Retrospective study concearning the risk factors, causes, type of birth indications and comparative analysis of complications in case of breech presentation of single fetus at term

State Medical and Pharmaceutical University “Nicolae Testemitanu”, Chisinau, Republic of MoldovaIntroduction: For 3-4% of pregnancies, the fetus will be in breech presentation at term. For most of these women, the approach to delivery is controversial. Purpose and objectives: • Identifying the causes that may lead to a higher rate of pregnancies with breech babies at term; • Highlighting the most frequent complications during pregnancy with breech presented babies; • Comparing natural delivery with caesarian birth and concluding witch way is safer for these particular cases. Materials and methods: The study is based on 46 pregnant women out of 1777, which is the total number of births for 2013 at the PI Municipal Maternity Nb.2. We did a retrospective trial, based on their clinical observation sheets, in order to determine which are the most common causes that may lead to this form of presentation and what the evolution of the pregnancy was. Also, we compared the policy of planned caesarean section with a policy of planned vaginal delivery and the complications occurred during and 5 days after birth for selected breech-presentation pregnancies. ResuIts: Data was received for 46 women out of a total of 1777 women, which represents 2.6%. 84.78% women assigned caesarian section, among which 15.38% were planned (66.67% - primiparous and 33.33% multiparous) and 84.62% were emergencies (63.63% - primiparous, 36.37% - multiparous). 15.22% assigned planned vaginal birth (42.86% - primiparous, 57.14% - multiparous). Out of the total number of breech births cases, 60.87% were primiparous, and 39.13% were multiparous.The identified complications during and after natural birth were: dynamic dystocia (hypokinetic and hypotonic) - 14.29% and hemorrhage - 14.29%; during and after caesarian delivery there has been one case with complication (hemorrhage) -2.56%. Out of the most common causes described in literature, the following causes have been revealed in our study: bicornate uterus - 2.17%, oligoamnios- 4.35%, hidramnios - 2.17%, fetal-placental insufficiency - 4.35%, macrosome fetus - 6.52%.The relative risk - the risk to develop complications during natural birth is 28,5 times higher than that for caesarian section. Conclusion: • The most common conditions that led to breech presentation at term are: bicornate uterus, oligoamnios, hidramnios, fetal-placental insufficiency and macrosomy; • The most frequent complications during delivery are dynamic dystocia and hemorrhage, both in case of vaginal delivery; • These results led us to the conclusion that planned caesarean section is safer than planned vaginal birth for fetus at term in breech presentation; There were no differences between groups in terms of maternal mortality or serious maternal morbidity

Optimizarea diagnosticului dereglărilor vegetative în sistemul stomatognat la pacienții cu bruxism nocturne sub influența substanțelor psihoactive

În articol sunt analizate dereglările vegetative în sistemul stomatognat la pacienții cu bruxism nocturn primar sub infl uența substanțelor psihoactive (nicotina, cafeina), depistate prin aplicarea complexului neurofi ziologic Neuro-MVP (Rusia), cu utilizarea a două variante de diagnostic: potenţialele vegetativ-simpatice evocate la angrenarea forţată fiziologică şi la cea maximală standardizată a maxilarelor. Au fost studiați 100 pacienţi cu bruxism nocturn primar, cu vârsta medie de 33,2±1,15 ani şi 30 persoane sănătoase din aceeaşi grupă de vârstă. Divizarea pacienților în grupe a fost realizată conform recomandărilor existente în literatură: grupele „consumul zilnic de cafeină” – 1) abstinenți (n = 32); 2) 1-3 cănuțe (n = 38); 3) 4-6 cănuțe (n = 19); 4) >6 cănuțe (n = 11); grupele „consumul zilnic de nicotină” – 1) abstinenți (n = 30); 2) 1-5 țigarete (n = 25); 3) >5 țigarete (n = 45). Pentru determinarea nivelului stresului emoțional, am aplicat scala vizuală analogică (SVA). Înregistrarea numărului și duratei totale a încleștărilor nocturne ale maxilarelor am realizat aplicând dispozitivul SleepGuard SG5 (SUA). S-a demonstrat că optimizarea diagnosticului dereglărilor vegetative simpatice în sistemul stomatognat se poate realiza în baza aplicării concomitente a ambelor variante (angrenarea maxilarelor habituală şi cea standardizată); sub acţiunea substanţelor psihoactive se manifestă diferite particularităţi ale proceselor de reglare vegetativă în sistemul stomatognat: cafeina provoacă preponderent dereglări cantitative în reglarea vegetativ-simpatică (sporirea amplitudinii răspunsurilor vegetative), iar nicotina provoacă preponderent dereglări calitative ale proceselor de reglare vegetativă (sporirea timpului central de reglare vegetativă)

Caracteristica genetică a meningioamelor – prezentare de caz clinic

Background: Meningiomas are extraaxial tumors that develop from the cerebral or medullary sheaths and are currently the most common primary tumors of the central nervous system. Objective of the study: Analysis of the variety of histological subtypes that can be extended by defining molecular changes and that can improve both the accuracy of the diagnosis and the determination of the individual outcome of the patient. Material and Methods: The literature review was conducted according to the keywords. The results of the patient’s investigations were analyzed and interpreted: brain magnetic resonance imaging (MRI), computed tomography angiography (CTA), histochemical analysis, tumor genetic analysis. Results: A 40-year-old female patient presents with focal epileptic seizures and severe headache, diagnosed with fibrous meningioma (World Health Organization Grade I) with alterations in the neurofibromatosis type 2 (NF2) gene, and a cavernous hemangioma with non-perilesional swelling, higher density than cerebrospinal fluid on MRI and signs of contrasting peritumor lesion at CTA suggestive of a hemangioma, located at the level of falx cerebri. The patient underwent surgery and showed no signs of recurrence at 12 months of follow-up. Conclusion: The association between meningioma and cavernous hemangioma is extremely rare. There are few data on molecular changes in such associations. Next-generation sequencing (NGS) is a novel method that can help make the diagnosis more accurate and predict the aggressiveness and risk of tumor recurrence.Introducere: Meningioamele reprezintă tumori extraaxiale care se dezvoltă din învelișurile cerebrale sau medulare și sunt în prezent cele mai frecvent întâlnite tumori primare ale sistemului nervos central. Scopul lucrării: Analiza varietății de subtipuri histologice care poate fi extinsă prin definirea modificărilor moleculare și care poate îmbunătăți atât acuratețea diagnosticului cât și determinarea rezultatului individual al pacientului. Material și Metode: A fost efectuată revista literaturii conform cuvintelor cheie. Au fost analizate și interpretate rezultatele investigațiilor efectuate de către pacientă: rezonanță magnetică cerebrală (IRM), angiografie prin computer tomografie (CTA), analiza histochimică, analiza genetică a tumorii. Rezultate: Pacientă de 40 de ani, se prezintă cu crize epileptice focale și cefalee pronunțată, diagnosticată cu meningiom fibros (Organizația Mondială a Sănătății grad I) cu alterări ale genei neurofibromatozei tip 2 (NF2) și un hemangiom cavernos care a prezentat o tumefacție perilezională neobișnuită cu densitate mai mare decât lichidul cefalorahidian la IRM și semne de contrastare a leziunii peritumorale la CTA sugestivă pentru un hemangiom, localizat la nivel de falx cerebri. Pacienta a fost supusă intervenției chirurgicale și nu a prezentat semne de recidivă la 12 luni de urmărire. Concluzii: Asocierea dintre meningiom și hemangiom cavernos este extrem de rară. Există puține date despre modificările moleculare în astfel de asociații. Secvențierea de nouă generație (NGS) vine în ajutor pentru efectuarea diagnosticului cu o acuratețe sporită și pentru pronosticul legat de agresivitatea și riscul de recurență al tumorii

GENETIC CHARACTERISTICS OF MENINGIOMAS - CLINICAL CASE PRESENTATION

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere: Meningioamele reprezintă tumori extraaxiale care se dezvoltă din învelișurile cerebrale sau medulare și sunt în prezent cele mai frecvent întâlnite tumori primare ale sistemului nervos central. Scopul lucrării: Analiza varietății de subtipuri histologice care poate fi extinsă prin definirea modificărilor moleculare și care poate îmbunătăți atât acuratețea diagnosticului cât și determinarea rezultatului individual al pacientului. Material și Metode: A fost efectuată revista literaturii conform cuvintelor cheie. Au fost analizate și interpretate rezultatele investigațiilor efectuate de către pacientă: rezonanță magnetică cerebrală (IRM), angiografie prin computer tomografie (CTA), analiza histochimică, analiza genetică a tumorii. Rezultate: Pacientă de 40 de ani, se prezintă cu crize epileptice focale și cefalee pronunțată, diagnosticată cu meningiom fibros (Organizația Mondială a Sănătății grad I) cu alterări ale genei neurofibromatozei tip 2 (NF2) și un hemangiom cavernos care a prezentat o tumefacție perilezională neobișnuită cu densitate mai mare decât lichidul cefalorahidian la IRM și semne de contrastare a leziunii peritumorale la CTA sugestivă pentru un hemangiom, localizat la nivel de falx cerebri. Pacienta a fost supusă intervenției chirurgicale și nu a prezentat semne de recidivă la 12 luni de urmărire. Concluzii: Asocierea dintre meningiom și hemangiom cavernos este extrem de rară. Există puține date despre modificările moleculare în astfel de asociații. Secvențierea de nouă generație (NGS) vine în ajutor pentru efectuarea diagnosticului cu o acuratețe sporită și pentru pronosticul legat de agresivitatea și riscul de recurență al tumorii.Background: Meningiomas are extraaxial tumors that develop from the cerebral or medullary sheaths and are currently the most common primary tumors of the central nervous system. Objective of the study: Analysis of the variety of histological subtypes that can be extended by defining molecular changes and that can improve both the accuracy of the diagnosis and the determination of the individual outcome of the patient. Material and Methods: The literature review was conducted according to the keywords. The results of the patient’s investigations were analyzed and interpreted: brain magnetic resonance imaging (MRI), computed tomography angiography (CTA), histochemical analysis, tumor genetic analysis. Results: A 40-year-old female patient presents with focal epileptic seizures and severe headache, diagnosed with fibrous meningioma (World Health Organization Grade I) with alterations in the neurofibromatosis type 2 (NF2) gene, and a cavernous hemangioma with non-perilesional swelling, higher density than cerebrospinal fluid on MRI and signs of contrasting peritumor lesion at CTA suggestive of a hemangioma, located at the level of falx cerebri. The patient underwent surgery and showed no signs of recurrence at 12 months of follow-up. Conclusion: The association between meningioma and cavernous hemangioma is extremely rare. There are few data on molecular changes in such associations. Next-generation sequencing (NGS) is a novel method that can help make the diagnosis more accurate and predict the aggressiveness and risk of tumor recurrence

Bruxism and its cofactors: psychoemotional, vegetative and motor aspects

Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, Department of Alternative and Complementary Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Bruxism is a parafunctional activity, consisting of excessive teeth grinding and jaw clenching. It affects at least 15-20% of the general population, and it is estimated that 85-90% of people experience at least one episode of bruxism during their lifetime. Awake bruxism has a higher prevalence in women, in contrast to sleep bruxism, that is more prevalent in men. The objectives of our research are the following: analyzing the quantitative indices of awake bruxism under the influence of stress, nicotine, caffeine and alcohol; assessing the diagnostic possibilities for the fractal analysis of cardiac rhythm. Materials and methods: There were studied 19 patients with awake bruxism and 19 persons without bruxism. The influence of bruxism cofactors was quantified. There were analyzed the quantitative indices of bruxism, the EMG activity of the masseter muscle and the fractal analysis indices of the heart rate (sample entropy - SampEn, correlation dimension – D2). There were used the Polispectr- Ritm, Neuro-MVP diagnostic equipment and the Sleep Guard SG5 device (USA). Results: All the studied cofactors had a higher intensity in bruxers than in non-bruxers, with the highest statistical significant difference observed for emotional stress (p˂0,001) and alcohol consumption (p˂0,01). Bruxers are more likely to smoke more cigarettes than non-bruxers (p˂0,02). Caffeine consumption is two-fold higher for bruxers in comparison to non-bruxers (p˂0,03). The surface electromyography has shown changes under the influence of all cofactors, the highest Amax value was recorded under the influence of alcohol (p˂0,01). The lowest influence on the bioelectrical activity ofthe masseter muscle was observed for caffeine and nicotine. The most significant changes (p˂0,05) for SampEn index were observed under the influence of alcohol. For the D2 index, the influence of alcohol and stress are more significant (p˂0,001) in comparison to nicotine and caffeine (p˂0,05). Conclusion: In patients with awake bruxism, the intensity of factors increases in the following order: caffeine˂nicotine˂alcohol˂stress; the number of episodes, their total duration and the bioelectric activity of masseter muscle increases under the action of the cofactors in the following order: alcohol˂nicotine˂caffeine˂stress. Differentiated evaluation of the action of daily cofactors in patients with awake bruxism can be achieved based on the fractal analysis of the heart rate, which reflects the peculiarities of quantitative manifestation of awake bruxism episodes

Lambert-Eaton myasthenic syndrome – a misdiagnosed condition

Department of Neurology No 1, Nicolae Testemitsanu State University of Medicine and Pharmacy, Department of Neuromuscular Disorders and Polyneuropathies, Institute of Neurology and Neurosurgery, Chisinau, the Republic of MoldovaBackground: Lambert-Eaton myasthenic syndrome (LEMS) is a rare disorder of the neuromuscular junction. Clinical features include proximal muscle weakness, markedly in the lower limbs, reduced deep tendon reflexes that can increase after exercise, and autonomic disturbances. The clinical picture as well as knowledge of the laboratory test that accompany LEMS will permit early recognition of the disease, that is crucial because it is often associated with malignancy, especially small cell lung cancer (SCLC). In this article we present a patient with proximal muscle weakness and typical changes on repetitive nerve stimulation, as well as a short literature review on the topic. Conclusions: The diagnosis of LEMS is usually made on clinical grounds. The diagnosis is confirmed by electrophysiological testing, main features including decrement response on slow repetitive nerves stimulation (3Hz), and an increment of more than 100% in CMAP amplitude after brief exercise, or high frequency repetitive stimulation (30-50 Hz). Immunological panel assay with positive P/Q-type VGCC antibody is strongly suggestive of LEMS. While symptomatic treatment with 3,4 – diaminopyridine is available, one of the main priorities is evaluation for underlying malignancies in these patients, the most common being SCLC. Evaluation of patients with LEMS and no known cancer should start with CT of the chest, abdomen and pelvis. Brain imaging is recommended if focal neurological signs are present. If the initial evaluation of the patient is negative, repeated screening for malignancy after 6 months and up to two years is recommended

Lambert-Eaton myasthenic syndrome – a misdiagnosed condition

Background: Lambert-Eaton myasthenic syndrome (LEMS) is a rare disorder of the neuromuscular junction. Clinical features include proximal muscle weakness, markedly in the lower limbs, reduced deep tendon reflexes that can increase after exercise, and autonomic disturbances. The clinical picture as well as knowledge of the laboratory test that accompany LEMS will permit early recognition of the disease, that is crucial because it is often associated with malignancy, especially small cell lung cancer (SCLC). In this article we present a patient with proximal muscle weakness and typical changes on repetitive nerve stimulation, as well as a short literature review on the topic. Conclusions: The diagnosis of LEMS is usually made on clinical grounds. The diagnosis is confirmed by electrophysiological testing, main features including decrement response on slow repetitive nerves stimulation (3Hz), and an increment of more than 100% in CMAP amplitude after brief exercise, or high frequency repetitive stimulation (30-50 Hz). Immunological panel assay with positive P/Q-type VGCC antibody is strongly suggestive of LEMS. While symptomatic treatment with 3,4 – diaminopyridine is available, one of the main priorities is evaluation for underlying malignancies in these patients, the most common being SCLC. Evaluation of patients with LEMS and no known cancer should start with CT of the chest, abdomen and pelvis. Brain imaging is recommended if focal neurological signs are present. If the initial evaluation of the patient is negative, repeated screening for malignancy after 6 months and up to two years is recommended

Эссенциальный тремор - критерии диагностики и методы лечения

Essential tremor (EЕ) is the most common cause of action tremor in adults. In most cases, TE can be managed by primary care physicians, starting with the exclusion of secondary causes and followed by initiation of propranolol or primidone therapy if the tremor causes disability. The decision to refer a neurologist depends on the clinician’s confidence in the diagnosis, his or her level of comfort with the use of medications recommended for tremor suppression, and the patient’s response to treatment.Tremorul esențial (TE) reprezintă cea mai frecventă cauză a tremorului de acțiune întâlnit la adulți. În cele mai multe cazuri, TE poate fi gestionat de medicii de asistență medicală primară, începând cu excluderea cauzelor secundare și urmată de inițierea terapiei cu propranolol sau primidonă dacă tremorul cauzează dizabilitate. Decizia de a trimite la un neurolog depinde de încrederea clinicianului în diagnostic, de nivelul de confort al acestuia cu utilizarea medicamentelor recomandate pentru suprimarea tremorului și de răspunsul pacientului la tratament.Эссенциальный тремор (ЭТ) - самая частая причина тремора действия у взрослых. В большинстве случаев ЭТ может лечить врачи первичной медико-санитарной помощи, начиная с исключения вторичных причин и заканчивая терапией пропранололом или примидоном, если тремор вызывает инвалидность. Решение о направлении у невролога зависит от уверенности врача в диагнозе, его уровня комфорта при использовании лекарств, рекомендованных для подавления тремора, и реакции пациента на лечение

Differential diagnosis of intracerebral haemorrhages. Cases from the institute of neurology and neurosurgery

Neurology Department, 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. Intracerebral hemorrhage (ICH) is the second most common type of stroke, responsible for about 20% of total number of cerebrovascular accidents. There are many pathologies associated with ICH, some related to common vascular risk factors like hypertension, others related to ruptured saccular aneurysm, and vascular malformation, and others to neurodegeneration like amyloid angiopathy. Case report. We present a series of cases of intracerebral haemorrhages related both to the most common causes and mechanisms of ICH, as well as other, less frequent, pathologies that could manifest as a hemorrhagic stroke. Differential diagnosis is based on hematoma localization, size and shape, age of the patients, and vascular risk factors. We also present data on prognostic factors for hematoma growth and outcome. All cases were collected from the Institute of Neurology and Neurosurgery ”Diomid Gherman”, Chișinau, Republic of Moldova. Conclusions. Although ICH is the second leading cause of stroke, there is a wide range of pathologies that can result in intracerebral hemorrhage and require an extensive work-up, especially in young patients without vascular risk factors

Metoda reflexo-bruxism-reglatoare: eficienţa în funcţie de nivelul stresului emoţional

În lucrare este descrisă metoda reflexo-bruxism-reglatoare (acțiunea mecanică asupra zonelor auriculare refl exogene ale sistemului stomatognat în asociere cu mișcările ritmice ale mandibulei timp de 3 min, cu intervale de 1-2 min) pentru autoajutorare la pacienții cu bruxism nocturn primar și stres emoțional pronunțat. Au fost investigați 30 pacienți cu bruxism nocturn primar și 30 persoane sănătoase în stare de confort relativ și în stare de stres emoțional, expresia căruia s-a determinat prin aplicarea termometrului stresului (scala analogică de autoapreciere a stresului, VAS-stres). Au fost aplicate teste psihometrice de determinare a calităţii somnului și metoda de apreciere a proceselor de reglare vegetativă în sistemul stomatognat (potenţiale vegetative simpatice cutanate). S-a demonstrat, că metoda propusă diminuează manifestările stresului emoțional, ameliorează somnul nocturn, contribuie la normalizarea activității proceselor de reglare vegetativă în sistemul stomatognat, ceea ce conduce la transformarea bruxismului streso-patogen în bruxism streso-sanoge