Colorectal polypoidal formations: prevalence and therapeutic approach

Scopul lucrării. Datele GLOBOCAN 2021 arată o creștere esențială a ratei morbidității, cancerul colorectal (CCR) ocupând al doilea loc după mortalitate. Cunoașterea detaliată a caracteristicilor leziunilor premaligne este foarte importantă, întrucât rezolvarea acestora conduce la diminuarea semnificativă a riscului de apariție a CCR. Scopul studiului este evidențierea numărului și tipului formațiunilor protruzive descoperite la nivelul unui eșantion de populație. Materiale și metode. Studiu prospectiv pe 85 pacienți cu leziuni precursoare maligne (polipi), depistate la colonoscopia diagnostică în 2018-2022 în cadrul IMU (Chișinău). Indiferent de gen sau vârstă, pacienții incluși în studiu au necesitat colonoscopie pentru stabilirea diagnosticului, fără a fi examinați colonoscopic anterior. Au fost analizate variabilele: date demografice, localizarea și morfologia formațiunilor, precum și atitudinea terapeutică. Rezultate. Dimensiunile polipilor au variat între 2 și 40mm, fără semnificație statistică între genuri (p>0.05); localizare: hemicolonul stâng – 66(76.6%), drept – 12(14.1%), transversul – 7(8.3%); histologic: 95% polipi de tip neoplazic, predominând cei tubuloadenomatoși – 37(43.5%), tubulo-viloși – 29(34.1%). Examenul anatomo-patologic a relevat: displazie ușoară – 68(80%), moderată – 14(16.5%), severă – 3(3.5%). În toate cazurile cu displazie ușoară/moderată s-a practicat polipectomie endoscopică, suficientă ca act terapeutic. În displazia severă – atitudine oncologică: rezecție recto-sigmoidiană cu ileostomie (n=1) și rezecție colonică cu anastomoză primară (n=2). Follow-up postpolipectomie la fiecare 6 luni – fără recidivă. Concluzii. CCR, fiind în majoritatea cazurilor o consecință evoluției polipilor adenomatoși maligni, diagnosticul precoce a acestora urmat de polipectomie, reduc considerabil riscul de dezvoltare a neoplaziilor colorectale.Aim of study. Data provided by GLOBOCAN 2021 show a significant increase in the morbidity rate, with colorectal cancer (CRC) taking second place in terms of mortality. Detailed knowledge of premalignant lesions, as their removal leads to decrease in the risk of developing CRC. The aim is to analyze the number and type of protrusive formations discovered globally, at the level of a sample population. Materials and methods. Prospective study on 85 patients with malignant precursor lesions (polyps), detected after diagnostic colonoscopies, performed at Emergency Hospital (Chișinău), during 2018-2022. Regardless of gender or age, the patients included in the study required colonoscopy for diagnosis, without having previously been colonoscopically examined. The variables were analyzed: demographic data, location and morphology of formations, as well as therapeutic attitude. Results. The size of the polyps varied between 2 and 40 mm, without statistically variations between sexes (p>0.05). Location: left colon – 66(76.6%), right – 12(14.1%), transverse colon – 7(8.3%). Histologically, 95% of polyps – neoplastic type, predominating tubulo-adenomatous – 37(43.5%), tubulovillous – 29(34.1%). Anatomical-pathological examination: low dysplasia – 68(80%), moderate dysplasia – 14(16.5%), severe dysplasia – 3(3.5%). In cases with low/moderate dysplasia – polypectomy: sufficient as a therapeutic act. In cases with high dysplasia – oncological approach: in 1 case – rectosigmoidian resection with ileostomy and in 2 cases colonic resection with primary anastomosis. After polypectomy, patients have been followed every 6 months – without recurrency. Conclusions. Because a large number of cancers arise from malignancy adenomatous polyps, their diagnosis in the premalignant phase followed by polypectomy considerably decrease the chance of the occurrence of colorectal neoplasia in the future

Bringing Video Communication to the Community: Opportunities and Challenges

The rise of online social networks, the wide availability of video communication technology and the deployment of high-speed broadband networks together provide the opportunity for video to become a medium for mass social communication among communities. However, current solutions provide poor support for ad hoc social interactions among multiple groups of participants. This position paper summarises the results of more than 5 years’ research to make communication and engagement easier between groups of people separated in space. It shows how communication can be effectively combined with different shared activities, and how the technical capabilities of Communication Orchestration and Dynamic Composition work together to improve the quality of human interactions. The paper also describes ongoing work to develop the Service-Aware Network as a means of optimising the quality of a user’s communication experience while making most efficient use of network resources. We believe these developments could enable video-mediated communication to become an effective and accepted enabler for social communication within community groups globall

Association of the IL-10 gene family locus on chromosome 1 with juvenile idiopathic arthritis (JIA)

The cytokine IL-10 and its family members have been implicated in autoimmune diseases and we have previously reported that genetic variants in IL-10 were associated with a rare group of diseases called juvenile idiopathic arthritis (JIA). The aim of this study was to fine map genetic variants within the IL-10 cytokine family cluster on chromosome 1 using linkage disequilibrium (LD)-tagging single nucleotide polymorphisms (tSNPs) approach with imputation and conditional analysis to test for disease associations

Clinical, endoscopic and morphological correlations in colon neoformations

Scopul lucrării. Cancerul colorectal (CCR) reprezintă una dintre principalele cauze de deces pe plan mondial din cauza diagnosticării tardive. Aceasta se datorează lipsei unei simptomatologii specifice în fazele inițiale ale bolii și întârzierea prezentării pacienților la medic. Scopul studiului este analiza corelațiilor simptomelor clinice și caracteristicilor endoscopico-morfologice ale neoformațiunilor colonice. Materiale și metode. Studiu prospectiv pe 83 de pacienți, dintre care 59(71.1%) cu CCR și 24(28.9%) cu leziuni precursoare malignității, efectuat în cadrul IMU (Chișinău) în perioada 2018-2021. Raportul B:F=1.19:1, vârsta medie – 61.4±1.32 ani (p<0.01). S-au analizat semnele clinice, datele endoscopice și morfologice. Rezultate. Dintre 83 pacienți, 18(21.7%) au fost asimptomatici, iar 65(78.3%) având substrat patologic. Analizând simptomatologia relatată, în lotul pacienților cu neoplazii au predominat tulburările de tranzit (alternanță – constipații/diaree) – 39(66.1%), dureri abdominale – 56(94.9%), hemoragie digestivă inferioară – 31(52.54%) și anemie – 55(93.2%). În lotul pacienților cu leziuni premaligne, simptomatologia a fost caracterizată prin hemoragie ocultă – 24(100%), dureri abdominale – 8(33.3%), febră inexplicabilă – 6(25.0%) și anemie – 16(66.6%) (p<0.01). Leziunile evidențiate colonoscopic în funcție de localizare, atât în leziunile premaligne, cât și în CCR au predominat la nivelul hemicolonului stâng – 61(73.5%), comparativ cu hemicolonul drept – 22(26.5 %), (p<0.001). Cel mai frecvent tip macroscopic și histologic în cazul pacienților cu CCR a fost adenocarcinomul – 44(74.6%), iar la cei cu neoformațiuni premaligne au fost polipii tubulo-adenomatoși cu displazie ușoară – 19(79.1%) (p<0.01). Concluzii. Corelațiile clinice, endoscopico-morfologice, pe lângă confirmarea malignității, aduc informații importante în stabilirea conduitei terapeutice, integrarea pacienților într-un grup de risc, ce conferă pacientului un anumit prognostic.Introduction. Colorectal cancer (CRC) is one of the leading causes of death worldwide due to late diagnosis. This is due to the lack of specific symptomatology in the initial stages of the disease and the delay in presenting patients to the doctor. Aim of study. Analysis of the correlations of clinical symptoms and endoscopic-morphological features of colonic neoformations. Materials and methods. Prospective study on 83 patients, of which 59(71.1.%) with CRC and 24(28.9%) with malignant precursor lesions, performed at Emergency Hospital (Chișinău), during 2018-2021. Ratio M:W=1.19:1, mean age – 61.4±1.32 years (p<0.01). Clinical signs, endoscopic and morphological data were analyzed. Results. Out of 83 patients, 18(21.7%) were evaluated occasionally, and 65(78.3%) had a pathological substrate. Analyzing the related symptoms, in the group of patients with neoplasms predominated transit disorders (alternation – constipation/diarrhea) – 39(66.1%), abdominal pain – 59(94.9%), lower gastrointestinal bleeding – 31(52.54%) and anemia – 55(93.2%). In the group of patients with premalignant lesions, the symptoms were characterized by occult hemorrhage – 24(100%), abdominal pain – 8(33.3%), unexplained fever – 6(25.0%) and anemia – 16(66.6%) (p<0.01). The lesions highlighted colonoscopically depending on the location, both in the premalignant lesions and in the CRC were predominantly on the left hemicolon – 61(73.5%) (p<0.001). The localisation is illustrated in the next picture. The most common macroscopic and histological type in patients with CRC was adenocarcinoma – 44(74.6%), and in those with premalignant neoformations were tubuloadenomatous polyps with mild dysplasia – 19(79.1%) (p<0.01). Conclusions. Clinical, endoscopic-morphological correlations, in addition to confirming malignancy, provide important information for establishing therapeutic behavior, integration into a risk group, which gives the patient a certain prognosis

Early postoperative complications in colorectal cancer operated in emergency

Catedra de chirurgie nr. 1 „Nicolae Anestiadi”, Laboratorul Chirurgie Hepato-Pancreato-Biliară, Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, IMSP Institutul de Medicină Urgentă, Chişinău, Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Cancerul colorectal (CCR) operat în urgență, prezintă încă, rate înalte de morbiditate şi mortalitate. Rezecţia colonului este o intervenţie laborioasă, agresivă, cu riscuri mari de complicaţii în perioada postoperatorie imediată. Scopul: Analiza complicațiilor postoperatorii în chirurgia cancerului colorectal complicat, operat în urgență. Material și metode: Studiul retrospectiv al 98 pacienți cu CCR operați de urgență, în IMU (Chișinău), perioada 2015 - 2017. B:F=1.1:1, vârsta medie – 63.96 ± 1.34 ani, sediul tumorii: colon drept – 25 (25.5%), transvers – 9 (9.18%), stâng – 64 (64.94%), (p<0.01). Cu ocluzie intestinală acută (OIA) și peritonită au fost 22 (22.44%), inclusiv 9 (9.18%) cu perforație, operați în primele 8h; OIA – 25 (25.5%) la 8-24h; sindrom subocluziv – 43 (43%) și hemoragie – 8 (8.2%), la 2-5 zile. Au fost efectuate anastomoze primare – 68 (69.38%), derivaţii externe – 30 (30.61%). Rezultate: Rata totală a complicațiilor postoperatorii a constituit 65.3%. Complicații comune intervențiilor chirurgicale abdominale specifice chirurgiei cancerului colonic au fost 20 (31.25%): dehiscențe anastomotice – 3 (4.4%), abcese parastomale – 2 (6.6%), retracția stomei – 2 (6.6%), necroza stomei – 2 (6.6%), dehiscența bontului rectal – 1 (3.3%), eviscerație parastomală – 1 (3.3%), eventrația plăgii – 3 (3.1%), supurarea plăgii – 6 (6.12%). Complicații postoperatorii generale – 44 (68.75%) cazuri, tanatogeneza fiind determinată de pneumonii – 6 (6.1%), MODS – 5 (5.1%), insuficiență cardiacă – 12 (12.2%), infecții urinare – 10 (10.2%), edem pulmonar – 4 (4.1%), TEAP – 7 (7.15%). Concluzii: Complicaţiile postoperatorii specifice chirurgiei colonului sunt în mare parte caracteristice intervenţiilor chirurgicale practicate în urgenţă, pe când cele generale determinate de terenul biologic al pacientului: vârstă, comorbidități, risc operator ASA.Introduction: Colorectal cancer operated in emergency, still has high rates of morbidity and mortality. The resection of the colon is a laborious, aggressive intervention with high risk of complications occurring both in the immediate postoperative period. Objective: Determination of postoperative complications of complicated colorectal cancer operated in emergency. Material and methods: Retrospective study of 98 patients with CCR operated in Emergency Hospital, between 2015-2017. Ratio M:F=1.1:1, mean age – 63.96 ± 1.34 years, with tumor localization : right sided – 25 (25.5%), transvers – 9 (9.18%), left sided – 64 (64.94%), (p<0.01). 22 (22.44%) patients were with intestinal obstruction (IO) and peritonitis, 9 (9.18%) of them – with perforation, operated within 8h; with IO – 25( 25.5%), over 8-24h; with partial obstruction – 43 (43%), bleeding – 8 (8.2%), over 2-5 days. Have been performed: primary anastomosis – 68 (69.38%), colostomy – 30 (30.61%). Results: The total rate of postoperative complications was 65.3%. Complications common to abdominal surgery and specific for colon cancer were 20: anastomotic leak – 3 (4.4%), peristomal abscess – 2 (6.6%), stoma retraction – 2 (6.6%), stoma necrosis – 2 (6.6%), rectal stump leak – 1 (3.3%), parastomal evisceration – 1 (3.3%), laparotomic wound eventration – 3 (3.1%), laparotomic wound supuration – 6 (6.12%). General postoperative complications occurred in 44 cases, tanatogenesis being determined by: pneumonia – 6 (6.1%), MODS– 5 (5.1%), heart failure –12 (12.2%), urinary infections –10 (10.2%), pulmonary edema– 4 (4.1%), TEAP –7 (7.15%). Conclusion: Postoperative complications specific to colon surgery are largely characteristic for emergency surgery, while the general are determinated of the patient's biological terrain: age, comorbidities, ASA risk

Ventilation and oxygenation of major trauma patients in ICU

Centrul Național Stiințifico-Practic de Medicină de Urgență, Catedra Anesteziologie Reanimatologie Nr. 1, USMF „N. Testemițanu”, Conferinţa a XI-a Naţională a ortopezilor-tramatologi din Republica Moldova “Politraumatisme – concepţii contemporane de diagnostic şi tratament”, 21 mai 2009, Chișinău, Republica MoldovaAstăzi traumatismul este comparat cu o epidemie. Unul din obiectivele de bază a managementului traumatismului major este oxigenarea și ventilația pulmonară. În articolul nostru am studiat câteva aspecte de VAP (ventilația artificială pulmonară) în traumatismele majore – indicațiile și regimurile VAP, ca unul din componenții complexului de tratament în traumatismul major cât și câteva aspecte ale strategiei ventilației pulmonare protective (protective lung ventilation).Currently trauma is recognized as an epidemic. One of priority directions in major trauma management is oxygenation and ventilation. In our article we have studied some aspects of mechanical ventilation in major trauma: indications and modes, as one important component in the management of major trauma, some aspects of use of protective lung ventilation

Characterisation of the fiber gene and partial sequence of the early region 4 of bovine adenovirus 2: Short communication

The full sequence of the fiber gene and partial sequence of the putative 17 kD protein gene of bovine adenovirus-2 (BAdV-2) were determined. The size of the fiber gene of BAdV-2 proved to be 561 amino acids, of which the amino acids 37 to 385 form a typical shaft domain of 22 repetitive motifs. On the complementary strand, a gene homologous to the 17 kD protein coded in the E4 region of several human adenoviruses was found. The sequence analysis seems to confirm the presence of an intron in the sequenced part of the E4 region

Association of the 5-aminoimidazole-4-carboxamide ribonucleotide transformylase gene with response to methotrexate in juvenile idiopathic arthritis

OBJECTIVES: Methotrexate (MTX) is the mainstay treatment for juvenile idiopathic arthritis (JIA), however approximately 30% of children will fail to respond to the drug. Identification of genetic predictors of response to MTX would be invaluable in developing optimal treatment strategies for JIA. Using a candidate gene approach, single nucleotide polymorphisms (SNPs) within genes in the metabolic pathway of MTX, were investigated for association with response to treatment in JIA cases. METHODS: Tagging SNPs were selected across 13 MTX metabolic pathway genes and were genotyped using Sequenom genotyping technology in subjects recruited from the Sparks Childhood Arthritis Response to Medication Study. Response to MTX was defined using the American College of Rheumatology (ACR) paediatric response criteria and SNP genotype frequencies were compared between the worst and best responders (ACR-Ped70) to MTX. An independent cohort of US JIA cases was available for validation of initial findings. RESULTS: One SNP within the inosine triphosphate pyrophosphatase gene (ITPA) and two SNPs within 5-aminoimidazole-4-carboxamide ribonucleotide transformylase gene (ATIC) were significantly associated with a poor response to MTX. One of the ATIC SNPs showed a trend towards association with MTX response in an independent cohort of US JIA cases. Meta-analysis of the two studies strengthened this association (combined p value=0.002). CONCLUSIONS: This study presents association of a SNP in the ATIC gene with response to MTX in JIA. There is now growing evidence to support a role of the ATIC gene with response to MTX treatment. These results could contribute towards a better understanding of and ability to predict MTX response in JIA

Interhospital transportation of major trauma patients in the Republic of Moldova

NCEM (Centre of Emergency Medicine), SMPhU (State Medical and Pharmaceutical University) „N. Testemitanu”, Congresul II Internaţional al Societăţii Anesteziologie Reanimatologie din Republica Moldova 27-30 august 2009Actuality Transportation of major trauma patients to, between, and within hospitals can be associated with potentially adverse events. Researchers have shown that increased vigilance, appropriate equipment, and well-trained personnel can lead to improved safety while major trauma patients are being transported. The aim of the study is to evaluate interhospital transportation of major trauma patients from district hospitals to trauma center on territory the Republic of Moldova. Materials and Methods Was performed retrospective analysis of 39 patients from archive, transferred from regional hospitals to National Centre of Emergency Medicine (NCEM) during the year 2008. Age between 20-74 years, 30 males, 9 females. Severity of trauma was evaluated according to NISS (New Injury Severity Score) with average value 45,1 ± 10,3 points, and MPMoIII (Mortality Probability Admission Model), with average value 67,3±18,9%. Patients were analyzed in dependencies on period of trauma, on distance and on severity of trauma. Results In table №1 is represented two comparable groups according to number of patients, gender, age, NISS. Patients who were transported before 48 hours were influenced by transportation more vastly (MPMoIII is higher) and had mortality in two times above. Rate of mortality was less for patients who were transported from distance < 70 km (table №2). Rate of mortality was directly dependant on severity of trauma (NISS) and conditions at admission (MPMoIII) in trauma center (table №3) and increased vastly in cause NISS>40 or MPMoIII>70%. Conclusions 1. It was observed some tendencies for major trauma patients during transportation. They depend on phase of trauma, distance between hospitals and severity of trauma according to NISS and MPMoIII. 2. The transportation of major trauma patients needs optimization through increasing caution, good equipping and special trained personal. 3. Activity of Department of Emergency Medicine should be directed on achievement of “Golden Hour” strategy in all territory the Republic of Moldova