Diagnosis and treatment of Tibial plateau fractures in Emergency medicine institute in the Republic of Moldova during 2019

Introduction. Tibial plateau fractures represent about 1% of the total fractures in the general population, 8% among old people, and 56.9% of the proximal tibia fractures. The sex distribution is an alternating one, in men, the most traumas of this kind are registered at the average age of 40-44 years, and in women, it is 55-59 years. Tibial plateau fractures most often occur through an indirect mechanism, valgus/varus movements, or vertical shock. Tibial plateau fractures at different ages, most often, have different production mechanisms. Tibial plateau fractures in the elderly occur as a result of falls with low kinetic energy (falls from one's height, slips, etc.), this is due to osteoporotic changes that occur in old age, especially in women who have more severe osteoporosis. Injuries characterized by high kinetic energy predominate among young people, such as road accidents, falls from high locations, and sports trauma. Tibial plateau fractures affect knee alignment, stability, and movement. Early detection and appropriate treatment are critical in minimizing the patient's disability and reducing the risk of complications, especially post-traumatic arthritis. Aim of study. To emphasize the diagnostic methods and the results of the treatment of tibial plateau fractures treated in Orthopedics and Traumatology Clinic „V. Bețișor” during 2019. Methods and materials. We analyzed 62 clinical cases: 32 men and 30 women; The mean age was 60 years among men and 64 years among women, and the general mean age was 61 years. As of Schatzker classification, there were 7 cases of type I, 12 – type II, 10 – type III, 12 – type IV, 12 – type V and 9 cases of type VI. CT scan and radiography were performed in 57 cases, while only radiography was done in 5 cases. 52 cases of habitual trauma, 6 car accidents, 2 sports trauma, and 2 cases of aggression were reported. Surgical treatment was done in 38 cases. Open reduction and internal fixation was done in 33 cases, closed reduction and internal fixation - 5 cases (4 percutaneous screws, 1 external fixator). 24 cases were solved by conservative treatment because of no absolute indications for surgical treatment or because of the very high anesthesia risks. Results. Postoperative follow-up was performed at 6, 12, 18, and 24 weeks. Patients were evaluated according to the Knee Society Clinical Rating System with an average of 85 points. One case of death on the 11th day of hospitalization was caused by comorbidities. Complications occurred in 5 cases (infection of the incision). Conclusion. The best results and less complications were achieved during a close and personalized approach to each case when proper investigations and methods of reduction, fixation were done and the patient’s compliance was good

Efficiency analysis and determination of the need to implement the PID-5 international instrument in medical practice

Department of Human Physiology and Biophysics, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. PID-5 (personality inventory for DSM-5) was created to improve a personality disorder diagnosis system described in the Manual of Diagnostic and Statistical Mental Disorders (DSM, 5th edition, American Psychiatric Association, 2013). PID-5 measures 25 maladaptive personality traits and five areas of traits and offers new opportunities in diagnosing personality disorders. Aim of the study. Determination of effectiveness and determination of the need to implement the PID-5 international instrument for the analysis of personality disorders included in DSM-V in medical practice. Materials and methods. The study was done on a group of 83 students from two universities: USMF and ASEM, over 2016. All students underwent the PID-5 questionnaire which contains 220 elements of personality self-reporting that measures maladaptive personality traits, which are DSM-5 characterized. The questions were answered on a scale of four, from 0 ("false or almost always false") to 3 ("very true or most often true"). Therefore the PID-5 offers scores on a scale of 4 points, for 25 facets (traits). These facets correspond to maladaptive personality traits, describe in section III of the DSM-5 and are included in the five superior domains, as well, described in section III: Negative Affectivity, Detachment, Antagonism, Disinhibition and Psychoticism. A score bigger than 2 of a certain number of facets is a quantitative indicator of one of the 6 types of PD: Antisocial, Borderline, Schizotypal, Avoidant, Obsessive-Compulsive or Narcissistic. PID-5 was translated and validated by a working group composed of collaborators from the faculty of Human Physiology and Biophysics of USMF „N. Testemițanu” and the department of Migraine and Vegetative Disturbances from the Institute of Neurology and Neurosurgery respecting the norms of translation, adaptation and validation of ITC and with the author's acceptance. Results. The study showed that USMF students predominate a higher index of personality disorders compared to ASEM students, namely obsessive-compulsive disorder. There is no significant difference in depending on gender among USMF students. The DSM-5 Personality Inventory has demonstrated the efficacy and support of its use in medical practice in the Republic of Moldova. Conclusions. The review of the Personality Disorder chapter in DSM V consists not only in the elimination or maintenance of various categories, but is also a fundamentally new approach that is significantly different from what was previously. PID-5 enables effective diagnosis of PD, so its use in medical practice is favorable

Dextrocardia cu situs inversus – modificări electrocardiografice

Background. Dextrocardia with situs inversus is a rare congenital anomaly, with an incidence 1:20000 of alive births, with equal involvement of men and women, diagnosed on imaging evaluation by: electrocardiogram (ECG), echocardiography (EcoCG) and computed tomography (CT). Objective of the study. Evaluation of electrocardiographic criteria in dextrocardia with situs inversus. Material and Methods. The literature review on the field with the evaluation of electrocardiographic changes in patients with dextrocardia for the early establishment of the anomaly that will facilitate their management in the future. Results. Patients with dextrocardia and situs inversus are in 95% asymptomatic, being detected at the routine examination. At ECG: negative P and T waves in the I, aVL leads, the decrease of the R waves and the predominance of the S waves in the V1-V6 leads, the electrical axis of the heart with right deviation, where T flattened in the V4-V6 leads. EcoCG and CT of the internal organs detect a mirror anatomy of the visceral organs with trilobar lung on the left and bilobar on the right, liver and gallbladder on the left and spleen and stomach on the right. Early detection of this abnormality is for real use in the management and treatment of emergency surgical conditions in these patients. Conclusion. Electrocardiographic changes suggestive of dextrocardia with situs inversus in an asymptomatic patient will allow us to diagnose the genetic abnormality early and will be of real use to prevent subsequent diagnostic errors in surgical emergencies. Introducere. Dextrocardia cu situs inversus este o anomalie congenitală rară, cu incidența de 1:20000 nașteri vii, cu afectarea în egală măsură a bărbaților și femeilor, diagnosticată în evaluarea imagisică prin: electrocardiogramă (ECG), ecocardiografie (EcoCG) și tomografie computerizată (CT). Scopul lucrării. Evaluarea criteriilor electrocardiografice în dextrocardia cu situs inversus. Material și Metode. Revista literaturii în domeniu cu evaluarea modificărilor electrocardiografice la pacienții cu dextrocardie și situs inversus pentru stabilirea timpurie a anomaliei cu facilitarea managnmentul acestora. Rezultate. Pacienții cu dextrocardie și situs inversus în 95% sunt asimptomatici, fiind depistați în examenul de rutină. La ECG standart diagnosticăm: unde P și T negative în derivațiile I, aVL, descreșterea undelor R și predominarea undelor S în derivațiile V1-V6, axa electrică a cordului cu deviație dreaptă, unde T aplatizate în V4-V6. EcoCG și CT organelor interne decelează o anatomie în oglindă a organelor viscerale cu plămân trilobar pe stânga și bilobar pe dreapta, ficatul și vezica biliară pe stângă, iar splina și stomacul pe dreapta. Depistarea precoce a acestei anomalii este de un real folos în managmentul și tratamentul stărilor chirurgicale de urgență la acești pacienți. Concluzii. Modificările electrocardiografice sugestive pentru dextrocardie cu situs inversus la un pacient asimptomatic ne vor permite să diagnosticăm precoce anomalia genetică și vor fi de un real folos pentru a preveni erorile diagnostice ulterioare în cazul urgențelor chirurgicale

Diabetul gestațional – un factor predispozant pentru macrosomia fetală

Background. Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable degrees, first recognized, during pregnancy. GDM pregnancies have up to a 3-fold higher rate to give birth to a macrosomic infant. Fetal Macrosomia (FM) implies numerous complications, making it an undeniable issue. Objective of the study. It was performed a literature review in order to highlight the impact of the Gestational Diabetes in Fetal Macrosomia prognosis outcome and its complications. Material and Methods. There were used “PubMed MEDLINE” database to select relevant full-text original articles published from 2015 till 2020, using a search formula “Fetal Macrosomia in Gestational Diabetes”, review articles were excluded. According to research criteria, there were retrieved 55 full-text, clinical trial articles. Results. Several studies have reported that women with GDM having poor glycemic control during pregnancy are more predisposed to have macrosomic infants. The prevalence of FM ranges by country, shifting from Scandinavian countries with 20% to 2% in Taiwan. The rate of FM in the Republic of Moldova is 5% and tends to rise by each year. Fetal Macrosomia is the consequence of fetal hyperinsulinism, hence stimulating an increased lipid synthesis and a disproportionate body growth. These newborns showed an increased rate of glucose metabolism disorders and fearful complications like asphyxia, hypoxemia, even leading to intrauterine death. Conclusion. Analysis of the results revealed an increased prevalence of Fetal Macrosomia among women with Gestational Diabetes Mellitus, frequently involving severe perinatal complications, making Fetal Macrosomia a major problem that needs to be prevented and controlled. Introducere. Diabetul gestațional (DG) este definit ca orice grad de intoleranță la glucoză, diagnosticat pentru prima dată în sarcină. Gravidele cu DG prezintă un risc de trei ori mai mare de a naște un făt macrosom. Macrosomia fetală (MF) implică numeroase complicații și este o problema actuală în medicină. Scopul lucrării. Studiul efectuat a avut drept scop evidenţierea impactului diabetului gestațional în dezvoltarea macrosomiei fetale și a complicațiilor acesteia. Material și Metode. Lucrarea este rezultatul unei sinteze a literaturii de specialitate, preluate din articolele „PubMed MEDLINE”, publicate între anii 2015 și 2020, formula de căutare fiind “Macrosomia fetală în diabetul gestațional”. Din rezultatele obținute, au fost identificate 55 de studii clinice, sintezele de literatură fiind eliminate. Rezultate. Studiile au demonstrat că femeile ce suferă de DG și au un control glicemic necorespunzător în timpul sarcinii sunt mai predispuse să nască un făt macrosom. Prevalența MF variază în funcție de regiune, de la 20% în țările scandinavice la 2% în Taiwan. În Republica Moldova rata MF se estimează la 5% și are tendință de creștere. Macrosomia fetală este consecința hiperinsulinismului fetal, ce stimulează sinteza accentuată lipidică şi creşterea disproporţionată a fătului. Acești nou-născuţi au prezentat o rată mult mai mare de tulburări ale metabolismului glucidic și complicații redutabile: asfixii, hipoxemii și moarte intrauterină. Concluzii. Analiza rezultatelor a demonstrat prevalența crescută a macrosomiei fetale la mamele cu diabet gestațional, generând complicații severe perinatale, ce determină macrosomia fetală drept o problemă de importanță majoră, care trebuie anticipată și controlată

Dextrocardia with situs inversus - electrocardiographical changes

State University of Medicine and Pharmacy „Nicolae Testemitanu”, Discipline of Cardiology, 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.Dextrocardia with situs inversus is a rare congenital condition in which the apex of the heart is located on the right side of the body, with equal involvement of men and women.Purpose.Evaluation of electrocardiographic criteria in dextrocardia with situs inversus.Material and methods.The literature review on the field with the evaluation of electrocardiographic changes in patients with dextrocardia for the early establishment of the anomaly that will facilitate their management in the future.Results.Patients with dextrocardia and situs inversus are usually asymptomatic, being detected at the routine examination. At ECG: negative P and T waves in the I, aVL leads, the decrease of the R waves and the predominance of the S waves in the V1-V6 leads, the electrical axis of the heart with right deviation, where T flattened in the V4-V6 leads.Conclusions.Electrocardiographic changes suggestive of dextrocardia with situs inversus in an asymptomatic patient will allow us to diagnose the genetic abnormality early and will be of real use to prevent subsequent diagnostic errors in surgical emergencies

Cardiomiopatia aritmogenă de ventricul drept – modificări electrocardiografice

Background. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare, idiopathic cardiomyopathy characterized by progressive fibro-fatty infiltration of the right ventricle (RV) myocardium, manifested by ventricular arrhythmias with guarded prognosis. Objective of the study. Evaluation of electrocardiographic criteria in Arrhythmogenic Right Ventricular Cardiomyopathy. Material and Methods. This study is a review of the latest literature on this topic, for the knowledge of ECG criteria, early diagnosis and appropriate management of pacients with ARVC. Results. In 90% of cases, ARVC is associated with ECG abnormalities: complete or incomplete right bundle branch block, inverted T waves, the presence of Epsilon waves in V1-V3; ventricular tachycardia, fibrillation or flutter. Echocardiographically: RV hypertrophy and dilatation, segmental dyskinesia and aneurysms of the RV, tricuspid prolapse and regurgitation. On MRI: global or segmental RV dysfunction, intramyocardial fatty deposition, inflammation and myocardial fibrosis. Management: antiarrhythmics, catheter ablation, implantable cardioverter defibrillator. Conclusion. Short paroxysms of ventricular tachycardia with left bundle branch block appearance. Inverted T waves in V1-V3 precordial leads with Epsilon wave detection. Implantable cardioverter defibrillators significantly reduce mortality in young pacients with ARVC. Introducere. Cardiomiopatia aritmogenă (CMPA) de ventricul drept (VD) este o cardiomiopatie idiopatică rară, caracterizată prin infiltrare progresivă a miocardului cu țesut fibro-adipos, manifestată prin aritmii ventriculare cu pronostic rezervat. Scopul lucrării. Evaluarea criteriilor electrocardiografice în cardiomiopatia aritmogenă de ventricul drept. Material și Metode. Acest studiu este o analiză din revista literaturii contemporane pentru cunoașterea criteriilor electrocardiografice la pacienții cu cardiomiopatie aritmogenă de ventricul drept, stabilirea precoce a diagnosticului și alegerea managmentului adecvat. Rezultate. Pacienții cu CMPA de VD prezintă simptome: palpitații, stări sincopale, dispnee inspiratorie, fatigabilitate, edeme, moarte subită. Electrocardiografic în 90% depistăm: bloc complet sau incomplet de ram drept a fasciculului Hiss, unde T negative și unde Epsilon în derivațiile V1-V3; tahicardie, fibrilație sau fluter ventricular. Ecocardiografic: diskinezii segmentare, anevrisme VD, hipertrofia și dilatarea VD, prolaps și regurgitarea tricuspidiană. La RMN: disfuncție globală sau segmentară a VD, depozite adipoase intramiocardice, inflamație și fibroza miocardică. Tratament: antiaritmice, ablație prin cateter, implantare de cardiodefibrilator. Concluzii. Paroxisme scurte de tahicardie ventriculară cu aspect de bloc de ram stâng a fascicului Hiss. Unde T negative în derivațiile V1-V3 cu prezența undei Epsilon. Implantarea cardiodefibrilatorului reduce semnificativ mortalitatea tinerilor cu această patologie severă