Clinical and radiological aspects of limited forms of infiltrative pulmonary tuberculosis and slowly resolving pneumonia

IMSP Institutul Ftiziopneumologie „Chiril Draganiuc”, IP Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”Algoritmul diagnosticului tuberculozei pulmonare este definit clar, însă sensibilitatea redusă a metodelor contemporane de laborator în formele limitate, condiționează dificultatea diagnosticului diferențial cu pneumonia, în special cu evoluție trenantă. A fost realizat un studiu de tip caz-control, prospectiv, selectiv, comparativ şi descriptiv pe un lot de 180 pacienți, divizați în 2 eșantioane: I -125 bolnavi de tuberculoză pulmonară infiltrativă cu extindere limitată și eșantionul II - 55 bolnavi de pneumonie comunitară trenantă. Rezultatele obținute au constatat predominarea manifestărilor de impregnare infecțioasă în eșantionul bolnavilor de pneumonie trenantă. Distrucțiile parenchimatoase și diseminația bronhogenă s-au identificat doar în eșantionul bolnavilor de tuberculoză pulmonară. Impactul comorbidităților și a vîrstei înaintate a fost mai impunător în eșantionul bolnavilor de pneumonie trenantă. La majoritatea pacienților a fost constatată o evoluție clinică și radiologică pozitivă sub acțiunea tratamentului etiotrop, însă resorbția considerabilă a infiltratului pulmonar a predominat la bolnavii de pneumonie trenantă.Despite of a clearly defined diagnostic algorithm of pulmonary tuberculosis, low sensibility of contemporary laboratory methods in limited forms of pulmonary tuberculosis contributes to a difficult differential diagnosis with community acquired pneumonia, especially with slowly resolving pneumonia. A case-control, prospective, selective, comparative and descriptive study was performed using a group of 180 patients, divided into two samples: I group - 125 cases with limited form of pulmonary infiltrative tuberculosis; II group - 55 cases with slowly resolving community-acquired pneumonia. The findings identified the prevalence of intoxication syndrome in the slowly resolving pneumonia sample. Lung destructions and bronchogenous dissemination was identified only in the tuberculosis sample. A higher impact of comorbidities and old age was more relevant in slowly resolving pneumonia sample. Clinical and radiological improvement was established in most patients of both groups, but the considerable resorbtion of lung infiltrates predominated in slowly resolving pneumonia sample

Particularităţile clinice şi morfopatologice ale infiltratelor pulmonare de diferită geneză

Tuberculoza este o provocare a sănătăţii publice din R. Moldova, cu o incidenţă plasând-o pe locul III printrе ţările cu povară înaltă a tuberculozei. Pneumonia curpinde un grup nozologic cu impact asupra sănătăţii publice cu un risc înalt al decesului. Material şi metode: A fost realizat un studiu pe 194 pacienţi (eşantionul dе studiu - 125 pacienţi cu tuberculoză pulmonară şi eşantionul de referinţă 65 pacienţi cu pneumonie comunitară severă). A fost demonstrat că vârsta comparativ mai tânără, adresarea directă către medicul de familie, simptomatologia specifi că de lungă durată a sindromului de intoxicaţie endogenă şi bronhopulmonar (astenia, scăderea vădită în greutate, subfebrilitatea, transpiraţii profuze, tusea non-responsivă la medicaţia simptomatică) sunt particularităţi ale infi ltratului pulmonar de geneză tuberculoasă. Iar vârsta înaintată, debutul simptomatic acut, starea generală grav alterată condiţionată de dispnee de grad înalt şi febră carcaterizează infiltratele pulmonare din pneumonia comunitară. Afectarea polisegmentară şi bilaterală a plămânilor, cu componentele distructive şi de diseminaţie au carcaterizat radioimagistic infiltratele pulmonare din tuberculoza pulmonară. Afectarea unui număr redus de segmente pulmonare, uni sau bilateral, nefiind acompaniate de destrucţii şi diseminaţie au defi nit radioimagistic infi ltratele pulmonare din pneumoniile comunitare. Evoluţia rapid pozitivă spre o resorbţie considerabilă cu o ulterioară vindecare a predominat la bolnavii cu pneumonii comunitare, iar rata înaltă a deceselor şi a bolnavilor pierduţi din supravegherea medicală a caracterizat evoluţia finală a tuberculozei

Clinical and paraclinical differential diagnostic criteria of pulmonary tuberculosis with community acquired pneumonia in actual context of the strategy DOTS

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testmiţanu”Introducere: Tuberculoza reprezintă o provocare pentru sănătatea publică în R. Moldova, cu o incidenţă pe care o situiază pe locul al treilea printre ţările cu cea mai mare povară a tuberculozei. Pneumonia reprezintă o entitate nozologică cu cel mai mare risc al decesului printre infecţiile tractului respirator inferior. Diagnosticul eronat stabilit de pneumonie determină depistarea tardivă a formelor severe, extinse, cu evoluţie cronică, avînd un risc înalt al decesului precoce. Material şi metode: a fost efectuat un studiu retrospectiv, selectiv şi descriptiv a unui eşantion, format din 194 pacienţi (eşantionul de studiu – 129 pacienţi cu tuberculoză pulmonară şi eşantionul de comparaţie – 65 pacienţi cu pneumonie comunitară). Rezultate: a fost apreciat că vîrsta tînără, reşedinţa urbană, factorul de risc epidemiologic şi expresivitatea joasă a sindromului de intoxicaţie şi bronhopulmonar, localizarea extinsă şi bilaterală a infiltratelor, caracterizează pacienţii cu tuberculoză. Vîrsta înaintată, comorbidităţile, accesibiltatea redusă la serviciile medicale înalt calificate, expresivitatea înaltă a sindromului de intoxicaţie şi bronhopulmonar, localizarea infiltratului într-un număr relativ mic de segmente, caracterizează pneumonia comunitară. Concluzii: Abordul complex al opacităţilor infiltrative pulmonare necesită a fi efectuat corect şi oportun, luînd în consideraţie gravitatea situaţiei epidemiologice a tuberculozei în R. Moldova.Tuberculosis is a big challenge for public health in R.Moldova, with an incidence that places it on the third place among high TB burden countries. Pneumonia is a distinct nosologic entity among lower respiratory pathologies with a high risk of poor outcome. Erroneously pneumonia diagnosis instead of tuberculosis causes late detection of severe, extensive and chronic forms with a high death rate. Material and methods. A retrospective, selective and descriptive study was realized on a sample of 194 patients (study group – 129 pulmonary TB patients, reference group – 65 pneumonia cases). Results_It was established that younger age, urban provenience, epidemiological high risk conditions, low expresseviness of intoxication and broncho-pulmonary syndromes, extensive bilateral localised infiltrates, characterise patients with pulmonary TB. Old age, comorbidities, reduced availability of high qualified medical care, high expresseviness of the intoxication and broncho-pulmonary syndromes, location of infiltrate in a limited number of segments, characterise communitic acquired pneumonia. Conclusions. Complex approach of infiltrative pulmonary opacities must be performed properly, considering the severity of epidemiogical situation in R. Moldova

Imunoexpresia matrix metaloproinazelor MMP1, MM2, MMP9 și MMP14 în endometrioza extragenitală și endometrul eutopic

Background. Matrix metalloproteinases are proteolytic enzymes responsible for the disorder of extracellular matrix modeling in endometriosis and their involvement in the invasion process. Objective of the study. The aim of this study was to evaluate the immunohistochemical expression of matrix metalloproteinases MMP1, MMP2, MMP9 and MMP14 in specimens, collected from women with extragenital endometriosis compared to their expression in the normal endometrium Material and Methods. The study included 40 female patients diagnosed with extragenital endometriosis. The used methods consisted in processing the specimens by classical histological technique with paraffin inclusion and enzymatic immunohistochemical technique for the detection of metalloproteinases MMP1, MMP2, MMP9 and MMP14. Results. The expression of matrix metalloproteinases MMP2, MMP14 was significant in stromal cells from endometriotic lesions, while MMP9 was evident in both stromal and glandular cells in these lesions. The expression MMP1 was not present. Normal endometrial tissue showed high reactivity for MMP14 and low reactivity for MMP2 and MMP9. Conclusion. This study reveals some aspects related to the morphological and clinical features of extragenital endometriosis with different locations and the correlation between the clinical evolution and some immunohistochemical markers with potential prognosis regarding the aggressiveness of such lesions. Introducere. Matrix metaloproteinazele sunt enzime proteolitice responsabile și de dereglarea modelării matricii extracelulare din endometrioză, și de implicarea lor in procesul de invazie. Scopul lucrării. Scopul acestui studiu a fost de a evalua expresia imunohistochimică a matrixmetaloproteinazelor MMP1, MMP2, MMP9 și MMP14 în specimenele de exereză recoltate de la femei de endometrioză extragenitală comparativ cu expresia lor în endometrul normal. Material și Metode. Studiul a inclus 40 paciente diagnosticate cu endometrioză extragenitală. Metodele utilizate au constat în prelucrarea specimenelor prin tehnica histologică clasică cu includere la parafină și tehnica imunohistochimică enzimatică de detectare a metaloproteinazelor MMP1, MMP2, MMP9 și MMP14. Rezultate. Expresia matrix metaloproteinazelor MMP2, MMP14 a fost semnificativă în celulele stromale din leziunile endometriozice, pe când MMP9 a fost evidentă atât în celulele stromale, cât și în cele glandulare de la nivelul acestor leziuni. Expresia MMP1 a fost absentă. Țesutul endometrial normal a arătat o reactivitate înaltă pentru MMP14 și scăzută pentru MMP2 și MMP9. Concluzii. Acest studiu permite elucidarea unor aspecte legate de comportamentul morfo-clinic al endometriozei extragenitale cu diferite localizări și stabilirea unor corelații între evoluția clinică și unii markeri imunohistochimici cu potențial prognostic privind agresivitatea unor astfel de leziuni

Immunoexpression of matrix metalloproteinases MMP-1, MMP-2, MMP-9 and MMP-14 in extragenital endometriosis and eutopic endometrium

Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Department of morphopathology, University of Medicine and Pharmacy, Craiova, Romania, Department of Pathology, 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: Endometriosis is a comon, benign, inflamatory, pathology, represented by the ectopic location of functional endometrial glands and stroma outside the uterine cavity [1, 2]. Matrix metalloproteinase (MMP) represents a large family zinc-dependent endopeptidases, involved in the degradation of the extracellular matrix in the process of endometrial cell implantation and are classified by their substrate specificity [7, 8]. Matrix metalloproteinases (MMPs) are essential in orchestrating proper physiological functioning of the endometrium; hence, alteration of MMP activities is considered as a critical factor for the development of endometriosis. MMPs are involved in the cellular event of epithelial-mesenchymal transition [10, 22]. Purpose: The aim of this study was to evaluate the immunohistochemical expression of matrixmetalloproteinases MMP1, MMP2, MMP9 and MMP14 in surgical excision specimens, collected from women with extragenital endometriosis compared to their expression in the normal endometrium. Material and methods: The patient group consist 42 women with endometriosis, age range of 21-63 years (median 40), diagnosed and surgically treated at Department of Surgery, Obstetrics and Gynecology from Gherghe Paladi Municipal Clinical Hospital, Sfantul Arhanghel Mihail Municipal Clinical Hospital, Chisinau, the Republic of Moldova and Emergency County Hospital, Craiova, Romania. Location included: the anterior abdominal wall after caesarean operation – 20, inguinal hernia – 7, umbilical hernia – 4, perineal region – 1, appendix – 4, colon – 5, and ileum – 1case. Results: The classical histopatological examination of the general expression of MMP-1, MMP-2, MMP-9 and MMP-14 revealed a diverse variability. For MMP-2, MMP-9, MMP-14 markers, the reaction positivity was variable not only from one case to another but also within each case, the latter being characterized by the identification of different areas within endometriosis. Immunohistochemical analysis has demonstrated the significant enhance of MMP-9 and MMP- 14 expressions in endometriosis and in endometrium. The distinctive feature of MMP-9 and MMP-14 expression in endometriosis was considerable increase of its activity precisely on the border of endometriotic lesion and the peritoneum. Conclusions: The MMP-9 and MMP-14 activity significant elevation, established on ectopic endometrium of women with endometriosis. Study of MMP-1, MMP-2, MMP-9 and MMP-14 activities in endometriotic lesions from women with endometriosis is perspective for further investigation in order to determine a possible role of matrix metalloproteinases in the development of invasiviness process in case of extragenital endometriosis

The predictors of pulmonary tuberculosis in Xpert MBT/Rif positive and resistant assay patients with diabetes mellitus

Department of Pneumophtisiology, Department of Morphopathology, Department of Family Medicine, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chiril Draganiuc Institute of Phtisiopneumology, Chisinau, the Republic of MoldovaBackground: One of the most important among risk factors for active tuberculosis development represents diabetes mellitus. The aim of the study was the assessment of the predictive factors for pulmonary tuberculosis in Xpert MBT/Rif resistant assay patients with diabetes mellitus. Material and methods: A retrospective, selective, descriptive and case-control study was performed. Were enrolled 119 pulmonary drug resistant tuberculosis patients, diagnosed and hospitalized in the Municipal Clinical Hospital of Phthysiopneumology of Chisinau city in the period of 01.01.2013- 01.01.2015. The patients were distributed in 2 groups: the 1st group – 34 MDR-TB patients with diabetes mellitus and the 2nd – 85 MDR-TB patients. Investigations were performed according to the National Clinical Protocol – 123. Results: The biological characteristics of the pulmonary MDR-TB patients with diabetes mellitus were old age with associated diseases, which contributed to a lower treatment outcome. For MDR-TB groups were common social-economic vulnerability, late detection as symptomatic cases and a high treatment success rate. Conclusions: Patients with MDR-TB and diabetes mellitus need an individualized approach for an early TB detection and prompt initiation of the adequate treatment regimen according of the susceptibility testing results

Immunoexpression of matrix metalloproteinases MMP-1, MMP-2, MMP-9 and MMP-14 in extragenital endometriosis and eutopic endometrium

Department of Morphopathology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, the Republic of Moldova, Department of Pathology, University of Medicine and Pharmacy, Craiova, Romania, The 75th anniversary of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova (1945-2020)Background: Matrix metalloproteinases are proteolytic enzymes responsible for the disorder of extracellular matrix modeling in endometriosis and their involvement in the invasion process. The aim of this study was to evaluate the immunohistochemical expression of matrix-metalloproteinases MMP-1, MMP-2, MMP-9 and MMP-14 in surgical excision specimens, collected from women with extragenital endometriosis compared to their expression in the normal endometrium. Material and methods: The study included 40 female patients diagnosed with extragenital endometriosis. The used methods consisted in processing the specimens by classical histological technique with paraffin inclusion and enzymatic immunohistochemical technique for the detection of metalloproteinases MMP-1, MMP-2, MMP-9 and MMP-14. Results: The expression of matrix metalloproteinases MMP-2, MMP-14 was significant in glandular cells from endometriotic lesions, while MMP-9 was evident in both stromal and glandular cells in these lesions. The expression MMP-1 was not present. Normal endometrial tissue showed high reactivity for MMP-14 and low reactivity for MMP-2 and MMP-9. Conclusions: This study reveals some aspects related to the morphological and clinical features of extragenital endometriosis with different locations and the correlation between the clinical evolution and some immunohistochemical markers with potential prognosis regarding the aggressiveness of such lesions

Tuberculosis characteristics and risk factors in urban compared with rural patients

Material and methods: A retrospective selective, descriptive study of socioeconomic, epidemiological peculiarities, case-management, diagnosis and microbiological characteristics of 694 patients with tuberculosis registered in Chisinau in 2016 was performed. Among them 581, had an urban residency and 112 rural residency. Results: Residents from rural population and young persons in urban areas were most affected. Socioeconomic vulnerability predominated in both subpopulations; however, the gravity was more represented in the urban group. Lower level of education and tuberculosis contacts were more dominating in the rural group. Comorbidities, HIV infection were more frequently identified in the urban group, but destructive forms – in the rural patients. Low treatment outcomes were more frequently established in the rural group. Conclusions: Risk factors for tuberculosis in urban subpopulation were: unemployment, lack of health insurance, homelessness, comorbidities, HIV infection. In rural population prevailed the following risk factors: low school education and tuberculosis contact

Клинические и патологоанатомические особенности туберкулеза легких со смертельным исходом

IP Universitatea de Stat de Medicină și Farmacie Nicolae Testemițanu, Institutul de Pneumoftiziologie Chiril Draganiuc, IMSP Spitalul Clinic Municipal de FtiziopneumologieTuberculosis represents an epidemic burden for Republic of Moldova associated to high mortality index. Aim of the study is the assessment of clinical-morphopatological features of pulmoary tuberculosis with letal evolution. A study group of 27 new pulmonary tuberculosis cases hospitalized in the clinical subdivisions of Municipal Hospital of Pneumophtysiology dead in the period 1.01.2014–31.12.2014 was evaluated. All cases were investigated according to the national standards. It was established that men, young age individuals and urban residents predominated. The main rate represented the unemployed patients, individuals with low educational level, low living conditions. History of migration, emprisonment and HIV infection were few patients. Microscopic positive for acid fast bacilli were one third, late detected with chronic evolution – two thirds and MDR-TB infected patients - one fi fth of assessed group. Each second patient was dead in the fi rst year after the detection and every third in the fi rst two weeks. Necroptic examination identifi ed predominantly dystrophic changes of internal organs, pulmonary oedema and disseminated intravascular coagulation. Туберкулез представляет серьезную проблему общественного здравоохранения Республики Молдова, связанную с высоким показателем смертности. Целью исследования являлась оценка клинико-патологоанатомических особенностей туберкулеза легких со смертельным исходом. Были анализированы 27 историй новых случаев больных туберкулезом легких, госпитализированных в клинические отделения Муниципальной клинической больницы фтизиопневмологии г. Кишинэу в период с 1.01.2014 до 31.12.2014. Все случаи были исследованы в соответствии с Национальными стандартами. Было выявлено преобладание мужчин, молодого возраста, городских жителей. Большинство пациентов были безработными, с низким уровнем образования и низким уровнем жизни. Единичные случаи были выявлены с ко-инфекцией ВИЧ, историей заключения и миграции. Хроническое течение туберкулезного процесса и позднее выявление констатировали у 2/3 больных. Положительный результат микроскопии был выявлен у 1/3 больных. Туберкулез с множественной лекарственной устойчивостью был констатирован у 15 пациентов. Смерть наступила в течение первого года после выявления у каждого второго пациента, в течение первых двух недель после госпитализации – у каждого третьего. Аутопсия выявила отек легких, диссеминированное внутрисосудистое свертывание и дистрофические изменения внутренних органов

Определение значимости скрининга в выявление туберкулеза у пациентов с сахарным диабетом

Catedra Pneumoftiziologie, IP USMF Nicolae Testemiţanu, Catedra Medicină de Familie, IP USMF Nicolae Testemiţanu, Catedra Morfopatologie, IP USMF Nicolae Testemiţanu, Spitalul Clinic Municipal de Ftiziopneumologie, IMSP Spitalul raional Ştefan VodăPacienţii cu diabet zaharat sau intoleranţă la glucoză necesită a fi investigaţi radiologic anual şi la apariţia semnelor clinice suspecte pentru tuberculoză, cu scopul diminuării ponderii formelor severe şi îmbunătăţirii rezultatului terapeutic. Scopul cercetării a fost stabilirea impactului screeningului în depistarea tuberculozei la pacienţii cu diabet zaharat. Au fost investigaţi conform Protocolului naţional 119 pacienţi cu tuberculoză pulmonară, distribuiţi în două loturi. Treizeci şi patru de pacienţi cu diabet zaharat au constituit lotul 1 şi 85 pacienţi fără perturbări ale metabolismului glucidic au constituit lotul 2. Studiul a stabilit că tuberculoza pulmonară la pacienţii cu diabet zaharat a fost depistată mai frecvent prin screeningul grupelor cu risc sporit. Vârsta peste 45 de ani, prezenţa suportului financiar convenţional şi contactul tuberculos au caracterizat pacienţii cu diabet zaharat. Vârsta tânără şi factorii de risc sociali, precum şi depistarea prin adresare au constituit indicatorii ce au caracterizat pacienţii cu tuberculoză şi fără comorbiditate metabolică. Deşi ponderea formelor severe, extinse, cu rezultat microbiologic pozitiv nu s-a diferenţiat de cea a grupului cu tuberculoză şi fără tulburări ale metabolismului glucidic, rata pacienţilor decedaţi a fost semnificativ mai înaltă în grupul bolnavilor cu diabet zaharat.Patients with diabetes mellitus or glucose intolerance need to be radiologically investigated annually or in occurrence of the clinical signs suspected for tuberculosis in order to reduce the severity of the disease and to improve the treatment outcome. The purpose of the research was to establish the impact of the screening in the detection of tuberculosis in patients with diabetes mellitus. A sample constituted from 119 patients with pulmonary tuberculosis distributed in two groups was investigated according to the national protocol. Thirty-four diabetic patients were included in the first group and 85 patients without metabolic disturbances were included in the second group. The research established that pulmonary tuberculosis in diabetic patients was more frequently detected by screening of the high-risk groups. Aged more than 45 years, the presence of a conventional financial support and tuberculosis contact characterized patients with diabetes mellitus. Young age and social risk factors, as well as detection by addressing, were indicators that characterized patients with tuberculosis and without metabolic disorders. Despite the fact that the rate of severe and extensive forms, as well microbiologically-positive results did not differ between the groups, the rate of died patients was significantly higher in the groups of patients with diabetes mellitus.Пациенты с сахарным диабетом или c заболеваниями, связанными с нарушениями углеводного обмена, должны ежегодно обследоваться радиологически или обследоваться при появлении клинических признаков, характерных для туберкулеза, для снижения тяжести болезни и улучшения результата лечения. Целью исследования было определение влияния скрининга на выявление туберкулеза у пациентов с сахарным диабетом. Были обследованы согласно Национальному протоколу 119 пациентов с туберкулезом легких, которые были распределены на две группы. Тридцать четыре пациента с сахарным диабетом составили первую группу и 85 пациентов не имели нарушений углеводного обмена. Исследование установило, что туберкулез легких у пациентов с сахарным диабетом чаще выявляется путем обследования групп высокого риска. Возраст более 45 лет, наличие финансовой поддержки и туберкулезный контакт характеризовали пациентов с сахарным диабетом. Молодой возраст и социальные факторы риска, а также выявление туберкулеза при обращении, характеризовали группу больных без нарушений углеводного обмена. Несмотря на то, что доля тяжелых и обширных формы туберкулеза, а также микробиологически положительных результатов не отличалось между группами, доля умерших пациентов была значительно выше в группе больных сахарным диабетом