The infection with the new Influenza A(H1N1) virus

Catedra Boli infecţioase, tropicale şi parazitologie medicală USMF „Nicolae Testemiţanu”The Novel Flu in Humans is an extremely contagious respiratory illness, wich is caused by the new Influenza A virus subtype H1N1 and has never been met in people before. This new virus appeared suddenly in human population. It was first dettected in the USA in April 2009. The outbreak intensified rapidly from that time spreading over more and more countries and continents. On 11-th of Juin 2009, WHO General-Director has decided to raise the current level of influenza pandemic alert to phase 6. This article presents the most important data about the infection with the new Influenza A(H1N1) virus. Gripa (porcină) sau de tip nou este o maladie respiratorie acută, extrem de contagioasă, cauzată de virusul gripal de tip A(H1N1), neîntâlnit anterior în circulaţia umană. Acest virus de tip nou a apărut în populaţia umană şi pentru prima dată a fost detectat în aprilie 2009 în SUA. Erupţia epidemică a evoluat vertiginos, răspândindu-se în mai multe ţări şi continente. La 11 iunie 2009 directorul general al OMS a declarat nivelul 6 de alertă pandemică, cauzată de acest virus. Lucrarea actuală aduce o informaţie importantă despre infecţia cu virusul gripal de tip nou A(H1N1)

Water Soluble Pleurotus ostreatus Polysaccharide Down-Regulates the Expression of MMP-2 and MMP-9 in Caco-2 Cells

Many polysaccharides and polysaccharide-protein complexes isolated from mushrooms have immunomodulatory and anti-cancer effects. Our aim was to study the regulatory mechanisms of Caco-2 cell response to water soluble P. ostreatus polysaccharide extract up to 72 hours. Specific enzymatic activities were assessed by kinetic measurements. The reduced glutathione content and the lipid peroxidation level were also analyzed. Protein expression of several heat shock proteins, Bcl-2 and metalloproteinases 2 and 9 were revealed by Western blot. Gelatin zymography assay was used to evaluate the MMP-2 and MMP-9 activities. Until the third day of exposure the total SOD activity decreased continuously by 30%, whereas GST and GR ones diminished by 17% respectively 30.5% compared to control. No significant changes were observed in CAT and G6PDH specific activities as well as in GSH and MDA concentration. After the third day of exposure a significant up-regulation of Hsp60 and Hsp90 expression and a down-regulation of Hsp70 one were registered. Bcl-2 protein levels were down-regulated by 50% in the first day of treatment but increased after 3 days. MMP-2 and 9 secretion in the culture medium was significantly reduced suggesting a diminished ability of invasion of colon cancer cells. Our data revealed that in vitro treatment with P. ostreatus aqueous polysaccharide extract does not induce apoptosis in Caco-2 cell line but it could inhibit the invasion of colon cancer cells through the basement membrane

Peculiarities of influenza A (H1N1)

Catedra Boli infecţioase, tropicale şi parazitologie medicalăThis article elucidated the clinical, epidemiological and laboratory features of influenza A H1N1 in 71 patients treated in the „Toma Ciorbă” Clinical Infectious Diseases Hospital during the spike period of the current pandemics. În acest articol sunt elucidate aspectele clinice, epidemiologice şi de laborator ale gripei A H1N1 la 71 pacienţi aflaţi la tratament în IMSP SCBI „Toma Ciorbă” în perioada de ascensiune a actualei pandemii

Впервые выявленный сахарный диабет, осложнённый кетоацидозом. Клинический случай

USMF Nicolae Testemiţanu, IMSP SCM Sfânta Treime, Conferinţa consacrată aniversării celor 40 de ani de la fondarea SCM Sfânta Treime 17 iunie 2016 Chișinău, Republica MoldovaKetoacidosis is a metabolic complication of the Diabetes Mellitus, that appears frequently in the Diabetes type 1, and much more rarely in diabetes 2. The patient, whose case is described represents clinical role of a severe ketoacidosis: weight loss, signs of deshydratation and hypovolemia, Kussmaul breathing, confusion, laboratory abnormalities (metabolic acidosis with pH 6,68 and bicarbonat 1 mmoli/l). Ketoacidosis was shown as an onset of diabetes. This situation required prompt diagnosis and appropriate intensive treatment. Therapeutic course, involves: rebalancing the volume and restoring the capital fluid, correction of dyselectrolytemia, correction of hyperglycemia and ketoacidosis and hyperosmolarity of the serum. Central vascular and hemodynamic monitoring approach was dictated by the degree of hypovolemia, cardiovascular status and pathology of the patient. The correction of hypokalemia was performed before starting the insulin infusion. Bicarbonate administration, continuous intravenous insulin therapy was targeted towards normalization of the anionic hole. Following the principles discussed, in approaching the diagnosis and intensive treatment of diabetic ketoacidosis, patient progress was favorable.Кетоацидоз – это тяжелое метаболическое осложнение, которое чаще появляется при сахарном диабете I-го типа и очень редко у пациентов с диабетом II-го типа. Oписывается клинический случай пациентки с классической картиной тяжелого диабетического кетоацидоза с потерей в весе, признаками гиповолемии и дегидратации, с дыханием Куссмауля, нарушением сознания, с метаболическим ацидозом pH 6,68 и бикарбонатом 1 ммоль/л. Параклинические исследования позволили обосновать диагноз: впервыe выявленный сахарный диабет осложненный диабетическим кетоацидозом. Это тяжёлое осложнение, которое проявилось в начале заболевания, нуждалось в ранней постановке диагноза и экстренном назначении адекватного интенсивного лечения: восстановление и коррекция объема жидкости, гипергликемии, гиперосмолярности крови и кетоацидоза. Внутривенное назначение бикарбоната и инсулина являлось главной терапевтической целью для восстановления анионической „дыры”. Коррекция гипокалиемии была проведена до начала инсулинотерапии

Расслаивающая аневризма аорты. Клинический случай

USMF "Nicolae Testemiţanu", IMSP SCM Sfânta Treime, Conferinţa consacrată aniversării celor 40 de ani de la fondarea SCM Sfânta Treime 17 iunie 2016 Chișinău, Republica MoldovaAortic dissection is one of the most serious cardiovascular emergencies that can occur at any age, most commonly to patients with ages between 50 and 80 years old. The intiating event is represented by a fissure in the intima of the aortic wall that allows the blood to penetrate in the aortic cavity and determines the detachment of the aortic tunics, forming a false lumen. Disections ussualy spread anterograde in a spiral manner but there are described casses of retrograde expansion. A case report of a 51 year old man, urgently hospitalized in ITU (Intensive Therapy Unit) with anterior chest pain that was persisting for 3 hours. The ECG (Electrocardiogram) suggested myocardial injury and ischemia, nevertheless the biomarkers of the myocardial injury did not confirm that. The Coronary angiography established severe atherosclerotic coronarian injury, moderately severe stenosis on circumflex artery Cx II and moderate stenosis on LAD II, LAD III, DIA I, OM I, RCA II. On the ultrasound examination an ascendent aortic anevrism was suspected that later was confirmed by the toraco-abdominal tomography and coronarography. After the aortic dissection was confirmed, the patient was consulted by the cardio surgeon and transferred to the Cardiovascular Surgery Clinic in the intensive care unit where he underwentРасслаивающая аневризма аорты является одной из наиболее серьезных сердечно-сосудистых неотложных патологий, которые могут возникнуть в любом возрасте, но чаще всего у пациентов от 50 до 80 лет. Первоначально развивается надрыв интимы, и кровь под давлением поступает через этот дефект и расслаивает срединную оболочку аорты, образуя ложный канал. Oбычно она распространяeтся по её ходу aнтерограднo, но описаны случаи и ретроградной диссекции. Мы представляем клинический случай: мужчина, 51 год, госпитализирован в срочном порядке в реанимационное отделение с выраженными продолжительными болями за грудиной, в течение 3-х часов. На электрокардиограмме при пoступлении выявлены повреждения и ишемическиe изменения в миокарде левого желудочка, которые не были подтвержд ены маркерaми некроза кардиомиоцитов (тропонин, креатинфосфокиназa, лактатдегидрогеназa). Kоронарография подтвердилa атеросклеротические поражения трёх коронарных сосудов: умеренно тяжелый стеноз огибающeй артерии Cx II (реканализированный тромб); умеренный стеноз в LAD II, LAD III, DIA I, OM I, RCA II. На эхокардиографии обнаружена аневризма восходящей аорты. Диагноз был подтвержден торако-абдоминальной компьютерной томографией с ангиографией. После постановки диагноза расслаивающей аневризмы аорты, пациент был переведен в клинику сердечно-сосудистой хирургии для оперативного лечения. Пациент перенёс срочную операцию, которая являлась единственным шансом для спасения его жизни

Острый инфаркт миокарда, осложнённый аритмогенным шоком

USMF Nicolae Testemiţanu, IMSP SCM Sfânta Treime, Conferinţa consacrată aniversării celor 40 de ani de la fondarea SCM Sfânta Treime 17 iunie 2016 Chișinău, Republica MoldovaMyocardial infarction is the most severe heart disease. A major complication of cardiogenic shock IM is often accompanied by disturbances of rhythm and conductivity. The study included 213 patients with an average age of 64±0,1 years, 58.6% for men and 41.4% for women. The patients were divided into 2 groups, with rhythm and conductivity disorders and without them. In the patients with AMI complicated with CS the incidence of arrhythmias was high, in anterior extended AMI prevailed supraventricular and ventricular arrhythmias, in posterior AMI – bradiaritmias and heart blocks, with lower surviving rateОстрый инфаркт миокарда (ОИМ) – это тяжелое сердечно-сосудистое заболевание, с гемодинамическими, электрическими и механическими нарушениями сердца. Основным осложнением ОИМ является кардиогенный шок (КШ), часто сопровождающийся нарушениями ритма и проводимости. Были исследованы 213 пациента с инфарктом миокарда, и разделенны на 2 группы: с нарушениями ритма и проводимости 145 (68%) и без 68 (32%). У пациентов с ОИМ, осложненным КШ, частота аритмий была выше: при передне-распространённом преобладали наджелудочковые и желудочковые аритмии, а при ОИМ задней стенки ЛЖ – брадиаритмии и блокады сердца с высокой летальностью

Clinical and epidemiological features of Herpes Zoster

Catedra Boli infecţioase, Tropicale şi Parazitologie medicală USMF „N.Testemiţanu”, Spitalul Clinic de Boli infecţioase „T.Ciorbă”Herpes Zoster is an eruptive virosis with sporadic appearance determined by the reactivation of latent infection of VZV. The disease can relapse to those with immune deficits, being an unfavorable evolution indicator and in cases with HIV infection. The effected investigation about one group of patients with various ages with HZ permitted the making evident of some clinical and epidemiological aspects of the disease in young persons and the necessity to investigate them to HIV infection. Herpes zoster este o viroză eruptivă cu apariţie sporadică, determinată de reactivarea infecţiei latente cu virus varicelo-zosterian. Boala poate recidiva la cei cu deficite imune, fiind un indicator de evoluţie nefavorabilă şi în cazurile de infecţie cu HIV. Studiul efectuat asupra unui lot de pacienţi de diferite vârste cu Herpes zoster a permis evidenţierea unor aspecte clinico-epidemiologice a acestei patologii la persoanele tinere şi necesitatea investigării lor la HIV-infecţie

Clinical manifestations and evolutionary peculiarities of COVID-19 infection (review)

Catedra de boli infecţioase, tropicale şi parazitologie medicală, Universitatea de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaRezumat Introducere. La 31 decembrie 2019, autorităţile chineze au stabilit un nou coronavirus, denumit nCoV-2019, care s-a dovedid a fi agentul patogen a Sindromului Acut Respirator Sever, abreviat SARS-CoV-2. COVID-19 apaţine familiei de coronaviruşi responsabili de declanşarea pneumoniei virale. Aceasta din urmă răspândinduse rapid, cauzând epidemie pe întreg teritoriul Chinei, care ulterior a trecut într-o formă pandemică la nivel global. Pneumonia este cea mai frecventă manifestare clinică a infecţiei cu COVID-19, dintre care aproximativ 15% trec în forme severe de hipoxie, dispnee sau implicare pulmonară extinsă. Material şi metode. Au fost analizate 72 de articole actuale, relevante la tema cercetată, utilizând următoarele baze de date: Google Scholar, PubMed, NCBI. Rezultate. Datorită spectrului larg de manifestare clinică a infeţiei COVID-19, adulţii diagnosticaţi cu SARS-CoV2 pot fi grupaţi în mai multe categorii de severitate a bolii: asimptomatici, forme uşoare, moderate, severe şi critice. Formele severe pt fi întâlnite atât la pacienţii, eventual, sănătoşi, de orice vârstă, însă totuşi s-a obsevat o predominare a formelor severe la pacienţii cu vârstă înaintată sau cu comorbidităţi adiacente. Cea mai frecventă şi severă manifestare a COVID-19 pare a fi pneumonia, ce se caracterizează prin apariţia primară a simptomelor, cum ar fi, febra, tusea, dispnea. Cu toate acestea pot fi prezente şi simptome ce nu implică sistemul respirator, şi anume, mialgia, artraligia, manifestări gastro-intestinale, stări de hipercoagulabilitate, dereglări olfactorii şi/sau gustative, semne cutanate, neurologice sau oftalmologice. O serie de complicţii des întâlnite în infecţia cu COVID-19 sunt: (1) insuficinţa respiratorie – o complicaţie majoră fii sindromul acut de detresa resiratorie (ARSD); (2) complicaţii cardiovasculare, ce includ infarctul miocardic şi şocul cardiac; (3) complicaţii trombembolice (4) infecţii secundare – şi anume, co-infeţia bacteriană şi fungică. Există o evidenţă de date paraclinice care, de asemenea pezintă informaţii esenţiale despre severitatea infecţiei COVID-19. Cele mai concludente date de laborator fiind: limfopenia, niveluri de transaminase, lactat-dehidrogenază crescute, valori crescute a markeri inflamatori (de exemplu, feritina, proteina C reactive, viteza de sedimentare a hematiilor), cât şi dereglările factorilor de coagulare. Dintre parametrii paraclinici asociaţi cu mortalitate crescută se enumeră: D-dimerii, limfopenia severă. Concluzii. Cercetarea dată pune la dispoziţie o caracterizare mai amplă a manifestărilor clinice a infecţiei COVID-19, a factorilor de risc şi a comorbidităţilor subiacente responsabile de o evoluţie severă şi o rată a moralităţii înalte printre pacienţii cu COVID-19.Abstract Introduction. Since December 31, 2019, Chinese authorities reported about an outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 belongs to the family of CoV that causes viral pneumonia. It rapidly spread, resulting in an epidemic throughout China, followed by a global pandemic. Pneumonia is the most frequent serious manifestation of infection, of which approximately 15% developing severe illness with hypoxia, dyspnea, or extensive pulmonary involvement. Material and methods. We analysed a total of 72 relevant publications that was selected from the following databases: Scholar Google, PubMed, NCBI. Results. By the wide spectrum of clinical presentation of COVID-19 infection, adults with SARS-CoV-2 infection can be grouped into the following severity of illness categories: asymptomatic, mild, moderate, severe and critical illness. Severe illness can occur in otherwise healthy individuals of any age, but it predominantly occurs in patients with advanced age or underlying medical comorbidities. The most frequent serious manifestation of COVID-19 appears to be pneumonia that is characterized primarly by fever, cough, dyspnea. However, it includes and other common symptoms that not include the respiratory tract, like myalgias, gastrointestinal disorders, hypercoagulable state, olfactory and/or taste disorder, dermatological manifestation, neurological and ophtalmological symptoms. Several complications of COVID-19 infection have been described to be: (1) respiratory failure – with the major complication of acute respiratory distress syndrome (ARDS); (2) cardiovascular complications that includes acute cardiac injury and shock; (3) thromboembolic complications; (4) secondary infections – that include bacterial and fungal coinfections. There is evidence that laboratory findings may also provide essential information about the severity of COVID-19 infection. The common laboratory findings among patients with COVID-19 include: lymphopenia, elevated aminotransaminase, lactat dehydrogenase levels, increased inflammatory markers (eg. ferritin, C-reactive protein, erythrocyte sedimentation rate) and abnormalities in coagulation tests. Several laboratory parameters, including high D-dimer levels, severe lyphopenia have been associated with critical illness mortality. Conclusions. The review provides a comprehensive characterization of clinical features among COVID-19 patients, the risk factors and medical comorbidities tend to have more severe clinical evolution and higher fatality

Nerve compression due to benign tumors or ganglion cysts in the upper limb – case series

Tumor nerve compressions in the upper limb are relatively rare, usually involving ganglion cysts and benign tumors. We present a case series of five patients with peripheral nerve compression in the upper limb due to tumor or cystic masses- ulnar nerve compression in the Guyon’s tunnel due to a ganglion cyst, large median nerve schwannoma compressing anterior interosseous nerve and median nerve, voluminous lipoma compressing median nerve in the proximal forearm, superficial branch of radial nerve compression by a synovial cyst and elbow region lipoma compressing radial nerve. In the beginning, those benign lesions are asymptomatic but, as they continue to grow adjacent to a peripheral nerve clinical manifestations appear progressively as compressive neuropathies. After a preoperative imagistic analysis, tumor resection with careful dissection, in order to preserve the neurovascular structures, is the elective surgical procedure in order to obtain an optimal functional recovery

Infecția cu coronavirus de tip nou (COVID-19): protocol clinic naţional (ediția VII) PCN-371

Acest protocol este elaborat și revizuit sistematic de grupul de lucru al Ministerului Sănătății al Republicii Moldova (MS), constituit din reprezentanți ai Comisiilor de specialitate ale MS, angajați ai Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” și Agenției Naționale pentru Sănătate Publică. Documentul nu este unul exhaustiv și se bazează pe recomandările actuale ale Organizației Mondiale a Sănătății privind infecția cu coronavirus de tip nou (COVID-19) și alte date disponibile la acest moment. Protocolul clinic național servește drept referință pentru elaborarea protocoalelor clinice instituționale, reieșind din posibilitățile reale ale fiecărei instituții medicosanitare