Patologia glandei tiroide în artrita reumatoidă

Discipline of Rheumatology and Nephrology, Nicolae Testemitanu SUMPhBackground. Rheumatoid arthritis is an autoimmune disease. The increased occurrence of thyroid dysfunction in rheumatoid arthritis patients has been reported in the literature. Some studies have confirmed an increased prevalence of rheumatoid arthritis in patients with autoimmune thyroid pathology. Objective of the study. To study the presence of thyroid gland (TG) pathology in patients with rheumatoid arthritis (RA) and to determine its correlation with disease activity. Material and Methods. A total of 59 rheumatoid arthritis and 48 non-RA patients were included in the study. Laboratory investigation included rheumatoid factor (RF), anti-CCP, CRP, ESR, TSH, fT4, TgAb, TPOAb. Disease activity in RA measured with DAS-28-ESR. Results. In patient with RA clinical hypothyroidism was reported in 20.33%, while 3.38% had clinical hyperthyroidism. Subclinical hyperthyroidism was reported in 11.86% of the RA patients, while 3.38% had subclinical hypothyroidism. In control group, subclinical hyperthyroidism was reported in 4,16 % of the patients, 2.08% had clinical and subclinical hypothyroidism.ESR (35.5 ± 24.2 mm/h vs. 18.4 ± 5.0 mm/h) was significantly higher in patients RA. According to our research, 3.39% of the patients had low disease activity, 20.34% had moderate disease activity, and 76.27% had high disease activity. High disease activity positively correlated with the presence of thyroid gland pathology. Conclusion. The association between thyroid pathology and RA was confirmed, its presence correlated with high disease activity by DAS28-ESR. The routine screening for thyroid disorders in patients with rheumatoid arthritis is recommended for early diagnosis and correction of TG pathology in RA.Introducere. Artrita reumatoidă este o boală autoimună. În literatura de specialitate a fost raportată apariția crescută a disfuncției tiroidiene la pacienții cu artrită reumatoidă. Unele studii au confirmat o prevalență crescută a artritei reumatoide la pacienții cu boală tiroidiană autoimună. Scopul lucrării. A studia prezența patologiei glandei tiroide la pacienții cu artrita reumatoida (AR) și a determina corelarea ei cu activitatea artritei reumatoide. Material și Metode. Un lot de 59 de pacienți cu AR și 48 pacienți fără AR au fost incluși în studiu. Investigațiile de laborator au inclus factorul reumatoid (FR), anti-CCP, VSH, TSH, fT4, TgAb, TPOAb. Activitatea bolii în AR a fost măsurată folosind DAS-28-ESR. Rezultate. La pacientii cu AR hipotiroidismul clinic a fost raportat la 20,33%, în timp ce 3,38% au avut hipertiroidism clinic. Hipertiroidismul subclinic a fost raportat la 11,86%, în timp ce 3,38% au avut hipotiroidism subclinic. În grupul de control, hipertiroidismul subclinic a fost raportat la 4,16% dintre pacienți, 2,08% au avut hipotiroidism clinic și subclinic. VSH a fost semnificativ mai mare la pacienții cu AR. Conform rezultatelor, 3,39% dintre pacienți au avut o activitate scăzută a bolii, 20,34% au avut o activitate moderată a bolii, iar 76,27% au avut o activitate crescută a AR. Activitatea crescută a AR a corelat pozitiv cu prezența patologiei glandei tiroide. Concluzii. Asocierea dintre patologia tiroidiană și AR a fost confirmată, prezența acesteia corela pozitiv cu activitatea crescută a AR prin DAS28-ESR. Screeningul de rutină pentru tulburările tiroidiene la pacienții cu poliartrită reumatoidă este recomandat pentru diagnosticarea precoce

Patologia osului și a glandei tiroide în artrita reumatoidă

Discipline of Rheumatology and Nephrology, Nicolae Testemitanu SUMPhBackground. Thyroid pathology is frequently associated with autoimmune rheumatic diseases. Moreover, thyroid pathology is one of the risk factors for osteoporosis, on the other hand osteoporosis is often diagnosed in patients with rheumatoid arthritis. Abovementioned served as the basis for our work. Objective of the study. To study the presence of thyroid gland pathology and osteoporosis in patients with rheumatoid arthritis (RA) and to determine their correlation with disease activity in RA. Material and Methods. A total of 78 RA patients and 82 non-RA patients were included in the study. The presence of thyroid gland pathology was estimated by TSH, free thyroxine (fT4), TgAb and TPOAb. Bone mineral density was measured by DXA, diagnosis of osteoporosis was made by WHO criteria. Disease activity in RA was evaluated using DAS-28-ESR. All the data were analyzed statistically. Results. The mean disease duration of RA was 10,1±5,6 years. Clinical hypothyroidism was reported in 20.33% of the RA patients and in 2.08% of the non-RA patients. Clinical hyperthyroidism was found in 3.38% of the patients with RA. Osteoporosis at the level of hip was confirmed in 41% of cases of RA and only in 17% of the control group, while osteoporosis at the level of lumbar spine was more common for non-RA patients in 48% VS. 13% in RA. High disease activity was in 76.27% of the patients. High disease activity positively correlated with the presence of osteoporosis and thyroid gland pathology (r= 0,58 and r=0,34), the presence of thyroid gland pathology was associated with lower BMD. Conclusion. The association between thyroid pathology, osteoporosis and RA was confirmed. Clinical hypothyroidism and bone loss at hip level were more characteristic for RA. Presence of both osteoporosis and thyroid gland pathology correlated with high disease activity by DAS28- ESR.Introducere. Patologia tiroidiană este frecvent asociată cu maladiile autoimune și este un factori de risc al osteoporozei. Pe de altă parte, osteoporoza este frecvent diagnosticată la pacienții cu artrita reumatoidă. Cele sus menționate stau la baza studiului nostru. Scopul lucrării. A studia prezența patologiei glandei tiroide și al osteoporozei la pacienții cu artrita reumatoidă (AR) și a determina corelația acestora cu activitatea bolii în AR. Material și Metode. 78 de pacienți cu AR și 82 de pacienți fără AR au fost incluși în studiu. Prezența patologiei glandei tiroide a fost estimată prin TSH, tiroxină liberă (fT4), TgAb și TPOAb. Densitatea minerală osoasă a fost măsurată prin DXA, diagnosticul de osteoporoză a fost stabilit conform OMS. Activitatea bolii în AR a fost evaluată prin DAS-28-ESR. Toate datele au fost analizate statistic. Rezultate. Durata medie al AR a fost de 10,1 ± 5,6 ani. Hipotiroidismul clinic a fost raportat la 20,33% pacienți cu AR și la 2,08% fără AR. Hipertiroidismul clinic a fost depistat la 3,38% pacienți cu AR. Osteoporoza la nivelul șoldului a fost confirmată în 41% din cazurile de AR și doar în 17% în grupul de control, în timp ce osteoporoza la nivelul coloanei vertebrale lombare a fost mai frecventă la pacienții non-AR în 48% vs 13% în AR. Activitatea crescută a bolii a fost depistată la 76,27% dintre pacienți. Activitatea înaltă a bolii a corelat pozitiv cu prezența osteoporozei și a patologiei glandei tiroide (r = 0,58 și r = 0,34), prezența patologiei glandei tiroide a fost asociată cu DMO mai mică. Concluzii. Asocierea dintre patologia tiroidiană, osteoporoză și AR a fost confirmată. Hipotiroidismul clinic și pierderea osoasă la nivelul șoldului au fost mai caracteristice pentru AR. Prezența osteoporozei și patologiei glandei tiroide corela pozitiv cu activitatea înaltă a bolii DAS28-VSH

Abordarea eutanasiei în societatea contemporană

Department of Forensic Medicine, Nicolae Testemitanu SUMPhBackground. Euthanasia remains a highly controversial topic and is often emphasized in society in ethical, legal and religious contexts. It eases the suffering of terminally ill patients but violates their fundamental right to life. Objective of the study. Reflecting society's attitude towards euthanasia in medical, legal, ethical and religious frameworks. Analysis of the experience of countries that have legalised euthanasia. Material and Methods. The Universal Declaration of Human Rights, the legislation of countries that have legalised euthanasia, and the local and international literature were used as sources. Results: The attitude towards euthanasia differs considerably among the population of different countries. Acceptance of this procedure depends on the level of education of the population, especially in terms of Human Rights, the level of the medical system, religious and cultural affiliation. The main arguments in favour of accepting euthanasia are to stop the suffering of terminally ill patients and to offer them a peaceful death, as well as to respect the patient's autonomy. The arguments against euthanasia include compromising the trusting relationship between doctor and patient; the risk of abusive use if legalised. Conclusion. Although euthanasia has already been legalised in some countries; the vast majority of the population in various countries criticizes this procedure as a violation of the right to life. The patient's right to die in dignity does not implicitly presume his right to be euthanized.Introducere. Eutanasia rămâne un subiect foarte controversat și adesea abordat în societate în context etic, juridic și religios. Recurgerea la acest procedeu ușurează suferința pacienților incurabili, însă încalcă dreptul primordial la viață. Scopul lucrării. Reflectarea atitudinii societății față de eutanasie în cadrul medical, juridic, etic și religios. Analiza experienței țărilor care au legalizat eutanasia. Material și Metode. Ca material de studiu au servit Declarația Universală a Drepturilor Omului, legislația țărilor care au legalizat eutanasia, literatura de specialitate autohtonă și internațională. Rezultate. Atitudinea față de eutanasie diferă considerabil în rândurile populației diferitor țări. Acceptarea acestui procedeu depinde de nivelul de educație a populației, în special în ce privește Drepturile Omului, de nivelul sistemului medical, apartenența religioasă și culturală. Argumentele principale ce pledează pentru eutanasie sunt stoparea suferinței pacienților în stări terminale și posibilitatea de a le oferi o moarte liniștită, precum și respectarea autodeterminării pacientului. Argumentele împotriva eutanasiei includ compromiterea relației dintre medic și pacient bazată pe încredere; riscul folosirii acesteia în mod abuziv, în cazul legalizării. Concluzii. Deși eutanasia a fost deja legalizată în unele țări, totuși marea majoritate a populației din diferite țări condamnă acest procedeu din considerentul încălcării dreptului la viață. Dreptul pacientului la moarte în demnitate nu presupune implicit și dreptul său de a fi eutanasiat

REM sleep and memory. Memory disorders in sleep pathology

State Medical and Pharmaceutical University “Nicolae Testemitanu”, Chişinău, Republic of MoldovaIntroduction: REM sleep has a great influence on the development of memory, due to intense brain activity and to metabolism which can be increased up to 20%. Special sequences of declarative memory are reorganized during sleep, being reflected by changes of activity in brain during the subsequent consolidation of memory. Propose and Objectives: To highlight the importance of sleep on memory and to mention the memory disorders that include sleep pathology. Results: One of the theories of REM sleep and memory (described by Roffwarg, Musio and Dement in 1966) suggests that repetitive neuronal activity during REM sleep of the fetuses is associated with the development and their growth; the same synaptic reorganization continues in adults during REM sleep, so the information is recalled due to repetitive use of it in the circuit that stores the information. Cholinomimetic drugs (with an action similar to acetylcholine) increasethe frequency of the REM sleep episodes.Therefore it was assumed that large neurons that secrete acetylcholine, located in the upper brainstem, could activate multiple brain areas. Theoretically this could be the cause of the hyperactivity met in different brain regions during REM sleep. The mechanism that allows memory consolidation through neural activity can be found in the hippocampus, a well-established brain region to memory. In this region, during REM sleep, are observed EEG theta waves that help to transfer the information to the neocortex. Have been observed that the sleep pathology as apnea, insomnia, generates memory disorders, it forms an imbalance in the duration of the REM sleep and its quality. Conclusion: The relationship between reverberation brain and memory consolidation still remains unclear, just some aspects of this link were studied till now. Due to the fact that neuronal reactivation during REM sleep was proved and it is sustained for long period of time, providing a mechanism for increasing the memory until it is stored effectively, it is to be asserted the importance o f this process that allows the brain to process the new information during the day

Placenta accreta-new trends in management

Introduction. The prevalence of placenta accreta continues to rise with a negative impact on overall women's health. Frequently, it’s incriminated in the occurrence of massive obstetric bleeding (according to literature data, pathological bleeding during placenta delivery and early postpartum is 50-80% of the total number of bleedings) resulting in increased maternal morbidity and mortality. Aim of study. Elucidation of conservative methods of treatment of placenta accreta to reduce maternal morbidity, mortality and increase quality of life. Methods and materials. International databases, such as: Cambridge Journals Online, Google Scholar and PubMed, publications from 2016-2021 have been analyzed on the conservative management of the placenta accreta. The search was performed using keywords: placenta accreta, obstetric bleeding, conservative management. Results. The placenta accreta results from an abnormal implantation, when the chorionic villi attaches to the uterine myometrium or uterine serosa, due to the presence of a defect at the base of the decidua. Dominant risk factors are: scarred uterus, history of segmental-transverse cesarean sections, uterine curettage, embolization or myomectomy. The management of the placenta accreta consists of two main strategies: 1) its identification, favored by assessing risk factors and complementary examinations and, 2) tactics of conduct in the placenta accreta, whose goal is to reduce maternal complications as much as possible. A multidisciplinary team care, immediate access to blood products, intensive care for adults and neonatal and enhanced expertise in complex pelvic surgery are essential in order to increase safe outcomes for mother and child. Four main methods of conservative management are described in the international literature:a) the technique of removal(manual removal)of the placenta; b)leaving the placenta in situ or the expected approach; c) conservative surgery in one step(removal of the acrid area); d) the Triple-P procedure(suturing around the accreted area after resection). These methods have been used alone or in combination, in many cases with additional procedures such as interventional radiology. Conclusions: Increasing the rate of cesarean section increases the occurrence of pathological insertions of the placenta, resulting in increased maternal-fetal mortality. Prenatal diagnosis is essential, and the management of these clinical cases must be well planned by an experienced multidisciplinary team to reduce the potential for maternal and neonatal morbidity and mortality, and maintain fertility

Planning Technique for Complex Economic Object’s Synergy at Mergers and Acquisitions

The paper reviews integration problems for complex economic objects aiming to achieve a synergy effect from complementary actions of their assets, which total value exceeds isolated functioning results. In the present times in Ukraine problems concerning assessment of synergy effect at M&A of companies are the new among examining objects and that is why need further development. It is shown that application of system approach to investigation the efficiency integration of economic objects at mergers and acquisitions with regards of process design peculiarities of managerial decisions allows maximum accurate analyzing the results of interaction of economic units within unified integrated structure. So, one of the main reasons to make a bargain on M&A is intention to obtain positive synergy effect because basing on management theory its appearance promotes competitiveness and efficiency increase of the company. According to carried out analysis of existing approaches to assessment of expected synergy effect mostly models offer to calculate one-off synergy effect. It is worth noting that different kinds of synergies can appear not just after combining, but with time, that requires further investigations. It has been proposed a planning mechanism developed on the base of conceptual description the function results for integrated formation, which is the key technique tool for mergers and acquisitions

Planning Technique for Complex Economic Object’s Synergy at Mergers and Acquisitions

The paper reviews integration problems for complex economic objects aiming to achieve a synergy effect from complementary actions of their assets, which total value exceeds isolated functioning results. In the present times in Ukraine problems concerning assessment of synergy effect at M&A of companies are the new among examining objects and that is why need further development. It is shown that application of system approach to investigation the efficiency integration of economic objects at mergers and acquisitions with regards of process design peculiarities of managerial decisions allows maximum accurate analyzing the results of interaction of economic units within unified integrated structure. So, one of the main reasons to make a bargain on M&A is intention to obtain positive synergy effect because basing on management theory its appearance promotes competitiveness and efficiency increase of the company. According to carried out analysis of existing approaches to assessment of expected synergy effect mostly models offer to calculate one-off synergy effect. It is worth noting that different kinds of synergies can appear not just after combining, but with time, that requires further investigations. It has been proposed a planning mechanism developed on the base of conceptual description the function results for integrated formation, which is the key technique tool for mergers and acquisitions

SURGICAL APPROACH IN MANAGEMENT OF PLACENTA ACCRETA

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Placenta accreta este cauza principală a histerectomiei printre femeile de vârstă fertilă, a decesului până la 7%, datorită hemoragiei masive postpartum. Incidența crește datorită intervenționismului pe uter având impact negativ asupra sănătății reproductive feminine. Scopul studiului. Descrierea tehnicilor chirurgicale de tratament ale placentei accreta pentru diminuarea morbidității și mortalității materne cât și creșterea calității vieții. Materiale și metode. Au fost cercetate bazele de date internaționale: Cambridge Journals Online, Google Scholar, PubMed asupra managementului placentei accreta fiind analizate publicațiile din anii 2017–2022. Căutarea a fost efectuată prin intermediul cuvintelor-cheie: placenta accreta, hemoragie obstetricală, tehnici chirurgicale. Rezultate și discuții. În literatura de specialitate, au fost descrise patru metode principale de management chirurgical: a) tehnica extirpativă (îndepărtarea manuală) a placentei; b) tehnica Soleymani-Alazzam-Collins (histerectomie radicală prin operație cezariană c) intervenție chirurgicală conservativă într-un singur pas (înlăturarea zonei accreta); și d) procedura Triplul-P (sutura în jurul zonei accreta după rezecție). Aceste metode au fost folosite singure sau în combinație și în multe cazuri cu proceduri suplimentare precum cele propuse de radiologia intervențională. Concluzii. Diagnosticul prenatal este esențial, iar gestionarea cazurilor clinice trebuie bine planificată de o echipă multidisciplinară cu experiență pentru a reduce morbiditatea și mortalitatea maternă și neonatală cât și pentru a menține fertilitatea.Background. The placenta accreta is the leading cause of hysterectomy among women of childbearing potential, with deaths of up to 7% due to massive postpartum hemorrhage. The incidence increases due to intervention on the uterus having a negative impact on female reproductive health. Aim of the study. The description of the surgical techniques of treatment of the placenta accreta for the decrease the maternal morbidity and mortality as well as increasing the quality of life. Materials and methods. The international databases were researched: Cambridge Journals Online, Google Scholar, PubMed on the management of placenta accreta, analyzing the publications from 2017–2022. The search was performed using keywords: placenta accreta, obstetric hemorrhage, surgical techniques. Results and discussions. In the literature, four main methods of surgical management have been described: a) the technique of removal (manual removal) of the placenta; b) the modified radical peripartum cesarean hysterectomy (Soleymani-Alazzam-Collins technique); c) conservative surgery in one step (removal of the acrid area); and d) the Triple-P procedure (suturing around the accreted area after resection). These methods have been used alone or in combination and in many cases with additional procedures such as interventional radiology. Conclusion. Prenatal diagnosis is essential, and the management of these clinical cases must be well planned by an experienced multidisciplinary team to reduce the potential for maternal and neonatal morbidity and mortality, as well as maintaining fertility

Anomaly crust fields from MAGSAT satellite measurements:their processing and interpretation

The space distribution of the magnetic anomaly field for the Pacific Ocean is obtained from data of the satellite MAGSAT. A number of long-wavelength magnetic anomalies of the region are identified. A spectrum analysis of a number of profiles of the anomaly field is performed disclosing typical scales of such anomalies. The wave transform of the anomaly magnetic profiles reveals and explicitly exposes the structure of the considered profile. A schematic complex cross-section is constructed, which demonstrates that the satellite data may be used in the study of the magnetic anomaly

Unele apreciative privind aplicarea combinată a soluţiei de normatin 0,5% şi bestoxol 4% pentru tratamentul bolnavilor de glaucom cu unghi deschis

Unele apreciative privind aplicarea combinată a soluţiei de Normatin 0,5% şi Bestoxol 4% pentru tratamentul bolnavilor de glaucom cu unghi deschis. Instilaţiile cu soluţie de 0,5% Normatin în combinaţie cu 4% Bestoxol în tratamentul bolnavilor cu glaucom primar cu unghi deschis asigură un efect hipotensiv stabil şi echilibru hidrodinamic