Institutional Repository in Medical Sciences of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
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Natural course of inflammatory cardiomyopathies
Full text linkIntroduction. Refractory heart failure with a poor prognosis is a key feature of dilated cardiomyopathy. Inflammatory cardiomyopathy,
often diagnosed via in vivo subendomyocardial biopsy, is considered a potential precursor to dilated cardiomyopathy.
The Dallas criteria, applied to morphometric and electron microscopic studies of biopsy samples, are essential
for differentiating the features of various inflammatory stages. Building upon these established diagnostic principles, our
study integrates immunohistological analysis with measurements of intramyocardial indices and intracardiac hemodynamics.
This comprehensive approach aims to characterize the natural course of inflammatory cardiomyopathy, seeking to
improve the understanding of the clinical trajectories and tissue structures that define both inflammatory cardiomyopathy
and its progression to dilated cardiomyopathy.
Material and methods. The study included 75 patients with inflammatory cardiomyopathies and 75 patients with dilated
cardiomyopathies. The following procedures were performed: coronary angioventriculography, repeated subendomyocardial
biopsy, immunohistologic analysis, and assessment of intracardiac and intramyocardial hemodynamics.
Results. Morphohistologic analysis of inflammatory cardiomyopathies at different stages revealed a maximum of 10-12
lymphocytes, which decreased to only isolated lymphocytes in late stages. In biopsies from early-stage inflammatory dilated
cardiomyopathies, the morphologic appearance showed lymphocytic infiltration of the myocardial stroma, vasculitis
of intramural arteries and arterioles. The biopsies performed after 36 months showed dystrophic structures, microfocal
and diffuse replacement fibrosis, predominantly perivascular, which are indistinguishable from the features of dilated
cardiomyopathy. Intracardiac hemodynamic indices in patients with dilated and inflammatory cardiomyopathies did not
differ. Similarly, left ventricular regional contractility, as verified by radiopaque ventriculography, was not significantly
different. The degree of radiotracer detection on thallium-201 scintigraphy was statistically insignificant between the two
conditions. Immune complexes and immunoglobulins G, M, and A in the blood were elevated in both groups, likely as a
consequence of heart failure.
Conclusions. Morphostructural analysis of biopsies taken from patients with inflammatory dilated cardiomyopathies, at
different stages of its natural course reveals the progressive development of dilated cardiomyopathies. These structural
changes correlate closely with findings from intracavitary and hemodynamic assessments and measures of regional contractility,
supporting a direct link between dilated and inflammatory cardiomyopathies
Features of microsurgical treatment in patients with pterygium
Full text linkIntroducere. Pterigionul se manifestă clinic printr-o cută triunghiulară a conjunctivei bulbare cu baza spre plica semilunară şi cu vârful spre cornee. El ar rezulta dintr-o al-teraţie epitelială corneo-conjunctivală, asociată cu o proliferare de ţesut fibrinogen, progresând între epiteliul şi membrana Bowman. Scop. De a aprecia eficienţa unei metode modificate în tratamentul microchirurgical al pteriogionu-lui prin formarea de lambou mobil, liber, dreptunghiular conjunctival si administrarea de 5-fluoruracil. Material şi metode. În studiu au fost incluşi 8 pacienţi (4 bărbaţi şi 4 femei) în vârstă 20-71 ani, care au fost supuşi înlăturării pterigionuluiS-a preparat lambou dreptunghiular cu laturile 5x3 mm, care a fost fixat conjunctival paralimbal, nazal în zona corpului pterigionului translocat în fornixul superior sau inferior si administrarea de 5-FU subconjunctival. Rezultate. Recuperarea postoperatorie a fost rapidă, însă timp de câteva zile după operaţie globul a fost hiper-emiat, iritat de fibrele de sutură folosite pentru a fixa auto-grefa conjunctivală. Sunt necesare antibiotic şi antiinflam-ator sub formă de colire. Astfel, la toţi pacienţii după 3 luni de la intervenţia microchirurgicală semne de recidivare a pterigionului operat nu s-au depistat. La 2 pacienţi cu adresare tardivă, pterigionul a fost extins pe cornee, ceea ce a determinat o cicatrizare profundă, fiind modificată raza de curbură corneană cu diminuarea acuităţii vizuale. Acesta este motivul pentru care operaţia de pterigion nu ar fi trebui amânată. Concluzii. Metoda microchirurgicală propusă pentru tratamentul pterigionului este sigură şi eficientă, determinând lipsa recidivării în postoperator (3 luni după intervenţia microchirurgicală). Intervenţia microchirurgi-cală în baza pterigionului este necesar de efectuat cât mai precoce.Introduction. Pterygium is manifested by a triangular fold of the bulbar conjunctiva with the base towards the semilunar fold and the tip towards the cornea.It result from a corneo-conjunctival epithelial alteration, proliferation of fibrinogen tissue, progressing between the epithelium reduced and the Bowman's membrane. Objective. To assess the effectiveness of a modified method in the surgical treatment of pterygium using the free conjunctival flap plus subconjunctival administration of 5-FU (fluoruracil). Material and methods. The study included 8 patients (4 men and 4 women) aged 20-71 years with pterygium. Rectangular flap with sides 5 x 3 mm was prepared inferiorly perilimbal, which was fixed conjunctival perilimbal, nasally in the area of the body of the pterygium translocated to the superior or inferior fornix plus subconjunctival and administration of 5-FU. Results. The postoperative recovery was fast, but for several days after the operation the globe was hyper-emic, irritating the suture fibers used to fix the conjunctival autograft. Antibiotic and anti-inflammatory in the form of eye drops are needed. Thus, in all patients, 3 months after the microsurgical intervention, no signs of recurrence of the operated pterygium were detected. In 2 late-presenting patients, the pterygium was extended onto the cornea, resulting in deep scarring. The radius of corneal curvature was changed with the decrease in visual acuity in the postoperative period. This is why surgery for pterygium should not have been delayed. Conclusion. The microsurgical method proposed for the treatment of pterygium is safe and effective, determining the lack of recurrence in the postoperative period (3 months after microsurgical intervention). Microsurgical intervention based on pterygium should be performed as early as possible
The necessity of central neuroprotection of the neuroendocrine mechanisms ensuring the functionality of the reproductive system
Full text linkThe paper is a review and synthesis of data that indicate the urgent
need to develop programs to protect and improve the reproductive functionality
of human resources, based primarily on the creation of environmental
conditions conducive to daily activity. The presented data
demonstrate the high sensitivity and vulnerability of fine neuroendocrine
mechanisms regulating reproductive functionality at different
stages of individual organism development. Also, the high socio-economic
importance for the sustainable development of the morpho-functional
state of the human reproductive system and the increased risk of
unfavorable epigenetic impact of the environment and modern society
are emphasized
New challenges, new achievements of liver transplantation in the Republic of Moldova
Full text linkIntroducere. La nivel global, cererea de organe de a fi transplantate depăşeşte cu mult oferta. Nevoia de organe şi disponibilitatea mică este că mulţi pacienţi decedează pe lista de aşteptare în fiecare an, astfel este necesar revizuirea listei de aşteptare pentru transplant hepatic din Republica Moldova. Scop. Evaluarea scorurilor prognostice, dezvoltarea managementului pre- şi postoperator, ne permite să micşorăm considerabil rata complicaţiilor postoperatorii şi mortalitatea la pacienţii ciroză hepatică. Material şi metode. Am evaluat 265 de pacienţi cu afecţiuni hepatice cronice, cu vârsta >18 ani, incluşi pe lista de aşteptare pentru transplant hepatic la Spitalul Clinic Republican, februarie 2013-ianuarie 2024. Abilităţile de prognostic pentru mortalitatea la 90 de zile au fost investigate aplicând analiza receptorului-funcţionare-caracteristică-curbă. Rezultate. Astfel în cadrul cercetării am determinat 49 de pacienţi (34%) au decedat (bărbaţi 28, femei 21, cu vârsta medie 48 ani) pe lista de aşteptare a transplantului de ficat în termen de 90 de zile de la listare. Toate scorurile au atins un scor mediu de calitate de 75,1%. La 51,66 % din pacienţi s-a înregistrat totuşi o creştere a punctajului scorului prognostic, decât ilustrează scorul MELD. Scorul MELD 3,0 a demonstrat o sensibilitate si specificitate mai veridică, reducând diferenţa de sex datorită variabililor aprobate. Monitorizarea si evaluarea pacienţilor în dinamică a demonstrat un rezultat mai bun postoperator la pacienţii transplantaţi. Concluzii. Aplicarea scorurilor prognostice, dezvoltarea managementului pre- şi postoperator, ne permite să micşorăm considerabil rata complicaţiilor postoperatorii şi mortalitatea la pacienţii cu ciroză hepatică decompensată, îmbunătăţind programul de transplant şi rezultatul general al pacientului.Introduction. Globally, the demand for organs to be transplanted far exceeds the supply. The need for organs and the low availability are such that many patients with liver cirrhosis die on the waiting list every year, thus it is necessary to review the waiting list for liver transplantation in the Republic of Moldova. Objective. Evaluation of prognostic scores, development of pre- and postoperative management, allow us to considerably reduce the rate of postoperative complications, mortality in patients with liver cirrhosis. Material and methods. We evaluated 265 patients with chronic liver disease, aged >18 years, included on the waiting list for liver transplantation at the Republican Clinical Hospital, February 2013-January 2024. We applied the prognostic scores. The prognostic abilities for 90-day mortality were investigated by applying receiver operating characteristic curve analysis. Results. Thus, in the research we determined that 49 patients (34%) died (28 men, 21 women, mean age 48 years) on the liver transplant waiting list within 90 days of listing. All scores reached a mean quality score of 75.1%. However, 51.66% of patients had an increase in the prognostic score, as illustrated by the MELD score. The MELD score of 3.0 demonstrated a more reliable sensitivity and specificity, reducing the gender difference due to the approved variables. Monitoring and evaluation of patients with decompensated liver cirrhosis in dynamics demonstrated a better postoperative outcome by reducing complications in transplanted patients. Conclusion. The application of prognostic scores, the development of pre- and postoperative management, allows us to considerably reduce the rate of postoperative complications and mortality in patients with decompensated liver cirrhosis, improving the transplant program and the patient's overall outcome
Benign oropharyngeal tumors in children: case report
Full text linkIntroducere. Din totalul tumorilor orofaringiene benigne la copii, doar 0,6% sunt diagnosticate la pacienţii cu vârsta sub 20 de ani. S-a demonstrat că diferite abordări, inclusiv cele imagistice şi biomarkerii epigenetici ar putea avea roluri cruciale în detectarea timpurie a tumorilor benigne orofaringiene la copii. Scop. Prezentarea unui caz clinic rar la o fetiţă cu vârsta de 5 luni la care se suspectează o formaţiune de volum la nivelul orofaringelui, manifestată prin tulburări de deglutiţie. Material şi metode. În secţia ORL a Clinicii,Emilian Coţaga” s-a internat o fetiţă cu vârsta de 5 luni cu suspiciune la o formaţiune tumorală situată la nivelul orofaringelui. Din spusele mamei, aceasta fiind vizibilă de aproximativ câteva luni, dar şi resimţită sonor atât în timpul suptului de către copil, cât şi aflată în stare de repaus. Rezultate. În urma efectuării a faringoscopiei la fetiţă, s-a pus în evidenţă o formaţiune de volum de culoare alb-roz ce atârnă din rinofaringe. Tactica următoare a impus efectuarea investigaţiilor imagistice precum tomografia computerizată cu scopul de a vizualiza atât localizarea, cât şi dimensiunea formaţiunii de volum prezente. Ulterior, conform rezultatelor tomografiei, s-a luat decizia de comun acord de către echipa ORL, prin metoda chirurgicală să se recurgă la ablaţia formaţiunii de volum cu expedierea preparatului la examinare histopatologică. Astfel, aceasta din urmă a confirmat prezenţa unui lipofibrom în evoluţie. Concluzii. Detectarea precoce a tumorilor orofaringiene la copiii de vârstă fragedă prin intermediul metodelor imagistice, precum tomografia computerizată, dar şi în urma unui examen obiectiv, dar şi clinic amplu, reprezintă paşii-cheie în tactica unui tratament chirurgical eficient.Introduction. Of all benign oropharyngeal tumors in children only 0.6% are diagnosed in patients under the age of 20. It has been demonstrated that various approaches, including imaging techniques and epigenetic biomarkers, may play crucial roles in the early detection of benign oropharyngeal tumors in children. Objective. To present a rare clinical case involving a 5-month-old female infant with a suspected oropharyngeal mass, clinically manifested through feeding difficulties and swallowing disorders. Material and methods. A 5-month-old female infant was admitted to the ENT Department of the Emilian Cotaga Clinic with a suspected tumor which was located in the oropharyngeal region. According to her mother, the mass had been visible for approximately several months and was also audible both during breastfeeding and while the child was at rest. Results. Pharyngoscopic examination revealed a pinkish-white, pedunculated mass protruding from the nasopharynx. The next step in the clinical approach involved performing imaging studies, including computed tomography (CT), aimed at accurately assessing the localization and dimensions of the detected mass. Based on the computed tomography findings, a multidisciplinary decision was made by the ENT surgical team to proceed with surgical excision of the mass. The mass was surgically excised, and the resected specimen was sent for histopathological analysis, which subsequently confirmed the diagnosis of an evolving lipofibroma. Conclusion. Early detection of oropharyngeal tumors in infants, through a combination of thorough comprehensive examinations and advanced imaging modalities such as computed tomography (CT), constitutes a sustainable basis for strategic planning and implementing effective surgical treatment
When bacterial silence tears the chords: a case of infective enterococcal endocarditis
Full text linkUniversitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Chișinău, Republica MoldovaIntroducere. Endocardita infecţioasă (EI) enterococică reprezintă ~15% din cazurile de EI, inclusiv 90% de Enterococcus faecalis. Debutul şi evoluţia subacută contribuie la tergiversarea diagnosticului şi apariţia complicaţiilor, precum ruptura de cordaje care necesită intervenţie chirurgicală în termini optimi. Scop. Prezentarea cazului clinic a unui pacient febril diagnosticat cu endocardită infecţioasă cu evoluţie trenantă şi complicaţii severe rezolvat printr-o abordare multidisciplinară. Material şi metode. Au fost utilizate date clinice, de laborator şi imagistice a pacientului spitalizat în secţia „Maladii Cardiace Dobândite” cu sus-pecţie de endocardită infecţioasă. Evaluarea a inclus datele anamnestice, examenul obiectiv, EKC, ecocardiografie, bio-markeri şi hemoculturi, cu tratament conform sensibilităţii şi ghidului ESC. Rezultate. Bărbat, 74 ani, cu febră timp de 3 luni (37,2-38,9°C), transpiraţii nocturne, dispnee, fatiga-bilitate, scădere ponderală, fără ameliorare după antibioter-apie pentru infecţie urinară (cateter Foley). Obiectiv: tegumente pale, suflu sistolic mitral. ECG: HVS, hemibloc ram drept. Ecocardiografie: vegetaţie mitrală 9x4 mm, ruptură cordaje, regurgitare gr. IV, FOP 3 mm. NT-proBNP 2310 pg/ ml. 3 hemoculturi E. faecalis +. După tratament specific, remiterea t°C la ziua 3. Echipa valvulară a decis intervenţia chirurgicală. S-a înlocuit valva mitrală cu proteză biologică (ST-JUDE EPIC N29), anuloplastie tricuspidei şi sutura FOP. Evoluţie favorabilă. Concluzii. Diagnosticul endocarditei infecţioase rămâne o provocare, în ciuda accesului la investigaţii. Cazul evidenţiază importanţa atenţiei la pacienţii febrili cu simptome cardiovasculare subtile în diagnosticul precoce al EI, şi rolul echipei multidisciplinare în rezolvarea complicaţiilor.Introduction. Enterococcal infective endocarditis (IE) represents approximately 15% of all IE cases, with Enterococcus faecalis being isolated in 90%. Its subacute onset and progression contribute to delayed diagnosis and complications such as chordae rupture, often requiring prompt surgical management. Objective. Case presentation of a febrile patient diagnosed with infective endocarditis with a prolonged course and severe complications, managed through a multidisciplinary approach. Material and methods. Clinical, laboratory and imaging data were used from a patient hospitalized in the “Acquired Heart Diseases” department with suspected infective endocarditis. The evaluation included anamnesis, physical examination, ECG, echocardiography, biomarkers, and blood cultures, with treatment according to sensitivity and ESC guidelines. Results. A 74-year-old man with a 3-month history of fever (37.2-38.9 °C), night sweats, dyspnea, fatigue, and weight loss, without improvement after antibiotics for urinary tract infection (Foley catheter). Exam: pale skin, mitral systolic murmur. ECG: LVH, right bundle branch hemiblock. ECHO: mitral vegetation 9x4 mm, chordae rupture, grade IV regurgitation, patent foramen ovale 3 mm. NT-proBNP 2310 pg/ml. Three blood cultures for E. faecalis +. Fever remission after targeted therapy on day 3. Valve team decided surgery: mitral valve replacement with biological prosthesis (ST-JUDE EPIC N29), tricuspid annuloplasty, PFO closure. Favorable outcome. Conclusion. The diagnosis of infective endocarditis remains a challenge, despite access to investigations. The case highlights the importance of attention in febrile patients with subtle cardiovascular symptoms in the early diagnosis of IE, and the role of the multidisciplinary team in resolving complications
Kinins in pain modulation: pathophysiologic role and emerging therapeutic targets
Full text linkIntroducere. Kininele sunt peptide vasoactive derivate din sistemul kinin-kalikreină, cu rol esenţial în vasodilataţie, inflamaţie şi nocicepţie. Înţelegerea mecanismelor (pato-) fiziologice prin care acţionează, permite identificarea unor ţinte terapeutice relevante în managementul durerii acute şi cronice. Scop. Identificarea mecanismelor (pato-)fiziolog-ice cheie prin care kininele modulează durerea şi explorarea implicaţiilor acestora ca ţinte terapeutice emergente în managementul sindromului algic. Material şi metode. A fost realizată o revizuire narativă conform criteriilor PRISMA. Criterii de includere: articole (art) în limba engleză, disponibile în text integral, publicate între anii 2018-2025. Au fost selectate 19 art (10 review-uri, 9 studii experimentale) din bazele de date: PubMed, ScienceDirect; utilizând cuvintele-cheie: „kinin”; „pain”; „bradykinin”. Rezultate. Kininele modulează durerea prin receptorii B1 (inductibili) şi B2 (constitutivi), cuplaţi căilor Gq-PKC/MAPK şi canalelor TRPV1/TRPA1 (16 art). B2R, exprimaţi majoritar în ganglionii spinali, mediază durerea acută(6 art), iar B1R au rol dual - răspuns nociceptiv cronic şi tranziţie spre durerea neuropată(7 art). Studii preclinice susţin eficacitatea analgezică a antagoniştilor B1R/B2R(9 art), inclusiv în durerea dermică indusă de transpiraţie (ex. icatibant) (2 art). Bra-dikinina este implicată în angioedem ereditar, inflamaţie şi neuropatii(6 art). Noi agenţi B1R-selectivi (ex. BAY2395840, MK-0686) oferă perspective analgezice promiţătoare. Concluzii. Kininele au un rol esenţial în patofiziologia durerii nociceptive şi neuropate. Receptorii B1 şi B2 reprezintă ţinte terapeutice promiţătoare, în special în afecţiunile în care tratamentele convenţionale oferă beneficii limitate, favorizând dezvoltarea unor noi agenţi cu acţiune analgezică.Introduction. Kinins are vasoactive peptides derived from the kinin-kallikrein system, with an essential role in vasodilation, inflammation and nociception. Understanding the (patho-)physiological mechanisms involved allows the identification of relevant therapeutic targets in the management of acute and chronic pain. Objective. To outline the key (patho-)physiological mechanisms through which kinins modulate pain and to explore their implications as emerging therapeutic targets in pain management. Material and methods. A narrative review was conducted according to PRISMA criteria. The inclusion criteria were: articles in English, full-text availability, published between 2018-2025. Nineteen articles (art) (10 reviews, 9 experimental studies) were selected from the databases PubMed and ScienceDirect using the keywords: „kinin”; „pain”; „bradykinin”. Results. Kinins modulate pain via B1 (inducible) and B2 (constitutive) receptors, coupled to Gq-PKC/MAPK pathways and TRPV1/TRPA1 channels (16 art). B2R, mainly expressed in spinal ganglia, respond to acute pain (6 art), while B1R have dual roles - chronic nociceptive response and transition to neuropathic pain (7 art). Preclinical studies highlight the analgesic efficacy of B1R/B2R antagonists (9 art), including in sweat-induced dermal pain (e.g. icati-bant) (2 art). Bradykinin is involved in hereditary angioede-ma, inflammation, and neuropathies (6 art). Novel B1R-se-lective agents (e.g. BAY 2395840, MK-0686) offer new analgesic avenues. Conclusion. Kinins play an essential role in the pathophysiology of nociceptive and neuropathic pain. B1and B2 receptors represent promising therapeutic targets especially in conditions where conventional treatments offer limited benefit, fostering the development of novel pain-modulating agents
Theoretical-conceptual aspects of dental anxiety
Full text linkAmong the most recently discussed topics is dental anxiety. In essence,
dental anxiety represents an intense emotional reaction, which can be
triggered even starting with a thought of addressing the dentist. In order
to eliminate or reduce this dominant psychological reaction from the
start, some specific actions are necessary, such as those of information
and communication with the patient. However, the subject in question
remains quite complex, taking into account all the possible effects that
can be triggered. This fact foresees essential interdisciplinary approaches
Risk factors for pneumonia in immunocompromised patients
Full text linkUniversitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Chișinău, Republica MoldovaIntroducere. Pneumonia este o sarcină clinică importantă pentru persoanele imunocompromise, fiind o cauză majoră de morbiditate şi mortalitate. Infecţiile pulmonare la aceşti pacienţi de cele mai multe ori asociază evoluţia complicată, eşecul terapeutic, rezolvarea întârziată şi persistenţa sechelelor pulmonare. Scop. Studiul a fost efectuat pentru identificarea particularităţilor clinico-paraclinice şi evidenţierea factorilor predictivi ai pneumoniilor la imunocompromişi. Material şi metode. În cadrul unui studiu prospectiv, au fost analizate datele clinice şi paraclinice ale unei cohorte de 96 pacienţi imunocompromişi cu pneumonii (PI) şi au fost comparate cu o cohortă de 96 pacienţi imunocompetenţi cu pneumonii (PC). Factorii de risc au fost identificaţi prin regresie logistică multivariată. Rezultate. Asocierea independentă cu PI a variabilelor care au diferenţiat cohortele PI şi PC a fost testată în cadrul unui model de regresie logistică. În rezultat au fost identificaţi 6 factori independenţi ce caracterizează pneumoniile la imunocompromişi: debut insidios (OR 3,28; 95%CI 1,19-8,14), tuse seacă (OR 2,67; 95%CI 1,1-5,96), hipotensiune arterială (OR 23,2; 95%CI 1,56-347,1), afectare radiologică bilaterală (OR 3,12; 95%CI 1,1-8,14), extinderea leziunilor pulmonare în 2 şi mai multe câmpuri pulmonare (OR 3,82; 95%CI 1,59-9,17), opacităţi de tip interstiţial, care au un rol predictiv pozitiv (OR 6,06; 95%CI 2,38-15,41). Concluzii. Există diferenţe clinico-par-aclinice semnificative dintre pneumoniile la imunocompro-mişi şi la imunocompetenţi. Aceste criterii ar putea contribui la un diagnostic precoce al pneumoniilor la gazdele imunocompromise.Introduction. Pneumonia is an important clinical burden for immunocompromised individuals, being a major cause of morbidity and mortality. Pulmonary infections in these patients often associate complicated course, treatment failure, delayed resolution and persistence of pulmonary sequelae. Objective. A study was performed identify clinico-paraclin-ical features and to highlight predictive factors of pneumonia in immunocompromised patients. Material and methods. In a prospective study, clinical and paraclinical data of 96 immunocompromised patients with pneumonia (PI) were analyzed and compared with a cohort of 96 immunocompetent patients with pneumonia (PC). Risk factors for pneumonia were identified by multivariable logistic regression. Results. The independent association of variables that differentiated the PI and PC cohorts with PI was tested in a logistic regression model. As a result, six independent factors characterizing pneumonias in immunocompromised individuals were identified: insidious onset (OR 3,2; 95%CI 1,19-8,14), dry cough (OR 2,67; 95%CI 1,1-5,96), hypotension (OR 23,2; 95%CI 1,56-347,1), bilateral radiological involvement (OR 3,12; 95%CI 1,1-8,14), extension of lung lesions in 2 or more lung fields (OR 3,82; 95%CI 1,59-9,17), interstitial opacities, which have a positive predictive role (OR 6,06; 95%CI 2,38-15,41). Conclusion. There are significant clinico-paraclinical differences between pneumonia in immunocompromised and immunocompetent patients. These criteria could contribute to early diagnosis of pneumonia in immunocompromised hosts
Types of pain in patients with systemic lupus erythematosus
No full textUniversitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Chișinău, Republica MoldovaIntroducere. Lupusul eritematos sistemic (LES) este o boală autoimună cronică, cu afectarea multisistemică. Tabloul clinic este foarte bogat, durerea reprezintă unul dintre cele mai frecvente simptome în LES şi poate avea multiple mecanisme patogenice şi localizări, influenţând semnificativ calitatea vieţii pacienţilor. Scop. Analiza celor trei tipuri de durere cronică - nociceptivă, neuropată şi nociplastică - resimţite de pacienţii cu lupus eritematos sistemic şi corelarea acestora cu activitatea bolii. Material şi metode. Studiul s-a bazat pe analiza datelor clinice colectate de la pacienţi diagnosticaţi cu LES. În cercetare au fost incluşi 30 de pacienţi care au raportat durere cronică cu intensitate mai mare de 3 pe scara VAS. Pentru o mai bună acurateţe, au fost excluşi pacienţii cu fibromialgie, pentru a evita interferenţa durerii specifice acestei afecţiuni. Rezultate. Durerea nociceptivă izolată a fost confirmată la un număr de 7 pacienţi, manifestată prin dureri articulare şi musculare, precum şi dureri pleuritice, specifice inflamaţiei pleurale. Pe de altă parte, durerea neuropată a fost diagnosticată la 4 pacienţi, caracterizată prin senzaţii de arsură, amorţeală sau furnicături, tipice afectării nervoase. În ceea ce priveşte durerea noci-plastică, aceasta a fost identificată la 10 pacienţi, fiind asociată cu modificări ale procesării durerii la nivel central. De asemenea, la 9 pacienţi s-a depistat durerea cu o etiologie mixtă, combinând elemente ale celor trei tipuri de durere menţionate anterior. Concluzii. Durerea în LES este multi-factorială şi se manifestă prin diverse forme. Un management eficient al durerii necesită o abordare individualizată, care combină tratamentele imunosupresive, analgezia şi suportul psihologic, esenţiale pentru îmbunătăţirea calităţii vieţii pacienţilor.Introduction. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multisystem involvement. The clinical picture is highly diverse, and pain represents one of the most common symptoms in SLE. It can have multiple pathogenic mechanisms and localizations, significantly impacting patients’ quality of life. Objective. Analysis of the three types of chronic pain - nociceptive, neuropathic, and nociplastic - experienced by patients with systemic lupus erythematosus and their correlation with disease activity. Material and methods. The study was based on the analysis of clinical data collected from patients diagnosed with SLE. The research included 30 patients who reported chronic pain with an intensity greater than 3 on the VAS scale. To ensure greater accuracy, patients with fibromyalgia were excluded to avoid interference from pain specific to this condition. Results. Isolated nociceptive pain was confirmed in 7 patients, mainly characterized by joint and muscle pain, along with pleuritic pain related to pleural inflammation. Neuropathic pain was diagnosed in 4 patients, presenting as burning, numbness, and tingling, which are typical of nerve damage. Nociplastic pain, involving altered central pain processing, was observed in 10 patients. Furthermore, 9 patients exhibited mixed-origin pain, combining nociceptive, neuropathic, and nociplastic features. This highlights the complexity of pain mechanisms in lupus patients and underscores the need for personalized treatment strategies. Conclusion. Pain in SLE is multifactorial, with varied manifestations. An effective pain management strategy requires an individualized approach that combines immunosuppressive treatment, analgesia, and psychological support, which are essential for improving the patients’ quality of life