Sindromul antifosfolipidic catastrofal asherson

Sindromul antifosfolipidic catastofal Asherson se dezvoltă rapid la persoanele pozitive pentru anticorpii antifosfolipidici, ca urmare a unui factor declanşator identifi cabil (infecţie, traumatism, coagulare inadecvată, patologie obstetricală). Cel mai frecvent este întâlnit la persoanele cu sindrom antifosfolipidic primar sau lupus eritematos sistemic (LES) ori afecţiuni „lupus-like” (LLD). Clinic, se manifestă prin tromboze ale vaselor mici, afectând diverse organe (inimă, creier, tract astrointestinal, rinichi, suprarenale). In 1/3 din cazuri apar ocluzii de vase mari, ca manifestări ale sindromului de răspuns infl amator sistemic (SRIS) sau sindromul de detresă respiratorie acută (SDRA). Cu toata terapia, precoce şi intensivă, ce constă în adminstrarea de anticoagulante, corticoizi, antibiotice, imunoglobuline intravenos, plasmafereză, mortalitatea rămâne crescută, ridicându-se la aproximativ 50% din cazuri

Decidua – actualităţi morfofuncţionale

The processes of deciduation of endometrium prepare the appearences of a structure which reprezented by decidua. This khew structure will regulated acceptation graft. Reprezented by pregnancy through specifi c immunologic mechanisms, which add endocrine and paracrine functions of decidua. The resence in decidua structures of numerous cytokine and cells with particular structures and activity, will permite trophoblastic invasion and changes to the interface level of mathernoplacentar. Profound study on decidua will lead to undestand with very high fi neness the mechanisms which is stoy on the basis of trophoblastic invasion

Evaluation of the effectiveness of Ferzym administration in digestive diseases

Department of Pediatrics, Nicolae Testemitsanu State University of Medicine and Pharmacy, Institute of Mother and Child, Chisinau, the Republic of MoldovaAbstract Background: Assessing effectiveness of the next generation probiotic Ferzym in conjunction with other probiotics for correction of the microbiocenotic status in different digestive disorders. Material and methods: 120 children aged between 6 months and 17 years, with the mean age of 9.3 ± 0.61 years, were included in the study, being admitted to Gastroenterology Department of Institute of Mother and Child. The research methods included: thorough anamnesis of the disease and comprehensive clinical examination. The clinical testing procedure included a clinical monitoring during the 10-day inpatient treatment and 1 month after the outpatient treatment. Results: A more favorable clinical and progressive improvement curve was observed in children who received Ferzym. Both the stool consistency and frequency improved faster. It has been recorded a gradual and continuous remission of the abdominal pain and decrease of the discomfort up to the 10th day of treatment. The final segment of the “treatment with probiotics” curve confirms the assumption that treatment effectiveness is maintained for about 10 days, so that it can cover the acute period of disturbances. Conclusions: Ferzym is practically the only solution in the intestinal microbiocenosis control in children with intestinal malabsorption and Coeliac disease, as the capsule does not contain dismulate gluten. Efficacy of Ferzym indicated to children with digestive disorders is a priority over the biological non-sorbit preparations and monocompetent ones because Ferzym regulates the microbiocenotic status of the small intestine and colon

Afectarea multisistemică în bolile inflamatorii intestinale şi boala celiacă la copii

Institutul Mamei şi Copilului, secţia gastroenterologie, Republica MoldovaActualitatea. Maladiile inflamatorii intestinale şi boala celiacă sunt entităţi patologice actuale, atît prin creşterea constantă a incidenţei, cît şi prin afectarea sistemică a majoritatea organelor. Acestea ducînd la necesitatea abordării multidisciplinare a cazurilor diagnosticate, în care doar o echipă formată din gastroenterolog, endoscopist, radiolog, reumatolog, alergolog, dermatolog poate realiza cu succes managementul de conduită al pacienţilor. Scopul. Evaluarea manifestărilor clinice extraintestinale în bolile inflamatorii intestinale şi boala celiacă la copii Material şi metode. Studiu prospectiv a pacienţilor cu maladii inflamatorii intestinale (41 copii), colită ulceroasă 36 (87,8%) copii şi boala Crohn 5 (12,2%) copii şi studiu retrospectiv a pacienţilor cu boala celiacă (84 copii). Rezultatele obţinute: La pacienţii cu boli infl amatorii intestinale au fost prezente următoarele manifestări extraintestinale: osteoarticulare 22%, prin afectarea articulaţiilor talocrurale 22%, genunchilor 14,6%, radiocarpală 4,9%, antibraţului 4,9%, manifestări mucocutanate 14,6%, cu stomatită aftoasă 12,2%, dermatită atopică 4,9%, manifestări endocrine 7,3%, patologia glandei tiroide 7,3%, retard pubertar 4,8%, manifestări hematologice 43,9%, afecţiuni hepatobiliare, prin colangită sclerozantă primară 2,4%. La pacienţii cu boala celiacă au fost prezente în 39,95% manifestări osteomusculare, cu afectare articulară 22,6%, hipoplazie dentară 17,3%; manifestări mucocutanate – 62,5%, hipecheratoză cutanată 31%, stomatită, glosită, gingivită 25%; manifestări neurologice - 70,23%, hiperexcitabilitate 60,71%; epilepsie 3,57%, manifestări endocrine – 57,14%, patologia glandei tiroide 33,3%, retard pubertar 23,8%, manifestări hematologice - 25%, anemie 23,8%, sindrom hemoragic 1,19%. Concluzii. Ponderea manifestărilor extraintestinale, în studiu nostru, este de 51,2% pentru bolile infl amatorii intestinale şi 86,9% pentru boala celiacă, comparativ cu literatura de specialitate 25-60%. Aceşti copii necesitînd o prudenţă semnifi cativă din partea specialiştilor în evitarea lacunelor de diagnostic, deoarece identificarea precoce a manifestărilor extraintestinale ar permite ameliorarea evoluţiei maladiilor de bază, cu ameliorarea semnificativă a calităţii vieţii acestor copii

Заболеваемость желудочно-кишечного тракта у детей Республики Молдова

The article presents the morbidity analysis of gastrointestinal pathologies among the children’s population in Moldova during the period of 2006-2011 in terms of statistical indicators of such digestive diseases as gastritis and duodenitis, gallstones, pancreatitis, stomach and duodenal ulcers as well as inflammatory bowel diseases (ulcerative colitis and Crohn’s disease). The data of National Bureau of Statistics, National Center of Health Management and other investigations, containing official data, have been used. During these 5 years both the prevalence and incidence of the digestive pathologies were rising, taking the second and the third places in the rating of the first three nosologies being after respiratory diseases and injuries. Yet, the trigger factors as well as the relapses of gastrointestinal and hepatobiliary diseases remain completely neglected in clinical assessments and in the management of children’s behaviour. Thus, maintaining the health of children is crucial to the health condition and longevity of future adults. After the multidimensional analysis of the indicators a number of proposals have been outlined to reduce the level of digestive diseases morbidity.В статье приводится анализ патологий желудочно-кишечного тракта у детей Республики Молдова на период 2006-2011 гг. Использованы статистические показатели таких пищеварительных заболеваний как гастрит, язва желудка и двенадцатиперстной кишки, желчно-каменная болезнь, панкреатит, язва и воспалительные заболевания кишечника (язвенный колит и болезнь Крона). Задействованы данные Национального Бюро Статистики, Национального Центра Менеджмента Здравоохранения, а также результаты других исследований, содержащих официальные данные. На протяжении этих 5-ти лет, как распространенность, так и рост заболеваемости патологиями пищеварительной системы постоянно увеличиваются, занимая вторую и третью позиции после заболеваний дыхательных путей и травм в рейтинге первых трех нозологий. Несмотря на это, факторы вызывающие данные патологии, а также рецидивирующие желудочно-кишечные и гепатобилиарные заболевания остаются полностью без внимания в. клинических исследованиях и, соответственно, терапевтическое поведение детей не корректируется должным образом. А поддержание здоровья ребенка является решающим для состояния здоровья и долголетия будущего взрослого. После многомерного анализа показателей приведен ряд предложений для снижения порога заболеваемости пищеварительными патологиями

Nitric Oxide Releasing Nanoparticles Are Therapeutic for Staphylococcus aureus Abscesses in a Murine Model of Infection

Staphylococcus aureus (SA) is a leading cause of a diverse spectrum of bacterial diseases, including abscesses. Nitric oxide (NO) is a critical component of the natural host defense against pathogens such as SA, but its therapeutic applications have been limited by a lack of effective delivery options. We tested the efficacy of a NO-releasing nanoparticle system (NO-np) in methicillin-resistant SA (MRSA) abscesses in mice. The results show that the NO-np exert antimicrobial activity against MRSA in vitro and in abscesses. Topical or intradermal NO-np treatment of abscesses reduces the involved area and bacterial load while improving skin architecture. Notably, we evaluated pro- and anti-inflammatory cytokines that are involved in immunomodulation and wound healing, revealing that NO-np lead to a reduction in angiogenesis preventing bacterial dissemination from abscesses. These data suggest that NO-np may be useful therapeutics for microbial abscesses

Histological changes in the vulva and vagina from ovariectomised rats undergoing oestrogen treatment

Background: The purpose of this study was to assess the histological changes occurring in the vagina and vulva in ovariectomised female rats, as well as the response to the administration of injectable oestrogens. Material and methods: We used 30 female Wistar white rats, distributed as follows: group 1 — the control group, group 2 — the operated but untreated rats, and groups 3, 4 and 5 — operated rats, to which oestrogenic treatment was administered (Estradiol, Estradurin, Sintofolin) at a dosage of 0.2 mg/rat/day. After 14 days of treatment, all animals were sacrificed and vaginal and vulvar biopsies were taken from all groups. Results: In group 2, we encountered structural changes of the vaginal mucosa, with severe atrophy and alterations in the thickness of the vagina and vulva. In groups 3, 4 and 5 we found marked hyperplasia of the vaginal and vulvar epithelium, eosinophilic and mast cell infiltration in the chorion. Conclusions: Our study proves that the histopathological changes during anoestrus after administration of oestrogens are cell hyperplasia, thickening of the superficial mucosal layer, eosinophilic and mast cells infiltrations, and chorionic congestion. Furthermore, we demonstrated that Estradiol therapy induces the most evident histological changes when compared to synthetic oestrogens such as Estradurin or Sintofolin.

Bridging the gap: safety and outcomes of intensivist-led ECMO retrievals

PurposeMost extracorporeal membrane oxygenation (ECMO) cannulations are performed by cardiothoracic surgeons (CTS). Due to an increase in utilization of ECMO and limited availability of CTS, there is a mismatch between ECMO demand and CTS accessibility for remote cannulations. We report our intensivist-led program’s experience in remote ECMO cannulations, retrievals, complications, and outcomes.Materials and methodsA prospective, single-center, observational study was performed on patients that required ECMO cannulation at the referring facilities and were transported to our institution between program initiation, on October 1, 2014 to September 30, 2022. Results were presented as mean ± SD, median (min – max) or number (%).ResultsSince program commencement, 305 patients were accepted for ECMO retrieval. Three hundred and three patients were placed on ECMO at the 47 referring hospitals among 5 states. In our study, 185 (61%) patients required veno-arterial ECMO and 115 (38%) were placed on veno-venous ECMO. Three patients (1%) were cannulated for veno-arteriovenous ECMO. Twenty patients were cannulated under cardio-pulmonary resuscitation. Most of the patients were transported by ambulance (79%), 14% by helicopter, and 7% by airplane. Six out of the 303 patients did not leave the referring facility. All patients that left the referring hospitals arrived safely to our institution. No major complications occurred in route.ConclusionOur study’s findings indicate that non-CTS physicians can successfully cannulate and retrieve patients with a low complication profile

The HELLP syndrome: Clinical issues and management. A Review

<p>Abstract</p> <p>Background</p> <p>The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10–20% of cases with severe preeclampsia. The present review highlights occurrence, diagnosis, complications, surveillance, corticosteroid treatment, mode of delivery and risk of recurrence.</p> <p>Methods</p> <p>Clinical reports and reviews published between 2000 and 2008 were screened using Pub Med and Cochrane databases.</p> <p>Results and conclusion</p> <p>About 70% of the cases develop before delivery, the majority between the 27th and 37th gestational weeks; the remainder within 48 hours after delivery. The HELLP syndrome may be complete or incomplete. In the Tennessee Classification System diagnostic criteria for HELLP are haemolysis with increased LDH (> 600 U/L), AST (≥ 70 U/L), and platelets < 100·10⁹/L. The Mississippi Triple-class HELLP System further classifies the disorder by the nadir platelet counts. The syndrome is a progressive condition and serious complications are frequent. Conservative treatment (≥ 48 hours) is controversial but may be considered in selected cases < 34 weeks' gestation. Delivery is indicated if the HELLP syndrome occurs after the 34th gestational week or the foetal and/or maternal conditions deteriorate. Vaginal delivery is preferable. If the cervix is unfavourable, it is reasonable to induce cervical ripening and then labour. In gestational ages between 24 and 34 weeks most authors prefer a single course of corticosteroid therapy for foetal lung maturation, either 2 doses of 12 mg betamethasone 24 hours apart or 6 mg or dexamethasone 12 hours apart before delivery. Standard corticosteroid treatment is, however, of uncertain clinical value in the maternal HELLP syndrome. High-dose treatment and repeated doses should be avoided for fear of long-term adverse effects on the foetal brain. Before 34 weeks' gestation, delivery should be performed if the maternal condition worsens or signs of intrauterine foetal distress occur. Blood pressure should be kept below 155/105 mmHg. Close surveillance of the mother should be continued for at least 48 hours after delivery.</p