Вирусные гепатиты В, С и D в Республике Молдова: достижения и проблемы

Agenția Națională pentru Sănătate Publică, IP Universitatea de Stat de Medicină și Farmacie Nicolae Testemițanu, IMSP Centrul Republican de Diagnosticare MedicalăRealizarea primelor trei Programe Naționale de combatere a hepatitelor virale B, C și D în Republica Moldova, începând cu anul 1997, au condus la reducerea semnificativă a morbidității prin hepatitele virale B, C și D acute, dar pe fundalul incidenței sporite a hepatitelor virale cronice, unde indicatorii îi depășesc vădit pe cei din țările Comunității Europene. Studiile realizate demonstrează că contingentele de populație cu risc sporit de infectare continuă să prezinte un potențial înalt ca sursă reală de infectare cu virusurile hepatice nominalizate pentru alte categorii de populație. Ca urmare a utilizării tehnicilor de biologie moleculară, au fost evidențiate genotipurile și subgenotipurile virusurilor hepatitelor B, C și D în special la contingentele de populație cu risc sporit de infectare, demonstrând că unele posedă un potențial înalt de cronicizare, cu evoluție spre ciroză și cancer hepatocelular. Utilizarea produselor antivirale de ultimă generație recomandate de OMS pentru tratamentul hepatitelor virale B și C a demonstrat o eficacitate înaltă nu numai terapeutică, ci și profi lactică, manifestată prin reducerea numărului de bolnavi purtători de virusuri și a noilor focare. Este important de menționat că prejudiciul economic prevenit ca urmare a realizării Programelor Naționale de combatere a hepatitelor virale în perioada 1997-2015 a constituit 822.453 mii lei, pe când cheltuielile din bugetul de stat pentru realizarea acestor programe au alcătuit 84.618,5 mii lei. Realizarea integrală a prezentului Program de combatere a hepatitelor virale B, C și D în contextul Planului Strategic al OMS de eliminare a hepatitelor virale parenterale până în anul 2030 va avea un beneficiu socioeconomic extrem de important pentru Republica Moldova.The implementation of the first three National Programs against viral hepatitis B, C and D in the Republic of Moldova since 1997 has allowed to significantly reduce morbidity of acute viral hepatitis B, C and D, but on the increased background of incidence of chronic viral hepatitis the indicators clearly outweigh those in the European Community. Studies have shown that the contingent of population at high risk of infection continues to show a high potential as a real source of infection with viral hepatitis viruses for other population categories. As a result of the use of molecular biology techniques, the genotypes and subgenotypes of hepatitis B, C and D viruses have been highlighted, particularly in contingent of population at high risk of infection, demonstrating that some have a high potential for chronicization with progression to cirrhosis and hepatocellular cancer. Using of next-generation antiviral drugs in the treatment of viral hepatitis B and C recommended by the WHO has shown a high, not only therapeutic but also prophylactic efficacy manifested by reducing the number of virus-bearing patients, and new outbreaks. It is important to note that the economic prejudice prevented by the implementation of the National Programs against viral hepatitis during the period 1997-2015 amounted to 822.453 thousand lei, while the spending from the State Budget for the implementation of the nominated programs amounted to 84.618.5 thousand lei. The full implementation of the current Program for combating viral hepatitis B, C and D in the context of the WHO Strategic Plan for the elimination of parenteral viral hepatitis by 2030 will have a very important socio-economic benefit for the Republic of Moldova.Реализация первых трех Национальных программ по борьбе с вирусными гепатитами B, C и D в Республике Молдова с 1997 года позволила значительно снизить заболеваемость острыми вирусными гепатитами B, C и D, но на фоне высокого уровня заболеваемости хроническими вирусными гепатитами, показатели явно перевешивают показатели стран Европейского Cоюза. Исследования показали, что среди групп населения с высоким риском инфицирования все еще присутствует высокий потенциал в качестве реального источника заражения вирусами гепатитов для других категорий населения. В результате использования методов молекулярной биологии были выделены генотипы и субгенотипы вирусов гепатитов B, C и D, особенно среди групп с высоким риском инфицирования, демонстрируя, что некоторые имеют высокий потенциал к хронизации и прогрессированию к циррозу и гепатоцеллюлярного рака. Использование противовирусных препаратов последнего поколения для лечения вирусных гепатитов В, C и D, рекомендованных ВОЗ, продемонстрировало не только высокую терапевтическую, но и профилактическую эффективность за счет сокращения числа вирусоносителей и новых очагов инфекции. Важно отметить, что предотвращённый экономический ущерб в результате реализации Национальных программ по борьбе с вирусными гепатитами в период 1997–2015 годов составил 822.453 тысяч леев, а расходы государственного бюд-жета на реализацию указанных программ составили 84.618,5 тысяч леев. Полная реализация текущей Программы по борьбе с вирусными гепатитами B, C и D в контексте Стратегического плана ВОЗ по элиминации парентеральных вирусных гепатитов к 2030 году будет иметь важное социально-экономическое значение для Республики Молдова

Utilizarea angioplastiei transluminale în urologie

Summary. During last years urology demonstrates considerable successes, the endovascular surgery is the most outstanding example in this sense. Owing this method many classic operations were replaced by less invasive once. The principle of the method is in dilatation of the stenosed zone of the artery, the approach to this artery is realized by the percutaneus punction of a single peripheral artery. We have applied the endovascular endoplasty in three cases

Acute pyelonephritis in urological practice - etiology, diagnosis and treatment

Catedra Urologie şi Nefrologie Chirurgicală, USMF„Nicolae Testemiţanu", Secţia Urologie, IMSP SCR, Al VI-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (21-23 octombrie 2015)Rezumat Infecţia tractului urinar (ITU) reprezintă una dintre cele mai frecvente infecţii bacteriene în ţările industrializate, fiind o infecţie bacteriană nespecifică, ce poate fi cauzată de către o varietate de agenţi patogeni.Actualmente diagnosticul acestei patologii s-a îmbunătăţit graţie prezenţei metodelor moderne de diagnostic.ln lucrare sunt expuse rezultatele studiului literaturii de specialitate referitoare la diagnostic, evoluţie şi tratament a Pielonefritei acute şi Pielonefritei acute la gravide.Summary Urinary tract infection is one of the most frequent bacterial infection in the development countries.Crrently,the diagnosis of this pathology was significantly improved due to the varios methods of diagnosis and treatment.This scientific work analyses data available in specialized literature,evolution and treatment of acute pyelonephritis and acute pyelonephritis in pregnancy

Our experience in acute pyelonephritis treatment in pregnancy

Secţia Urologie IMSP Spitalul Clinic Republican, Catedra Urologie şi Nefrologie Chirurgicală USMF „N.Testemiţanu”, Al V-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (1-13 iunie 2011)Summary. It is known that during the pregnant morbidity the extragenital pathology is ranked on the first place. Although the pregnancy is a physiologic phenomenon, the vulnerability of the organism in pregnancy is increasing, especially the cardiovascular system that should ensure a complex sanguine circuit – placenta, and of the kidneys that should detoxify a supplemental weight of fetus. The renal pathology in pregnancy occupies the second rank between extrauterine pathologies. Under the influence of some factors, the increasing of PNA in pregnant patients could be observed. Pyelonephritis in pregnancy is a complicated condition with no clear evolution and not very good prognosis for both - the mother and fetus. 49 pregnant patients were evaluated with PNA. In all cases, a treatment was adjusted with favorable results, that included ureteral catheterization and insertion of autostatic stent like JJ stent. The PNA treatment in pregnancy implies the JJ stent insertion, that has an essential role in decompression of renal pelvis and have minimal risk of complications. This contributes to reduction of treatment duration with antibiotics

Tratamentul chirurgical al Hiperplaziei Prostatice Benigne (HPB)

Summary The work is dedicated to comparative analysis of results of surgery treatment in patients with Benign Prostate Hyperplasia. The 543 patients with untreated prostate adenoma (exposed toadenoma removal - 415 patients, and transurethral resection - 128 patients). The analysis of the results demonstrated, that the rate and the character of intra- and post- operation complications depends considerably on rational choice of surgical intervenfion method (transvesical or transurethral) and quality of its realization. In present TUR remains the main method in the treatment of BPH, possessing many advantages and at the same time presenting many possibilities of simultaneous treatment of other diseases, which accompany BPH. Transvesical adenomaectomy remains a method of BPH treatment, having more narrow concrete indications: adenoma of great size and its combination with great or multiple urinary bladder stones

TOT versus TVT – mesh surgical treatment in stress urinary incontinence

Introduction: Stress urinary incontinence is a highly debilitating condition, with an important impact over the quality of life. When the conservative treatment fails, the surgical treatment is a viable solution. Minimally invasive sling procedures have become the gold standard of surgical management for stress urinary incontinence (SUI) in women. Material and methods: The study was conducted on 68 patients with stress urinary incontinence, 52 have undergone the retropubic tension-free vaginal tape and 16 patients were operated using the transobturator tape procedure. All the patients were evaluated before the operation and the indication of the surgical treatment was established on the basis of physical examination (all the patients had positive cough test), abdominal ultrasound (to determine postvoid residual urine volume), urinalysis and urine culture (the majority of the patients have had before the operation recurrent urinary tract infections). Results: The satisfaction was similar in both groups of patients, with an average satisfaction rate of 91% for TVT and 86% for the patients who have undergone TOT procedure. The patients were in a proportion of 78,9% at menopause, with an average number of natural births of 1.9 and a mean BMI of 28.2. Regarding the surgical duration, this has varied between 20 and 40 minutes, being higher in the TVT cases (up to 5-7 minutes longer than TOT), because cystoscopy was performed during the operation to verify if the bladder was perforated or not. The urethral catheter was removed immediately after the operation in the case of the TOT procedure and in the day after the operation for the patients who have undergone TVT procedures (all of these patients associated genital prolapse). The hospitalization time was 3 days. We haven’t encountered significant intraoperative and postoperative complications. Conclusions: The TOT and TVT procedures have proven to be highly effective and safe methods in the treatment of SUI. There are no significant differences regarding the efficacy of these two surgical methods, but the risk of intraoperative complications is a little higher for the TVT procedure. The mid urethral sling procedures improve significantly the quality of life for patients with stress urinary incontinence

Tratamentul adjuvant chimio-imunoterapeutic în tumorile vezicale superficiale

Summary Intraveziucal chemo and imunotherapy can reduce recurence rates of bladder tumors. The intraveyical imunitherapy or chemotherapy is indicated for pacients with high rise of tumors recurence in the bladder (multiple tumors, G2-3 tumors). An investigation on 74 patient with superficial bladder cancer is presented. The rezults of the treatment are analyzed

Rezecţia endoscopică a adenomului voluminos la pacienţii cu şi fară drenaj suprapubian

Summary Nowadays the transurethral resection is being often and best accomplished in the majority of the different volume BPH cases. We frequently find a growth of complications concerning urinary system at the patients, with large BPH, which increase the risk of the surgery treatment. Ussually in these cases it is indicated urgent cistostomy, and afterwards to use the Reuter type resection. The objective of this publication is to enlarge the indication field of the TUR.P for patients who might have multiple complications. Introducere. Actualmente rezecţia transuretrală reprezintă operaţia de elecţie aplicată majorităţii covârşitoare a adenomelor de prostată de diferit volum. La pacienţii cu adenom de prostată voluminos se constată o creştere frecventă a complicaţiilor atât a sistemului urinar (pielonefrita, IRC, retenţie de urină ş.a.), cât şi a altor sisteme (cardiovasculare, digestive, neurologice, etc.) ce măresc riscul tratamentului chirurgical (începând cu hemoragia imediată severă şi terminând cu multiplele sechele de tip obstructiv). În majoritatea cazurilor de acest gen se indică instalarea cistostomei urgente şi efectuarea rezecţiei tip Reuter ulterioare. Scopul lucrării. Scopul lucrării este aprecierea valorii cistostomiei prealabile TUR.P la bolnavii cu multipli factori de risc. Material şi metodă. Între anii 1998-2005 în centrul nostru au fost efectuate 507 rezecţii transuretrale a prostatei (TUR.P). Din 153 (30% ) pacienţi operaţi cu adenom voluminose” 60 gr, la 68 (44,4%) pacienţi s-a efectuat rezecţia endoscopică, cu instalarea preventivă a cistostomei (grupul I), iar în 85 (55,5%) cazuri rezecţie fără instalarea drenajului suprapubian preventiv (grupul II). Vârsta medie a pacienţilor a fost de 62 ani. Cistostoma a fost înlăturată la a doua zi la toţi pacienţii. Menţinerea sondei uretrale a constituit în medie 4-5 zile postoperatorii în ambele grupe. Rezultate. Intervenţia endoscopică pentru adenomul de prostată voluminos (cu şi fără instalarea cistostomei) a fost preconizată la 153 pacienţi, cărora operaţia deschisă clasică le-a fost contraindicată din motive de risc înalt (patologii asociate cardiovasculare, IRC, diabet zaharat, etc.). Cu toate că timpul rezecţiei a fost mai mic în grupul bolnavilor cu cistostomă cu ~20 min., decât în al doilea grup, nu s-a depistat o deosebire relevantă în frecvenţa complicaţiilor intraoperatorii: (sângerare masivă prin deschiderea de sinus venos (2,8 % faţă de 3,2%), perforaţia capsulei prostatice (2,5 % şi 3,0%), sindromul TUR (3,3 % şi 3,2%), precum şi frecvenţa complicaţiilor postoperatorii: (hemoragii tardive ( 2,4 % şi 2,6 %), uretrite (2,2 % faţă de 2,8 %), stări febrile (12,8 % faţă de 18,1%). Timpul rezecţiei în medie (70 min) a fost mai mic cu 22,3% în grupul I, iar volum ul rezecat mai mare în grupul I corespunzător cu 10% decât în al II-lea grup. Această diferenţă a fost restabilită prin prelungirea rezecţiei în medie cu 15-20 min şi cu obţinerea volumuri de adenom identic. Această prelungire a timpului operator nu s-a reflectat asupra modificării numărului complicaţiilor intra- şi postoperatorii. Concluzii 1. în cazul deţinerii unui echipament endoscopic sofisticat şi al respectării recomandărilor pentru rezecţia adenomului voluminos prelungirea intervenţiei endoscopice cu 15-20 min nu influenţează riscul şi numărul complicaţiilor intra- şi postoperatorii. 2. Instalarea cistostomei nu este obligatorie în adenoamele voluminoase ca etapă de pregătire pentru TUR.P, cu excepţia cazurilor de pielonefrite acute, IRC şi a retenţiei de urină acută. 3. Pentru a obţine rezultate operatorii considerabile în adenomul de prostată voluminos însoţit de riscuri operatorii, strategia operatorie trebuie stabilită în funcţie de patologiile grave asociate şi de existenţa sau de lipsa cistostomei instalate prealabil

Complications of radical retropubic prostatectomy – our experience

Introduction: Radical retropubic prostatectomy represents in its various forms (open, laparoscopic and robotic) the "gold standard" treatment for adenocarcinoma of the prostate. Unfortunately like al treatment solutions it has its shortcomings. Retropubic radical prostatectomy, external beam radiation therapy and brachytherapy are the curative options. Materials and Method: The experience of Clinic of Urology from Central Military Hospital representing more than 100 cases was analyzed . Classical open retropubic prostatectomy was performed in all cases. We focused in this paper on intraoperative complications and also precocious and late postoperative complications. Results: Our results are matching the other centers in terms of intraoperative complications (blood loss), early postoperative complications (hematuria, urinary tract infection, lymphatic drainage) or late postoperative complications (erectile dysfunction and urinary incontinence). However none of these complications are to be underestimated Conclusions: The limits of this intervention can be pushed a litle bit further, in our opinion the age factor is a relative one, some of these patients having a longer than 10 years life expectancy. It provides good oncological outcome with manageable complications most of the times

α-adrenoblocantele selective în tratamentul Hiperplaziei Prostatice Benigne

Summary The work is dedicated to comparative analysis of results after drugs treatment in patients with Benign Prostate Hiperplasia. The 46 patients with BPH treated with α-adrenoblokers (doxazosin, tamsulosin, prasosin, alfusosin). It was found that the efficacy of drugs, used in conservative treatment of BPH depends essentially on the mechanism and the point of their action in etiopatogenic process of BPH, on the moment of the beginning and duration time of their action. The chosen rationally and individually treatment may exclude the necessity of operation, but more often contribute to the extension of the period, in with operation is not needed (2-5 years and more) and to improve the conditions of carrying out the surgical intervention, to remove completely or decrease considerably intra -and post-operation complications