Institutional Repository in Medical Sciences of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
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The relationship between zinc levels and immunological biomarkers in oral fluid in children affected by dental caries
Full text linkIntroduction. Dental caries is one of the most widespread diseases in the human population, and the causes of increased
susceptibility to dental caries remain of continuing interest to researchers. Active immunological components of oral fluid
significantly influence the evolution of dental caries. The aim of this research is to study the relationship between zinc
levels, the antimicrobial peptide LL-37, and transforming growth factor beta-1 in oral fluid, and the incidence of dental
caries in children.
Material and methods. In this observational cohort study, 398 children aged between 3 and 15 years were clinically
examined. The research group included 132 children with dental caries, and the control group consisted of 266 caries-free
children. The Plaque Index (PI) and caries experience indices were evaluated. Caries risk was assessed using the Cariogram
software. The levels of zinc, the antimicrobial peptide LL-37, and transforming growth factor beta-1 in oral fluid were
determined using standard EliTeh kits, in accordance with the manufacturer’s recommendations. The study was conducted
in compliance with ethical standards and with written informed consent obtained from the children’s parents. Data were
processed automatically using the open-source software RStudio, version 2024.09.1+394.
Results. In children from the research group, a significant decrease in the levels of zinc, the antimicrobial peptide LL-37,
and transforming growth factor beta-1 was detected in oral fluid, showing an inverse relationship with caries morbidity
indicators.
Conclusions. Significantly decreased levels of zinc, the antimicrobial peptide LL-37 and transforming growth factor beta-
1 in oral fluid of caries-susceptible children may indicate an increased risk of caries. Low levels of zinc, the antimicrobial
peptide LL-37, and transforming growth factor beta-1 in oral fluid may also serve as indicators of rapid progression of
dental caries – a fact that should be taken into account when planning individualized preventive measures
Morphological and morphometric features of the confluence of sinuses structure in adults
Full text linkBackdround.
Variants of the venous system structure of the brain should be taken into account when planning surgery for better assessment of the location and degree of tumor, vascular malformation, or other pathologies to be treated.
Material and methods
The research material consisted of computed tomographic angiography scan data from 98 patients. Reconstruction of the skull and vascular structures with 3D model construction was performed using Vidar Dicom Viewer 3
software.
The cross-sectional area of the dural venous sinuses was measured at various points and diameters were determined. The obtained data were processed using statistical methods.
Results
The types of confluence of sinuses structure have been identified and classified. Qualitative and quantitative
characteristics of each type and subtype are presented. It was established that the most frequently encountered is the
partial type of confluence of sinuses of the dura mater, with asymmetric structure in 55,1% of cases showing dominance of the right transverse sinus (38,78% of the total number of patients).
The occipital sinus was bifurcated in 55,1% of patients, and in 9,18% of cases was divided into multiple sinuses.
Statistically significant correlations were identified between the type of confluence of sinuses and the presence
of certain forms of hypoplasia and aplasia.
Conclusions
Although anatomical variations of dural venous sinuses are frequently observed, classification by types of confluence of sinuses can help surgeons in preoperative assessment, treatment, as well as in the prevention of possible
complications. Invasive procedures for patients with partial type of sinus drainage confluence or with “no confluence” type should be performed more carefully, due to possible unilateral jugular vein obstruction
Surgical treatment outcomes in proximal humerus fractures
Full text linkIntroducere. Fracturile humerusului proximal reprezintă o patologie frecventă, în special la vârstnici, având un impact considerabil asupra funcţionalităţii membrului superior. Abordarea terapeutică modernă în cazul fracturilor cu deplasare sau instabile implică frecvent reducerea deschisă şi fixarea internă. Scop. Evaluarea rezultatelor funcţionale (scor DASH) la pacienţii cu fracturi de humerus proximal trataţi chirurgical şi corelarea acestora cu vârsta şi complexitatea fracturii (clasificarea Neer). Material şi metode. Studiu retrospectiv (2024) pe 89 pacienţi cu fracturi bazate pe clasificarea Neer. În lotul dat s-a efectuat osteosinteză cu şuruburi, plăci convenţionale T şi blocate (PHILOS-LCP), augmentată cu alogrefă osoasă la pacienţii peste 60 ani. Rezultatul funcţional final a fost evaluat prin scorul DASH (Disabilities of the Arm, Shoulder and Hand). Rezultate. Lotul de studiu a inclus 89 de pacienţi (69 femei - 77,5%; 20 bărbaţi - 22,5%), cu o vârstă medie generală de 62,2 ani şi o durată medie de spitalizare de 6,35 zile. Analiza funcţională, bazată pe scorul DASH, a relevat că rezultatul este dependent de doi factori majori. S-a observat o corelaţie directă între înaintarea în vârstă şi un scor DASH mai mare (dizabilitate crescută). Totodată, complexitatea fracturii ( în dependenţă de clasificarea Neer) a influenţat semnificativ prognosticul: pacienţii cu fracturi cominutive, de 3 şi 4 părţi, au înregistrat scoruri DASH net superioare celor cu fracturi simple, de 2 părţi. Concluzii. Tratamentul chirurgical oferă rezultate bune, însă prognosticul funcţional final depinde de vârsta pacientului şi complexitatea fracturii. Leziunile cominutive (Neer 3-4 părţi) şi vârsta înaintată sunt factori predictivi pentru o recuperare funcţională mai limitată, confirmând ipoteza.Introduction. Proximal humeral fractures are a frequent pathology, especially among the elderly, with a considerable impact on upper limb function. The modern approach for displaced or unstable fractures often involves open reduction and internal fixation, aiming to restore anatomy and enable early patient mobilization. Objective. To evaluate the functional outcomes (DASH score) in patients with surgically treated proximal humerus fractures and to correlate them with patient age and fracture complexity (Neer classification). Material and methods. A retrospective study on 89 patients with fractures classified by the Neer system. Osteosynthesis was performed using, screws, conventional T and locked plates (PHILOS-LCP), augmented with bone allograft in patients over 60. The final functional outcome was assessed using the DASH (Disabilities of the Arm, Shoulder and Hand) score. Results. The study cohort included 89 patients (69 female - 77.5%; 20 male - 22.5%), with an overall mean age of 62.2 years and an average hospital stay of 6.35 days. The functional analysis, based on the DASH score, revealed that the outcome is dependent on two major factors. A direct correlation was observed between advancing age and a higher DASH score (increased disability). Concurrently, fracture complexity (according to fragmenting fracture Neer classification) significantly influenced the prognosis: patients with comminuted, 3- and 4-part fractures had markedly higher DASH scores than those with simple, 2-part fractures. Conclusion. Surgical treatment offers good results, but the final functional prognosis depends on the patient's age and fracture complexity. Comminuted injuries (Neer 3-4 parts) and advanced age are predictive factors for a more limited functional recovery, thus confirming the initial hypothesis
Infecțiile tractului urinar: profil etiologic și rezistența la antimicrobiene
Full text linkIntroducere. Infecțiile tractului urinar (ITU) sunt considerate unele dintre cele mai
răspândite infecții bacteriene, atât în mediile comunitare, cât și spitalicești. Rata crescută a
rezistenței la antimicrobiene observată în cazul agenților uropatogeni, în special Escherichia
coli și Klebsiella pneumoniae, impune necesitatea actualizării constante a protocoalelor
terapeutice.
Scop. Evaluarea profilului etiologic al infecțiilor tractului urinar și a tendințelor actuale ale
rezistenței la antimicrobiene în contextul datelor recente regionale și internaționale.
Material și metode. A fost realizată o analiză a literaturii publicate în perioada 2015–
2025, utilizând principalele baze de date internaționale (PubMed, ScienceDirect, Scopus,
Hinari). Căutarea a fost efectuată pe baza unor cuvinte-cheie relevante: infecții urinare,
rezistența la antimicrobiene, spectru etiologic. Au fost selectate și analizate articole care
prezentau date privind sensibilitatea fenotipică la antimicrobiene, precum și studii care
investigau, prin metode moleculare, genele implicate în mecanismele de rezistență.
Rezultate. Predominanța Escherichia coli ca principalul agent etiologic în infecțiile
tractului urinar a fost confirmată, reprezentând peste 60% dintre toate izolatele. Klebsiella
pneumoniae a fost al doilea agent patogen cel mai frecvent identificat, urmat de Proteus
mirabilis și Pseudomonas aeruginosa. Peste 40% dintre izolatele de E. coli și K.
pneumoniae au produs betalactamaze cu spectru extins, rezultând niveluri ridicate de
rezistență la cefalosporinele de generația a treia și aminopeniciline. Rezistența la
carbapeneme a fost detectată din ce în ce mai frecvent, în special în rândul izolatelor de K.
pneumoniae, complicând opțiunile de tratament empiric. Testările fenotipice au arătat că
peste 35% dintre izolate erau rezistente la fluorochinolone, iar rata rezistenței la
aminoglicozide a depășit 25% în rândul tulpinilor Gram-negative izolate de la pacienți
spitalizați. Proteus mirabilis și Pseudomonas aeruginosa au demonstrat niveluri alarmante
de rezistență la carbapeneme și aminoglicozide, în special în cazurile de ITU complicate. De
asemenea, speciile de Enterococcus au înregistrat o emergență semnificativă a rezistenței la
vancomicină. Datele din Republica Moldova au fost în concordanță cu tendințele globale,
evidențiind o povară tot mai mare a patogenilor multirezistenți și o scădere progresivă a
eficacității antibioticelor convenționale. Introducerea tehnicilor moleculare rapide de
diagnostic, inclusiv PCR în timp real și tehnologiile de secvențiere de nouă generație, au
permis detectarea timpurie a mecanismelor de rezistență și a contribuit la ajustarea rapidă
a terapiilor antimicrobiene.
Concluzii. Creșterea rezistenței la antimicrobiene în infecțiile tractului urinar necesită
consolidarea măsurilor de supraveghere epidemiologică, optimizarea tratamentului empiric
și integrarea diagnosticelor moleculare rapide pentru a controla răspândirea tulpinilor
rezistente
HYSTERECTOMY DURING CESAREAN SECTION IN A LEVEL III PERINATAL CENTER
Full text linkUniversitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Chișinău, Republica MoldovaIntroducere. Rata ridicată a operaţiilor cezariene constituie un potenţial de creştere a incidenţei histerectomiilor în perioada peripartum. Acestă intervenţie critică este utilizată preponderent în situaţii obstetricale de urgenţă, dar rămâne drastică din cauza pierderii funcţiei reproductive la femei. Scop. Studierea cauzelor şi indicaţiilor recurgerii la histerectomie în peripartum, cât şi analiza particularităţilor acestei intervenţii drastice în Centrul Perinatal de nivel III. Material şi metode. Au fost analizate cazuri clinice din Institutul Mamei şi Copilului care în 2023 s-au finisat cu histerectomii, fiind utilizată o metodologie retrospec-tivă-descriptivă, axată pe revizuirea cazurilor clinice. Datele statistice au fost prelucrate prin intermediu programului SPSS şi cu ajutorul instrumentului Excel + Analysis ToolPak. Rezultate. Naşteri 4260, operaţii cezariene - 42,7%. His-terectomii 20, vârsta 25-44 ani; primipare 4, multipare 16; naşteri la termen 45 %, pretermen (55%). Operaţii planice 35%, urgente 65%. Indicaţii: cicatriciu pe uter, placenta praevia 11; FIV 2, cicatricu pe uter 1, distocie dinamică 1, pree-clampsie severă 1, decolare de placentă 1, miom uterin - 1, prezentaţie pelviană 1. Histerectomia în cadrul operaţiei cezariene 70%, histerectomia în lăuzie 30 %; cauza hemoragii uterine. Relaparotomii 20%, re-relaparotomii 10%. Pierderi sangvine 1200-2900 ml 40%, 3000-4900 ml 35%, 5000-7000 ml 25%. Histerectomii supravaginale 70%, totale 30%. Concluzii. Majoritatea operaţiilor s-au efectuat de urgenţă, din cauza patologiei placentare şi a cicatricilor uterine. O parte semnificativă a histerectomiilor efectuată pentru indicaţii vitale, în condiţii de pierdere masivă de sânge, se atribuie cazurilor de prevenire a mortalităţii materne.Introduction. A high rate of cesarean sections constitutes a potential increase in the incidence of hysterectomies during the peripartum period. This critical intervention is predominantly used in obstetric emergency situations but remains drastic measure due to the loss of reproductive function in women. Objective. Study of the causes and indications for resorting to peripartum hysterectomy, as well as the analysis of the particularities of this drastic intervention in the Level III Perinatal Center. Material and methods. Selected clinical cases from the Mother and Child Institute that concluded with hysterectomy in 2023, this cases were analyzed using a retrospective-descriptive methodology focused on clinical case reviews. Statistical data were processed with SPSS software and further analyzed using Excel alongside the Analysis ToolPak add-in. Results. Deliveries: 4260, cesarean sections 42.7%. Hysterectomies 20, age 25-44 years; primiparous 4, multiparous 16; term deliveries 45%, preterm deliveries: 55%. Elective surgeries 35%, emergency 65%. Indications: uterine scar, placenta previa 11; IVF 2, uterine scar 1, dynamic dystocia 1, severe preeclampsia 1, placental abruption 1, uterine fibroid 1, breech presentation 1. Hysterectomy during cesarean section 70%, hysterectomy during puerperium 30%; cause uterine hemorrhage. Relaparotomies 20%, re-relaparotomies 10%. Blood loss 1200-2900 ml 40%, 3000-4900 ml 35%, 5000-7000 ml 25%. Subtotal hysterectomies 70%, total hysterectomies 30%. Conclusion. The majority of surgeries were performed due to placental pathology and uterine scarring, in emergencies. A significant proportion of hysterectomies were performed for vital indications in the context of massive blood loss, highlighting their role in preventing maternal death
Community-acquired pneumonia in chronic heart failure: approach through the oxidative stress and systemic inflammation
Full text linkIntroduction. Diagnosing community-acquired pneumonia in patients with chronic heart failure can be challenging. Oxidative
stress and inflammatory response play an important role in the development and diagnosis of community-acquired
pneumonia and are also involved in many cardiovascular diseases, including chronic heart failure.
Materials and methods. A total of 210 patients were enrolled and divided into two groups: group 1 (n = 105) – patients
with community-acquired pneumonia associated with chronic heart failure, and group 2 (n = 105) – patients with community-
acquired pneumonia without chronic heart failure. Several biomarkers were measured. For oxidative stress, we
assessed prooxidant markers (ischemic modified albumin, advanced glycation end-products, advanced oxidation protein
products, malonic dialdehyde) and antioxidant markers (total antioxidant activity with CUPRAC and ABTS methods, superoxide
dismutase and catalase). Inflammatory status was assessed by determining leukocyte count, erythrocyte sedimentation
rate, lactate dehydrogenase, fibrinogen and C-reactive protein. In all patients, N-terminal pro b-type natriuretic
peptide values were determined.
Results. The age of patients in the study group ranged from 50 to 92 years, with an overall mean of 70.6 ± 8.89 years (95%
CI [68.8-72.3]), (F = 18.109; p = 0.205). Ischemic modified albumin values were higher in patients in Group 1 compared to
Group 2: 236.60 ± 57.23 μM/L and 229.77 ± 64.35 μM/L, respectively (F = 0.660; p = 0.045). Serum lactate dehydrogenase
had higher values in Group 1, compared to the control group: 232.65 ± 109.80 units/L and 192.40 ± 44.98 units/L, respectively
(p = 0.001). The mean fibrinogen values were also higher in Group 1 (5.24 ± 1.60 g/L), compared to Group 2 (4.51 ±
1.78 g/L), p = 0.002. Total antioxidant activity by CUPRAC method, had higher values in Group 1 (6.70 ± 4.62) versus Group
2 (4.99 ± 2.29), p = 0.006.
Conclusions. The coexistence of community-acquired pneumonia and chronic heart failure resulted in a higher inflammatory
response and greater accumulation of pro-oxidative reaction products. This condition was characterized by increased serum
lactate dehydrogenase, erythrocyte sedimentation rate and fibrinogen levels. Furthermore, the state of heightened oxidative
stress was marked by increased ischemic modified albumin and total antioxidant activity detected with CUPRAC method
Diastolic dysfunction and myocardial ischemia in TAVI patients
Full text linkIntroduction. Severe aortic stenosis and ischemic coronary artery disease are frequently associated in elderly patients,
adding complexity to interventional management. Diastolic dysfunction, a marker of myocardial impairment and elevated
filling pressures, may influence prognosis after transcatheter aortic valve implantation (TAVI), particularly in the presence
of concomitant coronary pathology. The aim of the study was to analyze the interaction between severe aortic valve stenosis,
left ventricular diastolic dysfunction, and coronary ischemia in elderly patients with complex cardiovascular disease.
Material and methods. This was a prospective analytical cohort study including 85 patients treated between 2019
and 2023, divided into two groups: Group I – TAVI without coronary intervention (n = 56), and Group II – TAVI associated
with percutaneous coronary intervention (PCI) (n = 29), consisting of patients with significant coronary lesions.
Echocardiography was performed according to the ESC/EACVI 2016 guideline standards, with detailed assessment of
diastolic function.
Results. The prevalence of left ventricular diastolic dysfunction of varying severity showed a statistically significant difference
between groups (p = 0.04): Group I – 35 patients (62.5%) versus Group II – 24 patients (82.7%). The E-wave velocity
was lower in Group II: 152.4 cm/sec (IQR = 43.0) compared to 173.0 cm/sec (IQR = 32.0), p = 0.01. The E/A ratio and the
incidence of E/A ≥2 showed a borderline significant difference (p = 0.04). Median E/e′ was higher in Group II – 9.2 (IQR =
5.4) compared to 6.4 (IQR = 4.2), p = 0.003. E/Vp was 1.2 (IQR = 0.4) versus 0.8 (IQR = 0.5), p < 0.001. Diastolic dysfunction
was more frequent in Group II, with significantly different echocardiographic parameters, including decreased E-wave
velocity, increased E/e′ and E/Vp ratios, and a higher incidence of E/A ≥2.
Conclusions. Patients undergoing both PCI and TAVI more frequently exhibited left ventricular diastolic dysfunction. The
echocardiographic parameters E, E/e′, and E/Vp showed statistically significant differences, suggesting an additive impact
of coronary artery disease on diastolic function impairment in the setting of severe aortic stenosis
The impact of psychotraumatic experiences on the onset and evolution of schizophrenia
Full text linkIntroducere. Pe parcursul ultimilor ani, au fost efectuate studii care au demonstrat rolul factorilor psihosociali în eterogenitatea etiologica a schizofreniei. Studiile sugerează că dincolo de vulnerabilitatea genetică, factorii biopsihosociali pot contribui la declanşarea simptomatologiei şi influenţa evoluţia bolii. Scop. A fost investigat impactul traumelor psihologice din copilărie (abuzul fizic şi psihoemoţional, neglijarea parentală) asupra riscului de debut, severităţii tulburărilor psihice şi prognosticului. Material şi metode. Au fost analizate 8 studii observaţionale şi meta-analize relevante din literatura de specialitate, care au investigat corelaţia dintre expunerea la traume psihologice şi riscul de dezvoltare a schizofreniei. Prelucrarea datelor a fost efectuată prin teste statistice unde s-a calculat riscul relativ asociat expunerii la psihotraume. Rezultate. Analiza datelor a evidenţiat o asociere relevantă şi semnificativă statistic între expunerea la experienţe negative în copilărie şi riscul de a dezvolta schizofrenie. Valoarea combinată a riscului relativ (RR) de a dezvolta schizofrenie a fost de 2,4 (interval de încredere 95%: 1,98-3,94) la persoanele expuse, comparativ cu cele neexpuse. Abuzul psihoemoţional a fost asociat cu cel mai mare risc (RR-2,8), urmat de abuzul fizic(RR-2,5) şi neglijarea parentală(RR-2,3). Pacienţii traumatizaţi au prezentat simptome psihotice cu o medie de 4,2 ani mai precoce asociat cu un polimorfism clinic accentuat şi un prognostic nefavorabil. Concluzii. Rezultatele obţinute confirmă că psihotraumele în copilărie precum abuzul psihoemoţional şi fizic, neglijarea parentală, sunt cel mai des asociate cu dezvoltarea schizofreniei, care evoluează cu simptome mai persistente, rate mai mari de recădere şi o calitate a vieţii redusă.Introduction. Over the past years, studies have demonstrated the role of psychosocial factors in the etiological heterogeneity of schizophrenia. The research suggests that beyond genetic vulnerability, biopsychosocial factors may contribute to the onset of symptoms and influence the course of the illness. Objective. The impact of childhood psychological trauma (physical and psycho-emotional abuse, parental neglect) on the risk of onset, the severity of mental disorders, and prognosis has been investigated. Material and methods. Eight observational studies and relevant analyses from the specialized literature were analyzed, investigating the correlation between exposure to psychological trauma and the risk of developing schizophrenia. Data processing was carried out using statistical tests, in which the relative risk associated with exposure to psychotrauma was calculated. Results. The data analysis revealed a relevant and statistically significant association between exposure to negative childhood experiences and the risk of developing schizophrenia. The combined relative risk (RR) of developing schizophrenia was 2.4 (confidence interval 95% 1.983.94) in exposed individuals compared to those unexposed. Psycho-emotional abuse was associated with the highest risk (RR = 2.8), followed by physical abuse (RR = 2.5) and parental neglect (RR = 2.3). Traumatized patients exhibited psychotic symptoms on average 4.2 years earlier, associated with marked clinical polymorphism and an unfavorable prognosis. Conclusion. The results obtained confirm that childhood psychotraumas such as psycho-emotional and physical abuse, and parental neglect, are most frequently associated with the development of schizophrenia, which progresses with more persistent symptoms, higher relapse rates, and a reduced quality of life
Surgical management particularities of Tornwaldt cyst
Full text linkUniversitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Chișinău, Republica MoldovaIntroducere. Chistul Tornwaldt este o formaţiune chistica, localizată pe peretele posterior al nazofaringelui, care apare ca urmare a persistenţei conexiunii dintre notocord şi far-inge. A fost descrisă în 1885 de Gustav Tornwaldt, cu o incidenţă estimată de 0,2-5 %. În majoritatea cazurilor, este asimptomatic. Scop. Evaluarea eficienţei, siguranţei şi rezultatelor pe termen lung ale tratamentului chirurgical endoscopic asistat cu laser în managementul chistului Tornwaldt simptomatic. Material şi metode. În acest studiu au fost incluşi pacienţi diagnosticaţi cu chist Tornwaldt simptomatic în perioada 2014-2019, care au fost supuşi tratamentului chirurgical în cadrul instituţiei noastre. A fost efectuată o analiză retrospectivă a foilor de observaţie medicală, cu evaluarea relevanţei metodelor diagnostice şi terapeutice aplicate. Rezultate. Intervenţia a fost efectuată prin abord transnazal, sub anestezie generală, utilizând endoscop flexibil. S-au realizat evacuarea conţinutului chistic, incizia largă a capsulei, şi prelevarea biopsiei, urmate de termode-strucţia pereţilor chistului cu laser diodă (980 nm, 12 W), în regim combinat continuu-pulsatil, atât în contact, cât şi non-contact. Evoluţia postoperatorie a fost monitorizată la 1, 3, 6 şi 12 luni. Intervenţia s-a desfăşurat fără complicaţii, iar vindecarea a fost completă, fără afectarea structurilor adiacente. La controalele ulterioare nu s-au evidenţiat semne de recidivă. Respiraţia nazală a fost restabilită integral. Concluzii. Tratamentul endoscopic asistat de laser s-a dovedit a fi eficient, asigurând un risc scăzut de recidivă. Monitorizarea postoperatorie s-a considerat esenţială pentru evaluarea rezultatelor pe termen lung. În conformitate cu standardele actuale, abordul endoscopic rămâne metoda de elecţie.Introduction. Tornwaldt cyst is a benign cystic lesion located on the posterior wall of the nasopharynx, resulting from the persistent embryological connection between the notochord and the pharynx. First described by Gustav Tornwaldt in 1885, it has an estimated incidence of 0.2-5%. In most cases, it remains asymptomatic. Objective. Comprehensive evaluation of the efficacy, safety, and long-term clinical outcomes of laser-assisted endoscopic surgical treatment in managing patients with symptomatic Tornwaldt cysts. Material and methods. Between 2014 and 2019, patients diagnosed with symptomatic Tornwaldt cysts were included in this study. All underwent surgical treatment and postoperative follow-up in our institution. A retrospective analysis of medical records was conducted, assessing the relevance of diagnostic methods and the applied therapeutic approach. Results. The intervention was performed via a transnasal approach, under general anesthesia, using a flexible endoscope. The procedure involved evacuation of the cystic content, wide capsule incision, biopsy sampling, followed by laser diode (980 nm, 12 W) thermodestruction of the cyst walls. The laser was applied in a combined continuous and pulsed mode, both in contact and non-contact technique. Postoperative follow-up was carried out at 1, 3, 6, and 12 months. The procedure was uneventful, with complete local healing and no damage to adjacent structures. No signs of recurrence were observed during follow-up. Nasal breathing was fully restored. Conclusion. Laser-assisted endoscopic treatment proved to be effective, offering a low risk of recurrence. Postoperative monitoring was essential for long-term outcome assessment. According to current otorhinolaryngological standards, the endoscopic approach remains the method of choice
The limits of patient autonomy in neurological disorders: bioethical implications for decision-making and informed consent
Full text linkIntroducere. Dreptul pacientului la autonomie este un principiu fundamental al bioeticii, însă aplicarea sa devine dificilă în cazul pacienţilor neurologici, deoarece le sunt afectate capacităţile decizionale şi cognitive, împiedicând exprimarea voinţei personale şi capacitatea de a lua decizii de tratament informate. Scop. Analiza limitelor autonomiei pacienţilor cu afecţiuni neurologice, punând accent pe implicaţiile bioetice privind capacitatea decizională şi consimţământul informat în practica medicală. Material şi metode. Studiul este de natură descriptivă şi analitică, fiind realizat printr-o analiză narativă a literaturii de specialitate din domeniul bioeticii şi neurologiei. Au fost consultate ghiduri etice, protocoale clinice şi articole ştiinţifice publicate în baze de date internaţionale precum PubMed, Scopus, Google Scholar şi Web of Science. Rezultate. Analiza literaturii a evidenţiat că autonomia pacienţilor neurologici este limitată din cauza alterării capacităţii decizionale. Provocările majore cu care se confruntă etica medicală apar atunci când familia pacientului ia decizii pe care le consideră în favoarea lui, însă ele sunt contradictorii cu opinia medicului, ce se bazează pe principii medicale şi etice, precum beneficiul terapeutic şi prevenirea suferinţelor. O altă dilemă frecventă este menţinerea echilibrului dintre autonomia pacientului şi non-maleficenţă, mai ales când pacientul nu mai poate decide informat, fiind greu de stabilit ce e bine pentru el fără a-i încălca voinţa. Concluzii. Afecţiunile neurologice degenerative limitează semnificativ capacitatea decizională a pacienţilor, impunând o reevaluare a aplicării principiului autonomiei. Este necesară elaborarea unor ghiduri etice pentru echilibrarea autonomiei şi non-maleficenţei în practica medicală.Introduction. The patient's right to self-determination is a fundamental principle of bioethics. However, its application becomes problematic in the case of neurological patients, because their decision-making and cognitive abilities are affected, thus hindering expression of will and ability to make treatment decisions. Objective. Analysis of the limits of autonomy of patients with neurological conditions, emphasizing the bioethical implications regarding decision-making capacity and informed consent in medical practice. Material and methods. This study is descriptive and analytical in nature, conducted through a narrative analysis of specialized literature in bioethics and neurology. In the development of this research, ethical guidelines, national protocols and scientific articles published in databases such as PubMed, Scopus, Google Scholar and Web of Science were consulted. Results. The literature analysis highlighted that the autonomy of neurological patients is often limited due to impaired decision-making capacity. Major ethical challenges arise when the patient's family make decisions they believe are in the patient's interest, yet these conflict with the physician's opinion, which is based on medical and ethical principles, such as therapeutic benefit and prevention of suffering. Another common dilemma is maintaining the balance between autonomy and non-maleficence, especially when the patient can no longer make informed decisions, making it hard to determine what is best for them without violating their will. Conclusion. Degenerative neurological diseases significantly limit patients’ decision-making capacity, requiring a reassessment of the application of the principle of autonomy. It is necessary to develop ethical guidelines to balance autonomy and non-maleficence in medical practice