Strategies of the treatment of cardiac prosthetic valve thrombosis

Department of Cardiac Surgery, Republican Hospital, Chisinau, the Republic of MoldovaBackground: The article deals with the analysis of principal causes of valve prosthesis thrombosis and “pannus” thrombosis. The diagnosis and contemporary treatment strategy of prosthesis dysfunction have been considered. Material and methods: In our department 1670 patients with extracorporeal circulation were operated on, among them 1260 had valve pathology that made up 74.2%. 1164 heart valves were replaced, 145 of them were biological prostheses and 1019 were mechanical ones of different types. Prosthesis thrombosis took place in 28 patients that represented 60% of the number of patients with prothesis disfunction and 2.2% of the total number of operated patients from which 21 patients, their age ranged from 35 to 63 years old. The surgical treatment was performed to 9 patients, thrombolysis – to 19 patients. Results: During last 6-7 years the thrombolysis treatment with ateplasum and reteplasse has been successfully implemented in the therapy of thrombosis valve prothesis. Thrombolysis was performed to 19 patients. The results are the following: in 17 cases good outcomes (a complete recovery of the prosthesis function with transprosthetic gradient and the normalization of systolic pressure in right ventricle) have been registered, one case has been complicated with transitory ischemic ictus. Out of 19 patients who underwent the thrombolysis treatment, there were 2 lethal cases. Conclusions: The patients that are in a critical state with prosthesis thrombosis (acute pulmonary edema, hypotension, heart insufficiency NYHA IV) should immediately receive EchoCG confirmation of the need of intravenous thrombolitic therapy. The thrombolysis efficacy in prosthesis thrombosis is high; the rate of embolic complications is low, which can be used as the first line treatment for all patients with prothesis thrombosis (in the absence of contraindications). In the case of partial response to the thrombolysis treatment, the patient can be operated on in good hemodynamic conditions and with low surgical risk

Организационные проблемы контроля туберкулеза в Республике Молдова

Chiril Draganiuc Institute of Phtysiopulmonology, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaTuberculosis became an epidemic in the Republic of Moldova in the last century as a result of the socio-economic crisis, insufficient financing of healthcare, and the lack of anti-TB drugs. Due to the continuing deterioration of the epidemiological situation; the Government approved the National Tuberculosis Program (NTP) based on the DOTS strategy. The successful implementation of the NTP is only possible if all the sections of the strategy are performed, attaching special importance to the identification of patients with tuberculosis (TB) and their treatment on an outpatient basis. Since most of the TB patients first apply for medical assistance at institutions of general healthcare these have a good opportunity to establish a constructive relationship with the patient. The final outcome of TB treatment depends on the early detection and treatment of patients under the direct supervision (DOT). Unfortunately, the family doctor’s identification of TB patients with the bronchopulmonary pathology is not more than 60% of actual cases. Meanwhile, because of the duration of the chemotherapy (especially with MDR-TB) it is difficult to maintain the patient’s desire to comply with the potentially successful treatment. However, the health worker to whom the patient first applies at may be instrumental in creating a proper attitude toward his the therapy program. Frequent interruptions in treatment result in resistance to the drug. Healthcare workers should also pay close attention to the development of the patient’s psychiatric symptoms. Psychological support is often very effective, in the form of both individual psychiatric consultation and group therapy. The patient’s intake of alcohol and drugs needs to be assessed. Such patients require early detection of the effects of alcohol and drugs and direction to the specialized hospitals for joint treatment with psychiatrists and narcologists as they develop encephalopathy and suffer mental decline, often not only violating the regime to abuse alcohol, even in the hospital, but also to stop treatment completely. However, even with DOT some patients do not comply with treatment regimen. To ensure adherence, the healthcare professional must use the tactic of providing patients “means” and “incentives”: additional tickets for transportation, food parcels, etc., which contribute to the treatment’s efficacy. Should the patient want to discontinue treatment it is necessary to assess the severity of depression and the extent of drug or alcohol abuse and consider the use of means and incentives to foster patient compliance. This is the objective of the collaboration between family physicians and phthisiopneumologists in implementing the National Program for the early diagnosis and effective treatment of tuberculosis.Эволюция туберкулеза в Республике Молдова приобрела эпидемический характер в 90-х годах прошлого века и в связи с продолжающимся ухудшением эпидемиологической ситуации, начиная с 2001г. Правительство утверждает каждые 5 лет Национальную Программу по контролю над туберкулёзом. Национальные Противотуберкулезные Программы (НТП), основаны на стратегии DOTS. Успешная реализация НТП возможна только при условии выполнения всех разделов стратегии. Особое значение мы придаем участию Первичной медицинской сети (ПМС) в выявлении больных туберкулезом (ТБ) и их лечению в амбулаторных условиях под непосредственным контролем (ДОТ). К большому сожалению, выявление больных ТБ из числа обратившихся к семейному врачу с патологией бронхолегочного аппарата осуществляется не более чем, в 60% случаев. Необходимо уделить пристальное внимание развитию у пациента психиатрических симптомов. Психологическая поддержка часто оказывается очень действенной в виде посещения врача психиатра. Однако даже при применении DОТ часть пациентов не соблюдает режим лечения и не является для приема препаратов. У пациента, желающего прекратить лечение, необходимо оценить тяжесть депрессивного состояния и степень злоупотребления алкоголем или наркотиками. Следует обдумать возможность использования средств и стимулов, которые способны обеспечить соблюдение пациентом режима лечения. Такие больные требуют своевременного выявления последствий алкоголя и наркотиков, определения в специализированные стационары для совместного лечения с психиатрами или наркологами. Приведены конкретные задачи для совместной работы семейных врачей и фтизиопульмонологов в реализации Национальной Программы по ранней диагностике и эффективному лечению туберкулеза

Automated information system as quality management providing human tissue banks

School of Management, Nicolae Testemitsanu State University of Medicine and Pharmacy, Info World Company, Laboratory of Tissue Engineering and Cell Cultures, Bank of Human TissuesBackground: Modern tissue bank should have management autonomy, to be equipped with modern equipment for tissue grafts procurement, processing, preservation and storage that met the requirements of the profile structures of the EU Directives and Authorized National Health Services. Material and methods: Article represents the analysis of the needs to create and use in human tissues and cells bank an automated information system (AIS) to provide qualitative and safe tissue and cells grafts for transplantation in the Republic of Moldova. Automated Information System components are analyzed and characterized, elucidated the functions they have to fulfill, their role in ensuring the effective management of human tissue bank (HTB) in providing secure grafts for health system in the Republic of Moldova. Results: Basic functions of the HTB AIS include: management of the life cycle of donated products; information about products recording and storing; grafts records and relevant information about them; monitoring of the stored products; indexing exactly the products location in storage devices; a comprehensive view of patient information products; listing information in real and historical time by textual and graphical means; generating and scanning labels for each product; evidence of testing and validation samples; view reports using aggregate data; restricting access rights per each group of users. Conclusions: Thus it appears that AIS is an important element in ensuring a strict accounting of human allergic graft throughout their movement from the procurement, processing, validation, storage, distribution and transplantation. AIS also permits easier integration into the European network for tissue, because it allows encoding of grafts according to European unique codes way enabling the identification of tissue grafts as Bank products and follow their path. The computerized record of practical grafts excludes human errors in grafts distribution

Risks and pregnancy management in the patients with heart valves prostheses

Department of Cardiac Surgery, Republican Teaching Hospital, Chisinau, the Republic of MoldovaBackground: We have performed a systemic review of the literature to determine pooled estimates of maternal and fetal risks associated with 3 commonly used approaches: 1) the administration of oral anticoagulants throughout the pregnancy, 2) replacing oral anticoagulants with heparin in the first trimester of the pregnancy, and 3) the administration of heparin throughout the pregnancy. The prenatal care of women with artificial heart valves remains one of the most complex issues for cardiologists and obstetrician-gynecologists all over the world. Pregnancy and labor of women with artificial heart valves are usually associated with a high risk. During the pregnancy appears not only the risk of the cardiac pathology progression, but also of the manifestation of subclinical running hereditary thrombophilia and/ or antiphospholipid syndrome, in the above mentioned case the risk of thromboembolic episodes pathologies increases manifold. This overview presents the updated data on the ways of administration of anticoagulants that are most frequently used in the obstetric care. It outlines the principles of the rational anticoagulant therapy during the pregnancy and labor of women with artificial heart valves, as well as the laboratory monitoring of the performed treatment. The question of the management of pregnant women with mechanical valve prostheses is quite controversial and there is no universal consensus in this regard. Here there is an increased risk of complications for both mother and fetus: abortion and placental hemorrhage. Conclusions: Anticoagulation in pregnant women is individual. Therefore, the therapy strategy should be adequate to ensure a minimum level of anticoagulation and bleeding complications