Screening and management of postpartum depression

Department of Psychiatry, Narcology and Medical Psychology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. According to statistics, postpartum depression occurs in every 7th woman. This is a current problem, which influences the mother-child relationship. Literary sources recommends screening for postpartum depression at least once in the postpartum period. Current screening tools for postpartum depression are: Edinburgh Postpartum Depression Scale (EPDS), Postpartum Depressive Screening Scale (PDSS), Healthy Patient Scale (PQ-9). Using all those screening tools makes the detection of postpartum depression (severity, clinical manifestations and differential diagnosis) much easier and it also helps in receiving better results of the psychological and medication therapy. Aim of the study. The aim of the work is to study the assessment of specific symptoms in postpartum depression and the screening tools, as well as its management. Materials and methods. During all the process were studied literature review (20 sources, published mainly over the last 5 years), devoted to the symptoms of the postpartum depression, its classification and screening in order to detect all the symptoms of depression and start the treatment on time so as the psychotropic medications that are allowed during lactation. Results. The results of the work includes all the issues of the screening for postpartum depression, but, with a focus on the specific screening tools that are considered worldwide indicators with a fairly hight sensitivity in determining this condition. According to the literature for the Edinburgh Postpartum Depression Scale (EPDS), sensitivity is 59-100% and specificity is 49-100%, for the Postpartum Depression Screening Scale (PDSS) sensitivity and specificity are respectively: 91-94% and 72-98%, and for the Healthy Patient Scale (PQ-9), sensitivity is 75% and specificity is 90%. We also studied the clinical picture of each state in postpartum depression (ranging from milder conditions - baby blues to severe postpartum depression with a psychotic component). Management algorithms were also examined for each state of postpartum depression (psychotherapy and drug treatment, taking into account medications that are allowed during lactation according to the recommendations of the FDA). Conclusions. In this work are listed the screening tools for postpartum depression, the examination of the clinical picture for each state of postpartum depression, and management algorithms for postpartum depression. We gave a special attention to the management and all possible issues of drug and non-drug treatment

Hepatoprotective products according to State Medicine Nomenclature from Republic of Moldova

Department of Pharmacology and Clinical Pharmacology, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. The acute and chronic hepatites remains to be the main problem for the humanity and also for R. Moldova, that´s why the evaluation of drugs with hepatoprotective action is esential, both from a medical and social point of view and also from an economic point of view. Hepatoprotective products are constituents capable of protecting the liver from the destructiv action of endogenous and exogenous factors. Aim of the study. Our main goal is to select all the hepatoprotective products that were recorded in R. Moldova, analyzing them according to the State Medicine Nomenclature(SMN). Materials and methods. For our research, as materials, were used: the SMN that contains 5137 drugs, available on Medicines and Medical Devices Agency (amed.md) and also the scientific literature and guides on the classification of hepatoprotective products. Results. Hepatoprotective products have a lot of 2.1% of the total number of medicine from the nomenclature (5137), the first in the list are the drugs with vegetal origins: Silymarin products - 31, followed by ursodeoxycholic acid products -18, amino acid products -17, phospholipids products -9, and other different groups own an amount of 32 products. At the moment, the following products are absent from the pharmaceutical market: amino acid derivatives: Betaina citrat, Ornitin aspartat; drugs which contain phospholipids: Fosfolip, Lipin, Eplir; drugs with a animal origins: Sirepar, Vitogepat; and also synthetic drugs. According to the pharmaceutical forms, the hepatoprotective can be presented in capsules-55%, followed by tablets-26%, injectable solution-11%, oral solutions-7% and just 1% for vegetal products. We mention that reported to the manufacturing, 43% of hepatoprotective products are produced by EU, and 16% are produced in R. Moldova, etc. Conclusion. The National Program to combat the viral hepatitis for the years 2017-2021 provides a reduction of 50% till 2021 of the incindence and prevalence for the acute and chronic hepatitis, including through the access of pacients with hepatitis to medical products and to quality treatment services

The use of Methotrexate in ectopic pregnancy

Department of Obstetrics and Gynecology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Ectopic pregnancy is one of the major emergencies in obstetrics and gynecology, being associated with a high rate of intra-abdominal bleeding if it is not diagnosed in a timely manner and is not subject to proper management. Aim of the study. To determine the effectiveness of Methotrexate in the treatment of ectopic pregnancy and which are the ß-HCG values to which it has the highest sensitivity. Materials and methods. A retrospective study was conducted during 2016-2019, in which we found out 320 cases, of which 45 cases were treated with Methotrexate solution - a single dose. Inclusion criteria was : ß-HCG ≤ 5000 mIU / mL in tubal pregnancy with gestational sac diameter ≤ 4 cm, lack of cardiac activity and no free fluid in Douglas space; Patients with ß- HCG ≥ 5000 mIU / mL and gestational sac diameter ≥ 4cm and presence of cardiac activity were excluded. Results. The success rate from a single dose of Methotrexate represented u = 10 cases - 22.8%, compared with failure u = 35 cases - 77.8%, which required surgery. The average age of the patients was 30 years, including the patients between 18-42 years. The success rate decreased with the older age of the patient. Pregnancies with more frequent occurrence at primiparity 7 cases - 70% and multiparity 3 cases - 30%. The average term of pregnancy at the time of diagnosis 4.3 weeks, p = 0.472. The success rate decreased with the increase of the gestation term. The diameter of the gestational sac was 2.3-4cm, and the success rate decreased in patients with gestational sac greater than 4cm, p = 0.132. The highest success rate was found in patients with a gestational sac of 2-3 cm in diameter - 67.2%. The study showed us a significant difference in the location of the pregnancy, although 56% were pregnancies located on the right (u = 26 patients) and 44% were located on the left (u = 29 patients). The β-HCG value ranged from 329-5200 mIU / mL, with an average of 1234 mIU / mL. Surgery against ineffectiveness required 35 cases (77.85%) that resulted in increased ß-HCG or tubal rupture and abdominal pain. All cases u = 35 (77.8%) resulted in surgical laparoscopy. In u = 7 cases, were detected tubal miscarriages performing salpingoplasty as treatment in 20% of cases and in 80% of cases was performed laparoscopic tubectomy. Conclusions. Our study demonstrated a low rate of efficacy of the conservative method of treatment of tubal pregnancy in evolution by administering Methotrexate. The data comes to contradict the beneficial experience and the weight of the success cases offered by the specialized literature in the conduct of patients with this pathology. If we strictly adhered to the inclusion criteria and the protocol of administration, it would be interesting to carry out an evaluation of the pharmacokinetics of the indigenous Methotrexate production preparation