Management of elderly patients with chronic myeloproliferative hemopathies

Discipline of Hematology, Nicolae Testemitanu State University of Medicine and Pharmacy Laboratory of Immunology and Molecular Genetics, Department of Hematology Institute of Oncology, Chisinau, the Republic of Moldova. The 75th anniversary of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova (1945-2020)Background: Chronic myeloproliferative hemopathies (CMPH) as a whole are the most common chronic leukemias in the elderly in the structure of morbidity by hematological malignancies with primary bone marrow involvement, being characterized in the advanced stages by a severe, recurrent evolution and unfavorable prognosis, with negative socio-economic impact. Material and methods: A clinical, analytical, and descriptive study was carried out along with the narrative review of the international literature on the subject. The study enrolled 91 elderly patients with different phases of chronic myeloid leukemia (CML), primary myelofibrosis (PMF) and polycythemia vera (PV), who were followed up and treated at the Institute of Oncology in the period of 1995–2020. According to the impact score, 25 relevant primary sources were identified and selected having a scientific, reproducible and transparent approach to the relevant subject, followed by data extraction and analysis. Results: The overall one- and 5-year survival in patients aged greater than or equal to 60 years old treated with tyrosine kinase inhibitors (TKIs) was 97.6 and 79%, being lower as compared with the same indices in the totality of CML. In elderly PV patients the overall 5-and 10-year survival made up 93.5% and 76.4%, being lesser than registered in all patients with PV. As reported in the recent references, a significant rate of patients with CMPH underwent reduced working hours, discontinued employment, and medical disability: PMF – 38%, 35%, 33%, and PV – 33%, 28%, and 15%, respectively. Conclusions: The long-term treatment results in elderly patients with CMPH fail compared to those in the CMPH totality, due to the development of age-related diseases and vascular accidents caused by leuko- and thrombocytosis

Evaluarea și monitorizarea siturilor înscrise în Lista patrimoniului mondial din România

Since 1972, UNESCO has established a frame of protection for cultural and natural heritage (Convention concerning the protection of the World Cultural and Natural Heritage) and the “World Heritage List”, which it considers as having an outstanding universal value. In 1994, at the Nara Conference, the Document of Authenticity was adopted, stating that ”the protection and enhancement of cultural and heritage diversity in our world should be actively promoted as an essential aspect of human development”. Since 1997, States Parties have to provide regular reports on the implementation of the World Heritage Convention and the conservation status of each site listed on the World Heritage List. So far, two periodic reports have been made (2000-2006 and 2008-2015), and the third was recently launched (2017-2022). Romania owns eight properties forming part of the World Heritage List (two natural and six cultural sites). Another fifteen properties are included into the Tentative List. The reports concerning the situation of the World Heritage Sites in Romania are done periodically, but most are just a formality without any strategic development and sustainable management plans. There is a significant discrepancy between the visibility and importance given to the sites included on the World Heritage List. These problems could be prevented through better monitoring and management methods, while regional cooperation could be a driver for identifying the best ways to do so at a regional level. Only a common and integrated approach will make it possible to enrich UNESCO standards of preservation and maintain the World Heritage Site status

The I of the Artist-Curator

This dissertation charts the proliferation of artist-curated exhibitions in museums and institutions of art from 1969 to the early 2010s. It is my contention that the artist-curated exhibitions of these four decades can be divided chronologically into several types: in the 1970s and ’80s, they disrupted museological conventions and helped contemporize the (perceived) aging collections of historical institutions; in the late 1980s and ’90s, they tackled pressing social and political issues, reimagining the practice of “institutional critique”; in the late 1990s and 2000s, they indulged in solipsistic investigations of the artist’s psyche, reinforcing the traditional, romantic conception of the artist as a singular creative genius. The growth of such exhibitions has transformed the fields of curating and exhibition design, redefining the parameters of exhibition-making and blurring the once distinct lines between installation art and exhibitions, as well as artists and curators. This dissertation is as much a critical analysis and history of artist-curated exhibitions as it is a narrative of the rise of contemporary art as a distinct and influential field. Whereas such artist-as-curator programs were inaugurated by historical museums seeking to render themselves more contemporary, in recent years they have been adopted by contemporary art institutions. This incongruous development is the result of a shift in the understanding of the category of contemporary art. No longer a mere descriptor denoting the present, the contemporary has come to designate a period that is out of time, asynchronous and multi-temporal. This dissertation will thus demonstrate that the proliferation of artist-curated exhibitions—with their largely unconventional, ahistorical approaches—has resulted in the dismantling of history as it was understood and represented during the modern period

BIOCOMPATIBLE SOLID PHASE MICROEXTRACTION

Today’s solid phase microextraction (SPME) is a well known technique that combines knowledge from different fields in an attractive, efficient, and economic way. The development of SPME has seen huge growth since its introduction as a new approach to sample preparation in the early 1990s. The applications of SPME are continuously expanding, and one of the most interesting current aspects consists of applying SPME for fast analysis of biological fluids, both in vitro and in vivo. In spite of this great potential, development of new bio-applications is considerably hindered by the lack of suitable SPME products. The goal of this study is to find SPME coatings that can be utilized for in vivo and in vitro extractions, in direct contact with a biological matrix such as blood or tissue. This thesis presents several effective ways of preparing SPME coatings based on biocompatible polymers and silica-based extractive phases, focusing on their biocompatibility as a must. After fabrication, the proposed coatings are tested for biocompatibility and analytical utility. Finally, some practical applications of the new coatings are presented, such as fast drug analysis and determination of drug plasma protein binding. Six test drugs with different physico-chemical properties are chosen for the investigation: diazepam, verapamil, lorazepam, warfarin, nordiazepam, and loperamide. It is shown that the application of these new SPME fibers for biological sample analysis greatly reduces the time required for sample preparation and limits the exposure of the analytical personnel to potentially infectious biofluids

Management of elderly patients with chronic myeloproliferative hemopathies - actual issue of internal medicine and public health

State University of Medicine and Pharmacy "N. Testemitanu", Institute of Oncology, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction. Chronic myeloproliferative hemopathies (CMPH) as a whole are the most common chronic leukemias in the elderlies in the structure of morbidity by hematological malignancies with primary bone marrow involvement, being characterized in the advanced stages by recurrent evolution and negative socio-economic impact.Purpose: Diagnosis identification and evaluation of management of CMPH. Material and methods. A clinico-analytical, descriptive, study was realized along with the narrative review of the international literature on the subject. The study enrolled 91 elderly patients with different phases of chronic myeloid leukemia (CML), primary myelofibrosis (PMF) and polycythemia vera (PV), who were followed up and treated at the PMSI Institute of Oncology in the period of 1995 – 2020. The following research methods were used: epidemiological, decsriptive, comparative, clinical-analytical, and cohort statistics. More than 50 reference bibliographic sources have been studied. According to the impact score, 25 relevant primary sources were identified and selected with a scientific, reproducible and transparent approach.Results. Thirty-four (37.3%) patients with PMF, 26 (28.6%) – with CML and 31 (34.1%) – with PV were diagnosed in the elderly age groups and followed up by our study. The age group of 60-69 years was more numerous in CML (22 cases, or 84.6%), constituting 25 (80.6%) cases in PV, and 25 (73.5%) cases in PMF.Thirty-four (37.3%) patients with PMF, 26 (28.6%) – with CML and 31 (34.1%) – with PV were diagnosed in the elderly age groups and followed up by our study. The age group of 60-69 years was more numerous in CML (22 cases, or 84.6%), constituting 25 (80.6%) cases in PV, and 25 (73.5%) cases in PMF. The duration of the disease from the time of onset of the initial clinical symptoms to diagnosis ranged in PMF between 1.4-7 months (median – 3.7±0.63 months), in CML between 1.5-12 months (median – 2.1±0.37 months) and in PV between 1-7 months (median – 3.8±0.54 months). Under the combination of chemotherapy and phlebotomies the clinico-hematological remission was achieved in all 31 patients with PV. The duration of response ranged from 3 to 9 months (median – 5.8 months). In all cases, the disease relapsed, with plethoric syndrome and thrombocytosis, which required the resumption of induction chemotherapy with busulfan, hydroxycarbamide, with regaining remissions. In elderly patients the overall survival over one year constituted 100%, over 5 years – 93.5%, over 10 years – 76.4% , being lower than those registered in all patients with PV (over one year – 100%, 5 years – 98.6%, 10 years – 85.9%).Conclusions. The long-term results of treatment in elderly patients with CMPH fail to those in the CMPH totality because of the development of age-related diseases and vascular accidents on the account of leuko-, thrombocytosis. The targeted treatment with TKIs remains a curative option of choice for CML patients of 60 years and more. In the elderly PV patients no significant difference was revealed in short- and longterm outcomes of chemotherapy with busulfan and hydroxycarbamide in combination with phlebotomy, being totally superior to those in PMF patients. The review of the literature shows that the patients with CMPH, especially those elderly, may endure a sizeable unfavorable impact on their employment status, which in turn may be associated with the reduced annual household income

Clinical aspects of oral candidiasis

Introduction: Mouth diseases are an important part of dentistry treatment and present a huge interest for dentists. In the recent years the number of diseases caused by pathogenic micro-conditions significantly increased. Among them the mucosal candidiasis mouth has a distinct place. Levuriforme mushrooms of the genus Candida predominate unicellular organisms which multiply by budding comprising about 150 species of fungi.Seven of them (C. albicans, C. tropicalis, C. parapsilosis, C. krusei, C. kefyr, C. glabrata and C. guilliermondi.) are medically recognized as important pathogens. In the human pathology the biggest role has the candidiasis caused by Candida albicans. In humans, these fungi are detected in the lining of the mouth, gastrointestinal tract, and urogenital organs. Oral candidiasis caused in most cases by C. albicans preferentially affects the elderly, young children and bearers of dental prostheses. Purpose: The purpose of the work is to study deeply oral candidiasis, the selection and practical application of a rational and effective in the treatment of oral candidiasis. Materials and methods: The study included a group of 10 people who underwent a thorough clinical and laboratory examination: 1) Research of fungal elements by direct examination of the collected material 2) Isolation of the fungi from growing on different culture mediums. Results: After the study conducted and based on subjective data of the clinical inspection, the differential diagnosis of the laboratory exam was established in 3 cases of OC. Treatment of patients with OC. was adjusted individually, taking into consideration the general condition and the particular process. In all the cases treatment included: General-l.Tab. Micosist (Fluconazol), 2. Caps. Linex, 3. Hiposensibilizante - Claritin, 4. Vitaminoterapie - Aevit-under listing. Local-1. Reclamation of the mouth, 2. Drug processing of the oral cavity with 1% ground, hydrogen peroxide, irrigations with Furacilin solution, applications with soil. Betadin and applications with Nistatin. 3. Echinacea - sucking piles. Conclusions-Oral candidiasis is an important part of dentistry treatment and presents a huge interest for dentists. Timely untreated it can lead to complications, in extreme cases, when it becomes disseminated, can be lethal, so it should be diagnosed and treated in time