatory syndrome development that interferes with nonspecific, humoral and cellular immune system. The surgical treatment of nephrolithiasis is closely related to drug therapy of urinary infection, one of the reasons being the reduction of the immune status. The work is performed by evaluating the immunological status preoperatively in 58 patients with complicated lithiasis. The analysis of the status in these patients demonstrated that complicated urolithiasis results in significant changes in the immune system, these changes being expressed at the cellular and humoral level of immunity

The role of contemporan lithitripters in the treatment of reno-uretheral stones

Republican Clinical Hospital, Chisinau, Moldova Republic Department of Urology and Surgical Nephrology, State University of Medicine and Pharmacy, Chisinau, Moldova Republi

The tubeless percutaneous nephrolithotomy – Advantages and safety

Departament of Urology and Surgical Nephrology, State Univercity of Medicine and Pharmacy, Chisinau, Moldova Republic Republican Clinical Hospital, Chisinau, Moldova Republi

The peculiarities of chemical composition of kidney stones in patients with recurrent urolithiasis in Republic of Moldova

Catedra Urologie și nefrologie chirurgicală, Universitatea de Stat de Medicină și Farmacie “Nicolae Testemițanu”, Chișinău, Republica Moldova, Secția Urologie, Spitalul Clinic Republican, Chișinău, Republica Moldov