Etiopathogenesis of the first psychotic episode

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, 2020Materials and methods. A review of 30 sources were studied based mainly on the etiology, pathogenesis of early psychotic manifestations, and risk factors. Results. Among all the hypotheses, theories, risk factors, pathogenetic mechanisms that can trigger psychosis, the most significant are: genetic predisposition, neurotransmitter and hormonal imbalance, progressive neurodegenerative changes and environmental factors. Multiple genetic risk loci for schizophrenia have been identified by modern science. The neurotransmitter dopamine plays a critical role in the pathophysiology of schizophrenia. Other neurotransmitter systems (as serotonin, glutamate) are also involved in the pathophysiology of this disorder. Molecular, cellular, structural and behavioral disorders in schizophrenia are associated with a decrease in neurotransmission on the NMDA glutamate receptors in the brain. Polymorphism in several genes associated with glutamate significantly increases the risk of schizophrenia. Estradiol significantly interacts with dopaminergic, serotonergic and glutamatergic systems, giving it the properties of atypical antipsychotic drugs. The limbic system, tonsils, hippocampus, basal ganglia and many areas of the cerebral cortex are rich in estrogen receptors. Due to the genomic and non-genomic interactions, estrogens act as a “neuroactive steroid” and affects neurodegenerative processes in the central nervous system. Anatomical abnormalities of the brain in patients with schizophrenia are reported (a decrease in the amount of gray matter in the frontal, temporal, limbic, striatal and thalamic areas, ventricular dilatation and anomalies of the medial temporal lobe and prefrontal cortex, irregular synaptic organization, ectopic neurons). Shortfall of astrocyte function is associated with incorrect glucose utilization, oxidative stress in the cerebral cortex in people with schizophrenia. Activation of inflammatory mediators (including microglia) in utero in genetically predisposed individuals increases the risk of schizophrenia. Conclusions. The etiology remains unknown, schizophrenia is considered a disorder of neural development with polymorphic clinical manifestations and widespread pathological changes in the forebrain that are the interaction results of many risk genes with environmental factors. Understanding the influence of risk factors leading to this pathology can reveal more effectiveness in pharmacological and behavioral interventions

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

Treatment of venous trophic ulcers of the lower limbs: PRF vs compressive treatment

Scopul lucrării. Cea mai frecventă cauză ale ulcerelor membrelor inferioare este insuficiența venoasă (ulcere de staza). Injectarea plasmei bogate în trombocite (PRP) este un factor în regenerarea tisulara. Scopul este analiza comparativa rezultatelor tratamentului ulcerelor venoase prin injectarea PRF și cu tratament compresiv. Materiale și metode. Studiu tip prospectiv. În studiu au fost incluși 28 pacienți, divizați în 2 loturi, cu ulcere trofice ale membrelor inferioare cu suprafața mică și medie, cu o durată de 6-24 luni fără dinamică de epitelizare. I grup 14 pacienți tratament combinat cu injectare PRF in ulcere venoase. II grup control – 14 pacienți care au beneficiat de tratamentul de bază general și local tratament compresiv. Toți pacienții au fost monitorizati timp de 3, 6, 9 și 12 luni sau până la epitelizarea ulcerelor. Rezultate. Epitelizare completă la 12 luni de tratament combinat cu PRF a fost obținută în 8 pacienți. În lotul control la 12 luni de tratament epitelizarea completă s-a obținut la (5) pacienți. Epitelizare incomplete 70% (din suprafața ulcerată) a fost obtinuta la 4 pacienți din grupul I, în grupul II epitelizare incompletă 40% la 6 pacienți. Concluzii. Injectarea de PRP în ulcere trofice cauzate de insuficiența venoasă cronică au demonstrat rezultate clinice mai eficiente în comparație cu terapia non PRF de compresie.Aim of study. The most common cause of lower limb ulcers is venous insufficiency (stasis ulcers). Injection of platelet-rich plasma (PRP) is a factor in tissue regeneration. The aim is comparative analysis of the results of the treatment of venous ulcers by PRF injection and compressive treatment. Materials and methods. Prospective study. 28 patients were included in the study, divided into 2 groups, with trophic ulcers of the lower limbs with a small surface and average, with a duration of 6-24 months without epithelization dynamics. I group 14 patients combined treatment with PRF injection in venous ulcers. II control group – 14 patients who have benefited from general basic treatment and local treatment compressive. All patients were monitored for 3, 6, 9 and 12 months or up to epithelialization of ulcers. Results. Complete epithelialization at 12 months of combined treatment with PRF was obtained in 8 patients. In the control group, after 12 months of treatment, complete epithelialization was obtained in (5) patients. Incomplete epithelialization 70% (of the ulcerated surface) a was obtained in 4 patients from group I, in group II incomplete epithelization 40% in 6 patient Conclusions. PRF injection in trophic ulcers caused by chronic venous insufficiency has been demonstrated to be more effective clinical results compared to compressive treatment

Autolog tranplantation of platelet rich fibrin in inguinal hernia repair in liver cirrhosis

Background. The objective of this study is to provide autologous platelet-rich fibrin transplantation in inguinal hernia repair in liver cirrhosis with ascites. Materials and methods. A study was conducted on 28 patients with inguinal hernia combined with liver cirrhosis and massive ascites-peritonitis. Group I: 14 patients with inguinal hernia associated with liver cirrhosis and massive ascites peritonitis underwent Lichtenstein type hernioplasty. Group II: 14 patients with inguinal hernia associated with liver cirrhosis and massive ascites peritonitis underwent Lichtenstein type hernioplasty with the application of autologous fibrin transplantation rich in platelets. All patients in both groups underwent laparoscopic lavage of the abdominal cavity with antibacterials and postoperative drainage with lavage. Results. Seroma wounds postoperative wounds I group 3 cases, II group 0 cases. Postoperative wound suppuration I group 1 case, In group II – 0 cases. Recurrence of the hernia at 1 year was not observed in both groups. Mortality consists of 2 patients, who developed liver failure after 2 months of hospitalization, 1 patient from group I. Conclusion. In patients with inguinal hernia and liver cirrhosis and ascites-peritonitis, the application of Lichtenstein-type surgical treatment with the application of autologous platelet-rich fibrin transplantation ensures safe local results, without postoperative complications in the postoperative wound (lack of seromaler and wound suppuration). Postoperative mortality does not determine a significant difference, being caused by liver reserves and liver failure. Surgical treatment without the application of autologous platelet-rich fibrin transplantation has an increased incidence of postoperative complications

Acute necrotizing pancreatitis complicated by postoperative pulmonary embolism and acute acalculous colecystitis. Case presentation with literature review

Rezumat. Introducere. Pancreatita acută necrozantă reprezintă 20-30% din pancreatitele acute și este asociată cu rate ridicate de morbiditate și mortalitate, cauzate de sindromul de răspuns inflamator sistemic. Trombembolia pulmonară în pancreatita acută este considerată o complicație rară, iar comunicările dedicate acestui subiect sunt sporadice. Prezentare de caz. Prezentăm un caz de pancreatita acută necrozantă complicată postoperator cu trombembolie pulmonară și colecistită acută acalculoasă. Pacientul de 56 ani a suportat necrosectomie cu drenarea spaţiului parapancreatic pentru pancreatita acută necrozantă. Perioada postoperatorie imediată evoluează favorabil cu îmbunătățirea stării generale a pacientului și a constantelor biologice. În a 13-a zi postoperatorie, starea generală se agravează brusc cu manifestări clinice de insuficiență cardio-pulmonară acută. Se suspectă trombembolie pulmonară, confirmată paraclinic: semne la Tomografie Computerizată pentru trombembolii pulmonare segmentare bilateral. Sursa trombemboliilor pulmonare se diagnostică la duplex scanarea sistemului venos al membrelor inferioare: tromboză recentă a sistemului venos profund pe stânga cu mase trombotice intraluminale, fără semne de flotaţie. Se instituie tratament anticoagulant cu efect pozitiv. Pe fuondal de stare relativ satisfăcătoare, în a 28-a zi postoperatorie evoluează tabloul clinic și imagistic de colecistită acută acalculoasă, ce impune o colecistectomie deschisă cu tablou intraoperator de gangrenă a vezicii biliare. Evoluție postoperatorie a fost favorabilă și, la aproximativ 1,5 luni de la internare, pacientul este externat, având parametrii clinici și paraclinici ameliorați. Concluzii. Trombembolia pulmonară în pancreatita acută este considerată o complicație extrem de rară, potențial letală, iar diagnosticarea precoce a tromboembolismului este imperativă. Pancreatita acută necrozantă infectată poate implica în proces inflamator organele adiacente, cu evoluția unor complicații imprevizibile în perioada postoperatorieIntroduction. Acute necrotizing pancreatitis accounts for 20-30% of acute pancreatitis and is associated with high rates of morbidity and mortality, caused by a systemic inflammatory response syndrome. Pulmonary thromboembolism in acute pancreatitis is considered a rare complication, and communications dedicated to this subject are sporadic. Case presentation. We present a case of acute necrotizing pancreatitis complicated postoperatively with pulmonary thromboembolism and acute acalculous cholecystitis. The 56-year-old patient underwent necrosectomy with drainage of the parapancreatic space for acute necrotizing pancreatitis. The immediate postoperative period evolves favorably with the improvement of the patient's general condition and biological constants. On the 13th postoperative day, the general condition worsens suddenly with clinical manifestations of acute cardio-pulmonary insufficiency. Pulmonary thromboembolism is suspected, confirmed paraclinically: Computer Tomography signs for bilateral segmental pulmonary thromboembolism. The source of pulmonary thromboembolism is diagnosed by duplex scanning of the venous system of the lower limbs: recent thrombosis of the deep venous system on the left with intraluminal thrombotic masses, without signs of flotation. Anticoagulant treatment is instituted with a positive effect. On the background of a relatively satisfactory state, on the 28th postoperative day, the clinical and imaging picture of acute acalculous cholecystitis develops, which requires an open cholecystectomy with intraoperative picture of gallbladder gangrene. Favorable postoperative evolution and approximately 1.5 months after admission, the patient is discharged, having improved clinical and paraclinical parameters. Conclusions. Pulmonary thromboembolism in acute pancreatitis is considered an extremely rare, potentially lethal complication, and early diagnosis of thromboembolism is imperative. Infected acute necrotizing pancreatitis can involve the adjacent organs in the inflammatory process, with the development of unpredictable complications in the postoperative period

The ALICE experiment at the CERN LHC

ALICE (A Large Ion Collider Experiment) is a general-purpose, heavy-ion detector at the CERN LHC which focuses on QCD, the strong-interaction sector of the Standard Model. It is designed to address the physics of strongly interacting matter and the quark-gluon plasma at extreme values of energy density and temperature in nucleus-nucleus collisions. Besides running with Pb ions, the physics programme includes collisions with lighter ions, lower energy running and dedicated proton-nucleus runs. ALICE will also take data with proton beams at the top LHC energy to collect reference data for the heavy-ion programme and to address several QCD topics for which ALICE is complementary to the other LHC detectors. The ALICE detector has been built by a collaboration including currently over 1000 physicists and engineers from 105 Institutes in 30 countries. Its overall dimensions are 161626 m3 with a total weight of approximately 10 000 t. The experiment consists of 18 different detector systems each with its own specific technology choice and design constraints, driven both by the physics requirements and the experimental conditions expected at LHC. The most stringent design constraint is to cope with the extreme particle multiplicity anticipated in central Pb-Pb collisions. The different subsystems were optimized to provide high-momentum resolution as well as excellent Particle Identification (PID) over a broad range in momentum, up to the highest multiplicities predicted for LHC. This will allow for comprehensive studies of hadrons, electrons, muons, and photons produced in the collision of heavy nuclei. Most detector systems are scheduled to be installed and ready for data taking by mid-2008 when the LHC is scheduled to start operation, with the exception of parts of the Photon Spectrometer (PHOS), Transition Radiation Detector (TRD) and Electro Magnetic Calorimeter (EMCal). These detectors will be completed for the high-luminosity ion run expected in 2010. This paper describes in detail the detector components as installed for the first data taking in the summer of 2008

ALICE: Physics Performance Report, Volume II

ALICE is a general-purpose heavy-ion experiment designed to study the physics of strongly interacting matter and the quark\u2013gluon plasma in nucleus\u2013nucleus collisions at the LHC. It currently involves more than 900 physicists and senior engineers, from both the nuclear and high-energy physics sectors, from over 90 institutions in about 30 countries. The ALICE detector is designed to cope with the highest particle multiplicities above those anticipated for Pb\u2013Pb collisions (dNch/dy up to 8000) and it will be operational at the start-up of the LHC. In addition to heavy systems, the ALICE Collaboration will study collisions of lower-mass ions, which are a means of varying the energy density, and protons (both pp and pA), which primarily provide reference data for the nucleus\u2013nucleus collisions. In addition, the pp data will allow for a number of genuine pp physics studies. The detailed design of the different detector systems has been laid down in a number of Technical Design Reports issued between mid-1998 and the end of 2004. The experiment is currently under construction and will be ready for data taking with both proton and heavy-ion beams at the start-up of the LHC. Since the comprehensive information on detector and physics performance was last published in the ALICE Technical Proposal in 1996, the detector, as well as simulation, reconstruction and analysis software have undergone significant development. The Physics Performance Report (PPR) provides an updated and comprehensive summary of the performance of the various ALICE subsystems, including updates to the Technical Design Reports, as appropriate. The PPR is divided into two volumes. Volume I, published in 2004 (CERN/LHCC 2003-049, ALICE Collaboration 2004 J. Phys. G: Nucl. Part. Phys. 30 1517\u20131763), contains in four chapters a short theoretical overview and an extensive reference list concerning the physics topics of interest to ALICE, the experimental conditions at the LHC, a short summary and update of the subsystem designs, and a description of the offline framework and Monte Carlo event generators. The present volume, Volume II, contains the majority of the information relevant to the physics performance in proton\u2013proton, proton\u2013nucleus, and nucleus\u2013nucleus collisions. Following an introductory overview, Chapter 5 describes the combined detector performance and the event reconstruction procedures, based on detailed simulations of the individual subsystems. Chapter 6 describes the analysis and physics reach for a representative sample of physics observables, from global event characteristics to hard processes

ALICE upgrades during the LHC Long Shutdown 2

International audienceA Large Ion Collider Experiment (ALICE) has been conceived and constructed as a heavy-ion experiment at the LHC. During LHC Runs 1 and 2, it has produced a wide range of physics results using all collision systems available at the LHC. In order to best exploit new physics opportunities opening up with the upgraded LHC and new detector technologies, the experiment has undergone a major upgrade during the LHC Long Shutdown 2 (2019–2022). This comprises the move to continuous readout, the complete overhaul of core detectors, as well as a new online event processing farm with a redesigned online-offline software framework. These improvements will allow to record Pb-Pb collisions at rates up to 50 kHz, while ensuring sensitivity for signals without a triggerable signature