Institutional Repository in Medical Sciences of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
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Symmetric multiple benign lipomatosis (Madelung’s disease, Launois-Bensaude syndrome). Case report.
No full textIntroducere. Lipomatoza simetrică multiplă benignă (LSM), cunoscută și sub denumirea de boala Madelung
(sau sindromul Launois-Bensaude), este o afecțiune rară a țesutului adipos care duce la formarea de
depozite adipoase simetrice, în special în zona gâtului, umerilor, părții superioare a trunchiului și pe brațe.
Scopul lucrării. Prezentarea și analiza tehnicii de excizie radicală (lipectomie) ca metoda de tratament
a lipomatozei simterice multiple benigne în regiunea oro-maxilo-facială.
Material și Metode. Prezentare de caz clinic. Pacientul P.D., B/64 ani, internat la IMU IMSP în secţia de Chirurgie
Oro-Maxilo-Facială cu diagnosticul de lipomatoză simetrică multiplă benignă. Datele clinice și paraclinice
au permis stabilirea diagnosticului sus-numit și a tacticii de tratament prin excizie radicală (lipectomie).
Rezultate. Abordul chirurgical prin lipectomie radicală s-a dovedit a fi o metodă sigură și cu rezultat predictibil
în cazul pacientului inclus în studiu, datorită posibilității de înlăturare în totalitate a depozitelor adipoase extinse.
Concluzii. Lipectomia radicală ca și metodă de tratament chirurgical a LSM reprezintă o tehnică de
predilecției în cazul pacienților cu formațiuni extinse datorită posibilității de înlăturare radicală a țesutului
adipos proliferativ și reducerea complicații ce pot fi provocate de acesta: dispnee, disfonie, disfagie precum și
sindroame de compresiune pe trahee sau vena cavă superioară.Background. Symmetric Multiple Benign Lipomatosis (SMBL), also known as Madelung’s disease (or
Launois-Bensaude syndrome), is a rare adipose tissue disorder that leads to the formation of symmetric fat
deposits, particularly in the neck, shoulders, upper trunk, and arms.
Objective of the study. The presentation and analysis of the radical excision technique (lipectomy) as a
treatment method for symmetric multiple benign lipomatosis in the oro-maxillofacial region.
Material and Methods. Case report. The patient P.D., a 64-year-old male, was admitted to the Oro-Maxillofacial Surgery
Department of IMU IMSP with a diagnosis of symmetric multiple benign lipomatosis. Clinical and paraclinical data allowed
for the establishment of the above-mentioned diagnosis and treatment strategy through radical excision (lipectomy).
Results. The surgical approach through radical lipectomy proved to be a safe and predictable method in the
case of the patient included in the study, due to the possibility of completely removing the extensive fat deposits.
Conclusions: Radical lipectomy as a surgical treatment method for SMBL is the preferred technique
in patients with extensive formations, due to the ability to radically remove proliferative adipose tissue and
reduce complications caused by it, such as dyspnea, dysphonia, dysphagia, and compression syndromes affecting
the trachea or superior vena cava
The role of polyfunctional immunomodulatory proteins in premature birth. Summary of the Doctor of Medical Sciences Thesis : 321.15 – Obstetrics and gynecology
No full textCurrent situation and importance of the problem
Premature birth (PN) is one of the greatest challenges of contemporary obstetrics,
a global perinatal health problem, representing the main cause of morbidity, neonatal
and infant mortality worldwide. According to statistical data, in the last decade the
frequency of prematurity has maintained a stable trend at the global level, moreover,
in some highly developed countries, the rate of this obstetric pathology has increased
[19, 22, 25].
Currently, contemporary methods of prognosis and prevention of prematurity are
widely used in obstetric practice. However, despite this fact, approximately 1 million
newborns die annually due to complications associated with prematurity, and millions
of surviving premature babies remain disabled throughout their lives [21, 24]. Thus,
the World Health Organization (2023) established new strategies for the prevention of
preterm birth by deepening research in the field of identifying the mechanisms
underlying preterm labor, as well as detecting effective predictors of this obstetric
pathology.
The literature data report that in the structure of premature birth 2/3 represent
spontaneous premature birth [14, 15, 16], and scientific research in the field of
contemporary obstetrics states that premature birth represents a syndrome that includes
multiple causes and associated etiologies [1, 2, 8, 13]. Thus, among the certain causes
of spontaneous premature birth, inflammatory ones have been demonstrated, especially
intraamniotic inflammation [17, 18]. Intraamniotic inflammation can occur in two
different contexts: through intraamniotic microbial invasion, while the second occurs
in the absence of microbial substrate and is associated with a local increase in
endogenous danger signals, thus called sterile inflammation [5, 9, 10].
It is important to note that a growing number of scientific publications emphasize
that these two inflammatory conditions have similar clinical outcomes, and the
correlation between the innate immune system and the evolution of sterile or nonsterile
intraamniotic infection is crucial [3, 17, 18].
Recent studies have found a link between the immune system and the
development of sterile or nonsterile inflammation (intraamniotic infection). Therefore,
knowledge of the changes in the innate immune system that occur in the case of
intraamniotic infection and sterile intraamniotic inflammation is essential for
understanding the mechanisms of development of preterm birth and determining the
correct management of patients at risk of prematurity [4, 6, 7, 11, 12]. And early
identification of changes in the innate immune system would provide the possibility of
a prognosis of the development of sterile or infectious (nonsterile) inflammation
associated with the risk of preterm birth, would provide the possibility of developing
an appropriate obstetrical conduct, which may contribute to improving perinatal
outcomes [20, 23, 25].
Summarizing the above, we conclude that preterm birth represents an important
perinatal problem due to the complexity and subtlety of the polyetiological
mechanisms underlying it. And a more detailed understanding of the changes in the
maternal immune system offers the possibility of developing new prognostic methods,
which will facilitate the timely prevention of preterm birth and the development of
therapeutic strategies that will improve the expected perinatal outcomes [20, 23, 25].
Therefore, the polyetiological and complex features underlying preterm birth have
generated the development of the present study, defining the purpose and objectives of
the research.
Purpose of the study. The study was conducted to assess the role of
polyfunctional immunomodulatory proteins in premature birth triggered to optimize
obstetric management and improve perinatal outcomes.
Objectives of the study:
1. Study the evolution of pregnancy, birth and perinatal outcomes in women with
spontaneous premature birth.
2. Assessment of serum values of polyfunctional immunomodulatory proteins (LF
and a2 – MG) in spontaneous premature birth.
3. Assessment of serum values of proinflammatory cytokines (Il-1b, Il-6 and
TNF-a) in spontaneous premature birth.
4. Evaluation of the correlation between serum values of polyfunctional
immunomodulatory proteins and proinflammatory cytokines in spontaneous
premature birth.
5. Determining potential predictors for preterm birth with the development of an
algorithm to optimize obstetric management and improve perinatal outcomes of
pregnant women at risk of preterm birth.
General research methodology. The research was organized and conducted
based on the Department of Obstetrics and Gynecology within the Nicolae Testemițanu
State University of Medicine and Pharmacy, in obstetric wards 1, 2, 3 of the
Perinatology Center within the Gheorghe Paladi Municipal Clinical Hospital IMSP and
the Biochemistry Laboratory of the Nicolae Testemițanu State University of Medicine
and Pharmacy, with permission from the administration of the respective institutions
for the collection and processing of primary data during the years 2018-2022. The
research project and the study protocol were approved by the Research Ethics
Committee of the Nicolae Testemițanu State University of Medicine and Pharmacy
(minutes no. 16 of November 21, 2017) and by the Bioethics Committee of the
Gheorghe Paladi Municipal Clinical Hospital IMSP (minutes no. 1-A of February 2,
2018). Scientific novelty and originality: The study elucidated the peculiarities of the
evolution of pregnancy, childbirth and perinatal outcomes in pregnant women with
spontaneous preterm birth. In the study, the serum values of LF and a2 – MG as well
as proinflammatory cytokines (Il-1b, Il-6 and TNF-a) were assessed as a whole, as
well as the correlation of these inflammatory markers in women with spontaneous
preterm birth. A predictive model of preterm birth was developed, based on the
anamnesis, comorbidities of women whose pregnancy was complicated by preterm
birth. Based on the results obtained, a diagnostic and management algorithm for
pregnant women at risk of spontaneous preterm birth was proposed to optimize clinical
management and improve perinatal outcomes.
The theoretical significance: The results of this study make important
contributions to the understanding of the pathogenetic mechanisms of preterm birth,
confirming the determining role of intrauterine inflammation and immunological
imbalance in the initiation of preterm labor. The analysis of serum biomarkers,
especially Lactoferrin (LF), α2-Macroglobulin (α2-MG) and proinflammatory
cytokines (IL-1b, IL-6, TNF-α), provided new insights into the screening and
prevention of prematurity, paving the way for the implementation of more efficient
methods for the identification and management of patients at high risk of preterm birth.
The applicative value of the study: Integrating biomarker testing into prenatal
screening allows the identification of high-risk pregnant women before clinical signs
of preterm labor become evident.
Monitoring serum levels of LF and α2-MG could help obstetricians to establish
the prognosis of pregnancy progression and adjust the individualized care plan.
The predictive models developed in the current research can be used to guide clinical
interventions, ensuring a better allocation of medical resources and avoiding excessive
treatment of low-risk patients.
The personalized therapeutic protocol proposed based on this study could lead to more
effective prevention strategies, through the administration of antenatal corticosteroids
to correctly selected patients, the use of anti-inflammatory therapies and preventive
antibiotic therapy.
Identification of serum biomarkers of prematurity can optimize the monitoring of high-
risk pregnancies, allowing for early diagnosis, better targeted treatments and the
reduction of unnecessary medical interventions.
The implementation of an obstetric management algorithm, based on biomarkers of
polyfunctional immunomodulatory proteins, proposed following the study, could
improve diagnostic accuracy, guide treatment and reduce neonatal complications
associated with prematurity.
Implementation of scientific results: Based on the study, a predictive model of
preterm birth was proposed, which was implemented in the Perinatological Center of
the PMI Gheorghe Paladi Municipal Clinical Hospital. Based on the study, a
Methodological Recommendation was developed and implemented in the teaching
process of the Departament of Obstetrics and Gynecology of Nicolae Testemițanu PI
SUMPh, as well as in the curent activites of PMI Gheorghe Paladi Municipal Clinical
Hospital.
Approval of scientific results. The basic principles of the work were reported
and discussed in various national and international scientific forums:
• Conference Days of the State University of Medicine and Pharmacy "Nicolae
Testemițanu". Chișinău, October 15-19, 2018.
• The 7th International Medical Congress for Students and Young Doctors MedEspera.
Chișinău, May 3-5, 2018.
• The 15th International Congress for Medical Students and Young Doctors. Romania,
Iasi, May 3-6, 2018.
• The 8th International Medical Congress for Students and Young Doctors MedEspera.
Chișinău, September 24-26, 2020.
• National Congress of Fetal and Neonatal Medicine with international participation.
Romania, Bucharest, May 11-13, 2023.
• The 28th EBCOG CONGRESS. Poland, Krakow, 18-20 May, 2023.
• European Exhibition of Creativity and Innovation EUROINVENT l5th edition, 26-
28 May 2023.
• The 37th Balkan Medical Week ”PERSPECTIVES OF BALKAN MEDICINE IN
THE POST COVID-19 ERA”. Chisinau, 7-9 June 2023.
• National scientific and practical conference “DAYS OF ACADEMICIAN
GHEORGHE PALADI ON HIS 95TH ANNIVERSARY”. Chisinau, 17 May 2024.
• 13th National Congress of the Romanian Society of Obstetrics and Gynecology.
Romania, Bucharest, 21-23 November 2024.
Publications on the topic of the thesis. Based on the study materials, 25 works
were published, of which 1 article in national journals, 4 articles in international peer-
reviewed journals, 2 articles without co-authorship, 7 abstracts in the proceedings of
national and international scientific conferences, 1 innovator's certificate, 1 certificate
of registration of objects of copyright and related rights, 4 communications at
international and 2 national scientific forums, 5 international posters, 1 methodological
recommendation.
Thesis volume and structure. The thesis is presented on 162 typewritten pages
and consists of: introduction, literature review (chapter 1), research material and
methods (chapter 2), three chapters of own results (chapters 3, 4, 5), synthesis of the
obtained results, general conclusions, practical recommendations, bibliography with
203 sources, 8 annexes, information on the use of research results. The work contains
20 tables, 22 figures
Cunoștințe, atitudini și practici ale femeilor privind reabilitarea fizică postnatală
No full textContext: Evaluarea nivelului de cunoștințe, atitudini și practici ale femeilor în perioada postnatală
privind reabilitarea fizică este esențială în conturarea unor intervenții eficiente pentru sănătatea
mamei. Deși recuperarea fizică are un rol determinant în prevenirea complicațiilor, acest aspect
este adesea neglijat în educația prenatală și în practica medicală curentă. Studiul vizează
identificarea lacunelor informaționale, a barierelor de comportament și a percepțiilor asociate
reabilitării, cu scopul de a fundamenta recomandări pentru politicile de sănătate maternală.
Importanța acestui demers este susținută de frecvența ridicată a disfuncțiilor de planșeu pelvian,
diastazisului abdominal și depresiei postnatale, care pot fi ameliorate prin activitate fizică ghidată.
Metode: Studiul a fost de tip cantitativ, descriptiv și transversal. Eșantionul a inclus 416 femei
aflate în perioada de 6 săptămâni postpartum, selectate pe baza unor criterii clare. Datele au fost
colectate printr-un chestionar structurat de tip KAP (Knowledge, Attitudes, Practices), validat prin
pretestare, și prelucrate cu ajutorul Google Forms. Analiza statistică a inclus metode descriptive și
coeficientul de corelație Spearman, potrivit pentru variabile ordinale. Chestionarul a fost alcătuit
din compartimente care au vizat datele socio-demografice, cunoștințele, atitudinile și practicile
legate de exercițiile fizice postnatale. Completarea cercetării a fost realizată printr-o abordare
calitativă, incluzând 3 focus-grupuri și 2 interviuri în profunzime cu specialiști și factori de decizie
din domeniul sănătății. Analiza calitativă a avut scopul de a oferi o perspectivă contextuală asupra
aplicabilității politicilor de sănătate existente. Rezultate: Majoritatea dintre respondente (70,4%) știau despre importanța exercițiilor postnatale,
dar doar 48,3% le practicau regulat. Corelația între cunoștințe și practică a fost pozitivă și
semnificativă (ρ = 0,289, p = 0,007). Vârsta a corelat negativ cu deschiderea față de reabilitare (ρ
= -0,192, p = 0,034), iar numărul de sarcini s-a corelat pozitiv cu participarea la sesiuni prenatale
(ρ = 0,305, p = 0,005). De asemenea, femeile cu studii superioare au demonstrat o implicare mai
activă în activitățile fizice postnatale. Printre barierele principale s-au numărat lipsa timpului
(78%), insuficiența informațiilor (53%) și suportul medical deficitar (41%). Sursele principale de
informare au fost rețelele sociale (46,2%), medicii de familie (24,6%) și forumurile pentru mame
(18,7%). Interviurile calitative au evidențiat lipsa unui cadru instituțional clar privind reabilitarea
fizică postnatală și nevoia formării personalului în acest domeniu.
Discuții: Studiul confirmă necesitatea extinderii programelor de educație prenatală care să includă
reabilitarea fizică postnatală ca temă prioritară. Diferențele în nivelul de implicare în funcție de
vârstă, educație și paritate evidențiază nevoia de intervenții personalizate și sprijin constant din
partea personalului medical. Implicarea activă a femeilor în recuperarea postnatală poate reduce
complicațiile pe termen lung și crește calitatea vieții. Rezultatele susțin adoptarea unei abordări
multidisciplinare și dezvoltarea de politici publice dedicate sănătății materne în perioada
postpartum. Este necesară crearea de protocoale standardizate care să includă evaluarea fizică
postnatală, recomandări personalizate și urmărire continuă a mamei în perioada de lăuzie. Aceste
măsuri ar contribui la creșterea autonomiei femeii și la scăderea riscurilor de morbiditate
postnatală
Parkinson’s disease and cerebrovascular changes: a clinico-epidemiological and neuroimaging study. Summary of the Habilitation Thesis in Medicine. 321.05 - Clinical neurology
No full textRelevance of the Topic. Parkinson’s disease (PD), which is experiencing a
global increase in prevalence [1], is frequently associated with vascular risk factors
(hypertension, diabetes mellitus, dyslipidemia) that contribute not only to
cerebrovascular morbidity but also potentially to the initiation or progression of
neurodegenerative processes [2-4]. Evidence supporting the interaction between
subclinical cerebral ischemia, vascular dysfunction, and dopaminergic degeneration
underpins the hypothesis of a vasculo-neurodegenerative co-evolution [5-6].
Investigating these shared mechanisms may facilitate the identification of common
biomarkers and enable early differential diagnosis between idiopathic PD and vascular
parkinsonism [7-8]. Clinically, the association of PD with vascular lesions correlates
with cognitive impairment, more severe motor symptoms, and reduced responsiveness
to levodopa, suggesting a significant functional and prognostic impact [9-13].
Incorporating the vascular profile into the evaluation of PD patients provides a
foundation for personalized therapies and secondary prevention interventions, thereby
mitigating disability progression and socio-economic burden [13-14]. In a transitioning
healthcare system such as that of the Republic of Moldova, local clinicalepidemiological research is essential for adapting screening policies, treatment
approaches, and interdisciplinary management of PD [2], [14].
Description of the Study Field and Identification of Research Problems.
Despite progress in recent decades, the relationship between Parkinson’s disease (PD)
and cerebrovascular disease (CVD) remains incompletely understood, with multiple
unresolved issues: (1) common pathogenic mechanisms — evidence for the
involvement of microcirculatory impairment, chronic inflammation, and oxidative
stress remains indirect [4,15-16]; (2) the role of chronic subclinical cerebral ischemia
and its impact on PD progression and therapeutic response is still insufficiently studied;
advanced methods such as diffusion-weighted imaging (DWI) and MRI perfusion may
aid in early detection [4], [17]; (3) there remains a lack of specific biological or imaging
markers for mixed PD–CVD forms, limiting differential diagnosis; (4) characterization
of micro- and macrostructural vascular lesions through comparative studies between
PD patients and the general population is needed [18], [11]; (5) particularities of
vascular risk factors remain unclear — the extent to which the expression of
hypertension, diabetes mellitus, or dyslipidemia differs in PD patients compared to the
general population is unknown [8], [19]; (6) the influence of therapeutic adherence on
PD progression in the context of vascular risk is poorly documented; (7) the impact of
CVD on non-motor symptoms of PD — including cognitive impairment, depression,
and apathy — requires further investigation to clarify causal relationships [9], [20]; (8)
knowledge, attitudes, and practices (KAP) studies on patient and physician perceptions
regarding PD–CVD comorbidity could provide a basis for educational and
organizational intervention strategies [21]; (9) the absence of clear integrated
management guidelines at both international and regional levels complicates treatment
of patients with PD and cerebrovascular comorbidities.
Approaches to addressing the issues outlined above include longitudinal clinicalepidemiological studies, multimodal brain imaging (advanced MRI, PET), analysis of
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inflammatory and genetic markers, KAP surveys, and the development of composite
risk scores for PD–CVD. In the Republic of Moldova, the lack of epidemiological and
clinical-imaging data concerning PD and vascular comorbidities justifies the need for
an integrative study to guide public health policies and enable treatment
personalization [14, 22-23].
Research Aim: To investigate the clinical-epidemiological, imaging, and
management characteristics of patients with Parkinson’s disease in the population of the
Republic of Moldova, through analysis of the association between vascular risk factors
and cerebral vascular neuroimaging changes, evaluation of imaging heterogeneity to
assess its clinical impact, and development of personalized and systemic management
recommendations tailored to the specific needs of this patient group.
Research Objectives:
1. To conduct a clinical-epidemiological evaluation of patients with Parkinson’s
disease in the population of the Republic of Moldova to identify an integrative
clinical-epidemiological profile and the medico-social particularities of these
patients.
2. To phenotype Parkinson’s patients based on the nature of the association
(comorbidity or causality) with cerebrovascular disease, as well as according to the
dominant clinical-evolutionary syndrome, to develop personalized management
recommendations tailored to patient needs.
3. To investigate the presence and extent of vascular involvement in patients with
Parkinson’s disease and its impact on the clinical manifestations of Parkinson’s
disease.
4. To assess vascular risk factors in Parkinson’s disease patients, their pharmacological management, and their influence on clinical manifestations of Parkinson’s
disease, as well as to study the correlation between these factors and cerebral
neurovascular imaging lesions.
5. To evaluate the association of Parkinson’s disease with neurovascular imaging
lesions and to investigate their role in the clinical manifestations of Parkinson’s
disease.
6. To study the management of Parkinson’s disease patients within the healthcare
system of the Republic of Moldova through Knowledge, Attitudes, and Practices
(KAP) analysis and to identify existing barriers.
7. To develop institutional and national recommendations regarding the
comprehensive diagnosis of Parkinson’s disease and the interdisciplinary
management of these patients.
Summary of Research Methodology and Justification of Chosen Methods.
Fundamental research and clinical studies in the field of Parkinson’s disease
have served as the theoretical and scientific methodological foundation, demonstrating
that Parkinson’s disease is a pathology with considerable impact on the patient, their
immediate entourage, and society [24], as well as a condition that demands significant
involvement of the healthcare system [25]. The selection of research methods and
interpretation of results were guided by recent studies indicating associations between
Parkinson’s disease and cardiovascular and cerebrovascular pathology, which
6
negatively affect the progression and clinical manifestations of Parkinson’s disease
[26]. The current research considered neuroimaging studies from recent years
highlighting the presence and role of cerebral vascular lesions in the onset and
evolution of Parkinson’s disease [27]. Cerebral vascular lesions and vascular risk
factors are investigated from the perspective of potential aggravating factors for
Parkinson’s disease [4].
The study’s aim and objectives were addressed through clinical and
neuroimaging methods, as well as through interviews with physicians and patients to
elucidate their knowledge, attitudes, practices, and encountered barriers. Data
collection was performed both qualitatively and quantitatively via questionnaires and
assessment scales covering epidemiological, medico-social, motor and non-motor
clinical aspects, as well as psycho-affective and cognitive domains. Additionally,
internationally approved neuroimaging protocols for evaluating patients with
Parkinson’s disease were applied, in accordance with international recommendations
aimed at optimizing Parkinson’s disease research [28].
Novelty and Scientific Originality:
• The novelty of the conducted research lies in the complex, multidimensional, and
interdisciplinary innovative approach to patients with Parkinson’s disease in the
Republic of Moldova — a neurodegenerative disorder potentially strongly
influenced by vascular pathophysiological mechanisms.
• The study provides an integrative concept of Parkinson’s disease within the
population of the Republic of Moldova, highlighting the clinical heterogeneity of
PD and presenting the patient’s profile in relation to family, society, and healthcare
services.
• The in-depth investigation of neurovascular imaging changes identified greater
severity of vascular impairment and specific patterns of cerebral vascular lesion
localization in PD patients.
• The research found that cerebrovascular changes impact the progression and
severity of Parkinson’s disease, functional disability caused by both conditions,
quality of life, development of neuropsychiatric symptoms, and cognitive
impairments, which consequently affect family and societal integration through
reduced work capacity, disability, workforce dropout, and increased burden on
healthcare systems.
• The study emphasizes the necessity of early detection of vascular risk factors to
enable comprehensive, multidisciplinary, early, and proactive management.
Significant Problem Addressed in the Field. This study is the first and only
research in the Republic of Moldova to phenotype the medico-social aspects and
clinical particularities of patients with Parkinson’s disease from the country, as well as
to map the barriers to specialized medical care for these patients. The study’s findings
identified an aggravating effect of the association and burden of vascular risk factors
and cerebrovascular lesions on the clinical severity of Parkinson’s disease. These
results enable the optimization of personalized management for patients with
Parkinson’s disease in the Republic of Moldova.
7
Theoretical Significance. The results of this research extend and deepen the
existing knowledge regarding the role of vascular mechanisms in the neurodegenerative processes of Parkinson’s disease and their impact on the clinical-evolutionary
severity of the disease. The study identified an aggravating effect of the presence and
burden of vascular risk factors, as well as the presence and severity of cerebral vascular
lesions, on the severity of motor and non-motor symptoms of Parkinson’s disease,
patients’ functional status, and their quality of life.
Applied Value. The importance of a multidisciplinary approach to patients with
Parkinson’s disease was established, emphasizing early and proactive detection of
vascular risk factors—key mediators of the relationship between Parkinson’s disease
and cerebrovascular disease. This study is the first in the Republic of Moldova to
evaluate the management of Parkinson’s disease patients from both the perspective of
healthcare service beneficiaries and providers. Barriers to access specialized medical
services for Parkinson’s disease patients were identified, aiming to improve patientcentered access to care. Preferences of both patients and healthcare providers regarding
Parkinson’s disease management were assessed to formulate tailored
recommendations.
Main Results Submitted for Defense:
1. The clinical-epidemiological and medico-social pattern of patients with Parkinson’s
disease in the Republic of Moldova varies according to biological criteria and
disease progression.
2. The nature of the association — comorbidity or causality — between
cerebrovascular disease and parkinsonism results in particular clinical-evolutionary
phenotypes of the disease, necessitating differentiated management for these
patients.
3. The dominant clinical syndrome of Parkinson’s disease may be indicative of a
specific clinical-evolutionary phenotype, which determines the specific needs for
personalized patient management.
4. Vascular risk factors are more prevalent in the population of patients with
Parkinson’s disease.
5. The presence and burden of vascular risk factors are associated with greater severity
of motor and non-motor symptoms.
6. Cerebrovascular lesions are more prevalent in the population of patients with
Parkinson’s disease and exhibit a specific pattern of localization.
7. The presence and severity of cerebrovascular lesions are associated with distinct
clinical features, onset, and progression of Parkinson’s disease.
8. Barriers exist in the management of Parkinson’s disease within the healthcare
system of the Republic of Moldova, both at the level of patients and specialized
service providers.
Approval of the Study Results. The main results of the research were
communicated and discussed at various national and international scientific forums,
including the European Academy of Neurology Day in the Republic of Moldova, held
jointly with the Congress of Neurologists of the Republic of Moldova (Chișinău, 16–
18 September 2021); the National Alzheimer’s Disease Conference (CNALZ) (Iași,
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Romania, 23–26 February 2022, invited lecturer); the 4th Edition of the National
Conference on Modern Neurosciences “Parkinson’s Disease & Other Movement
Disorders” (Iași, Romania, 6–8 April 2023, invited lecturer); the 6th International
Conference on Nanotechnologies and Biomedical Engineering (Chișinău, Republic of
Moldova, 20–23 September 2023, invited lecturer); the 6th National Congress of
Neurosciences (Iași, Romania, 9–12 October 2024, invited lecturer); the National
Conference on Modern Neurosciences "Parkinson’s Disease and Other Movement
Disorders" (Iași, Romania, 11–13 April 2024 and 11–13 April 2025, invited lecturer);
the 26th World Congress on Parkinson’s Disease and Related Disorders (Amsterdam,
Netherlands, 1–4 May 2021); the European Academy of Neurology Congress MDS
(Copenhagen, Denmark, 27–31 August 2023); and the International Headache
Congress (on-line, audio presentation, 8-12.09.2021).
The thesis was discussed and approved at the joint meeting of the Functional
Neurology Laboratory of the INN, Neurology Departments 1 and 2 of the Nicolae
Testemițanu State University of Medicine and Pharmacy, and the Brain Health Center
on 22 May 2025 (Minutes No. 7); as well as at the Scientific Seminar of specialties 312
Physiology; 321 General/Specialized Medicine: 312.02 Neurosciences (including
Psychophysiology), 321.05 Clinical Neurology, 321.21 Neurosurgery, minutes dated 1
July 2025.
Publications on the Thesis Topic. A total of 42 publications have been produced
on the thesis topic, including: 1 national monograph, 1 chapter in an international
monograph (SCOPUS indexed), 1 chapter in a national monograph, 5 SCOPUS-indexed
articles, 1 article in other international journals, 1 national article category A, 4 national
articles category B+, 3 national articles category B, 4 national articles category C, 4 other
articles from the Republic of Moldova, 8 national abstracts, 11 international abstracts, as
well as 4 innovations, 4 implementation acts, and 3 copyrights.
Volume and Structure of the Thesis: The thesis contains an introduction, six
chapters of original results and discussions, conclusions and recommendations, a
bibliography of 455 titles, 24 appendices, 265 pages of main text, 74 figures, and 42
tables. The research results have been published in 42 scientific works
Pulmonary hypertension and right ventricular dysfunction: prognostic implications in patients with different clinical phenotypes of ischemic heart failure. Summary of the doctoral thesis in medical sciences: 321.03 – Cardiology
No full textHeart failure (HF) is a heterogeneous syndrome with a poor prognosis. Its prevalence is
17.2 per 1000 individuals [1], varying between 1% - 3% of the adult population [2,3]. In terms of
HF phenotype, the reported prevalence of HF with preserved ejection fraction (HFpEF) is
continuously increasing, while the rate of HF with reduced ejection fraction (HFrEF) remains
stable or gradually decreases [2]. Among the multiple causes of HF, coronary artery disease (CAD)
represents the predominant etiology, accounting for 26% of the total burden [2,4].
The prognosis of HF has improved following the implementation of guideline-directed
medical therapy. Nevertheless, the mortality rate remains elevated, ranging between 6.4% - 17.4%
[2], while HF hospitalization accounts for approximately 1% – 2% of all-cause admissions,
representing the leading cause of hospitalization among individuals aged over 65 years [4].
Although multiple scores for estimating mortality risk in HF are available, there are currently no
reliable tools for assessing the risk of HF-related hospitalization or worsening HF (WHF) episodes
[5], which are unfavourable outcomes with an enormous social and economic burden.
The development of pulmonary hypertension (PH) represents a turning point in the natural
course of HF [6], worsening its prognosis regardless of the HF phenotype. PH is further associated
with an increased risk of both mortality [7–9] and morbidity [7,10]. The prevalence of PH
associated with left heart disease (PH-LHD) varies between 36% - 83% in patients with HF [7,10].
The gold standard for the evaluation of pulmonary hemodynamics is right heart catheterization;
however, as an invasive diagnostic method, it is often unjustified in subjects with LHD.
Echocardiographic estimation of the PH probability (PHpr) is recommended in this category of
patients, despite the fact that echocardiography has the capacity to both underestimate and
overestimate pulmonary artery pressure [11].
PH-LHD can be stratified according to pulmonary vascular resistance (PVR) into isolated
post-capillary PH (IpcPH) and combined post- and pre-capillary PH (CpcPH) [11,12]. Studies and
meta-analyses have demonstrated a significant negative prognostic impact and reduced survival in
patients with Cpc-PH [7,13]. Attempts have been made to identify non-invasive indicators that
could estimate the presence of a precapillary component within PH-LHD [14,15]; however, their
correlation with invasively measured parameters is not well demonstrated or validated, and their
prognostic impact is supported by limited evidence.
Despite being recognized in recent decades, the importance of right ventricular (RV)
function and its prognostic role remains significantly underestimated. There is no unanimously
accepted definition of right ventricular dysfunction (RVD). Thus, while some expert
recommendations define it as the determination of a parameter that characterizes RV function
outside the reference range [16], other sources emphasize the differentiation between RVD, which
involves RV structural or functional abnormalities without hemodynamic compromise, and RV
failure, caused by reduced filling and/or RV output [17,18]. The prevalence of RVD shows
significant variability across studies and meta-analyses, ranging from 19% to 77%, due to the use
of varying diagnostic criteria [21–24]. It is associated with a poor prognosis, independent of the
underlying pathogenetic mechanism: throughout the entire spectrum of HF phenotypes [18,21,22],
after cardiac surgery [23], acute myocardial infarction (AMI) [24] and PH [11].
Surgical or percutaneous myocardial revascularization has made remarkable progress in
managing obstructive CAD. Percutaneous coronary intervention (PCI) has a clear benefit in
improving survival in patients with AMI [25], while coronary artery bypass grafting (CABG) has
proven effective in reducing cardiovascular (CV) mortality and hospitalization over a 10-year period in patients with severe left ventricular (LV) systolic dysfunction [26]. However, studies
comparing the outcomes of patients undergoing CABG [26] or PCI [25,27] with optimal medical
therapy, as well as those evaluating the two types of myocardial revascularization [28,29], have
primarily focused on endpoints such as mortality, CV-related hospitalization, and the risk of AMI
or stroke. Limited studies have explored the long-term evolution of ischemic HF and its
phenotypes, so the impact of myocardial revascularization on HF prognosis remains insufficiently
elucidated. Although some small studies have analyzed RV function or PH in patients undergoing
CABG or PCI, these have primarily focused on the early postoperative stage, as well as their shortterm prognostic impact. Thus, the prevalence, evolution and long-term prognostic value of PH and
RVD in patients who have undergone myocardial revascularization through CABG or PCI are
sparsely and fragmentarily reported in the specialized literature.
The aim of this study was to investigate the characteristics of pulmonary hypertension
associated with left heart disease and right ventricular dysfunction in patients with ischemic heart
failure, as well as to develop long-term prognostic criteria following myocardial revascularization.
The objectives of the research were:
1. To assess the evolution of manifestations defining heart failure phenotypes over 12 months
after myocardial revascularization.
2. To analyze the evolution of echocardiographic parameters suggestive of postcapillary
pulmonary hypertension and its subtypes 12 months following myocardial
revascularization, and to investigate their correlation with heart failure phenotypes
3. To estimate the modifications of right ventricular function parameters over 12 months after
myocardial revascularization.
4. To perform a comparative analysis of the evolution of pulmonary hypertension, right and
left ventricular dysfunction according to the type of myocardial revascularization: coronary
artery bypass grafting or percutaneous coronary intervention.
5. To develop long-term prognostic criteria for the evolution of ischemic heart failure after
myocardial revascularization and to determine the impact of pulmonary hypertension and
right ventricular dysfunction in this context.
Scientific novelty and originality. The research provided new data on the prevalence of
PH in patients with ischemic HF and myocardial revascularization. For the first time in the
Republic of Moldova, we performed non-invasive (echocardiographic) diagnosis of postcapillary
PH subtypes (IpcPH and CpcPH), with estimation of their prevalence in patients undergoing
myocardial revascularization. We established a moderate and statistically significant correlation
between echocardiographic parameters defining PH and HF characteristics. The independent
impact of the HFrEF phenotype, LV remodeling and diastolic dysfunction parameters, the
preexisting early changes within the pulmonary circulation, CV and non-CV comorbidities
(arterial hypertension, atrial fibrillation, chronic kidney disease) on the progression of the
echocardiographic probability of PH was demonstrated.
Furthermore, we reported the prevalence of RVD in patients with both surgical and
percutaneous myocardial revascularization, thus supplementing the existing data in this field. We
presented evidence supporting a multifactorial pathophysiological mechanism in the development
of RVD in patients with ischemic HF, determined by ventricular interdependence, RV afterload
and the impaired RV- pulmonary artery coupling. For the first time in the Republic of Moldova,
the cardiopulmonary exercise test (CPET) was conducted in patients with PH and RVD,
demonstrating reduced peak oxygen uptake (VO2p) and ventilatory inefficiency. As a result of this study, we provided solid evidence of the major prognostic impact of
echocardiographic parameters defining PH and RVD on the risk of HF hospitalization and WHF
episodes, as well as on the composite endpoint of all-cause mortality and HF-related
hospitalization.
The scientific issue addressed in the research consists in identifying the parameters of PH
and RVD with prognostic impact and quantifying their contribution in patients with ischemic HF
and myocardial revascularization with respect to the defined endpoints – HF hospitalization and
WHF episodes, as well as the composite endpoint: all-cause mortality and HF hospitalization.
Additionally, prognostic factors determining the progression of the echocardiographic probability
of PH at 12 months after the acute cardiac event were identified, thereby revealing the impact of
both systolic and diastolic LV dysfunction, early changes in the pulmonary vascular bed and of
CV and non-CV comorbidities in the development of PH-LHD. At the same time, prognostic
determinants influencing de novo RVD at 12 months after myocardial revascularization were
highlighted, emphasizing the importance of RV afterload, RV–pulmonary artery coupling and
ventricular interdependence.
The theoretical significance of the research lies in identifying the correlation between
PH-LHD, its subtypes and HF phenotypes in patients who underwent myocardial revascularization
through CABG or PCI. Additionally, the parameters that demonstrated prognostic impact in the
context of progression of the echocardiographic probability of PH 12 months after myocardial
revascularization suggest the presence of subtle alterations in pulmonary circulation early after the
acute cardiac event. These changes appear to progress under the influence of systolic and diastolic
LV dysfunction, interacting with CV comorbidities (arterial hypertension and atrial fibrillation)
and non-CV comorbidities (chronic kidney disease). At the same time, the impact of LV morphofunctional characteristics, echocardiographic parameters of PH and its precapillary component on
the development of de novo RVD outlines a multifactorial pathophysiological mechanism
underlying RVD in patients undergoing myocardial revascularization: ventricular interdependence
and increased afterload, with impaired RV–pulmonary artery coupling. Strong arguments were
presented in support of the major determining role of PH and RVD in the progression of ischemic
HF, enhancing the risk of all-cause mortality, HF-related hospitalization and WHF.
Practical value of the research. The study demonstrated the feasibility of non-invasive
echocardiographic differentiation of PH-LHD subtypes: IpcPH and CpcPH. The research
emphasized the importance of incorporating parameters characterizing RV morphology and
systolic function, as well as PH indices, such as tricuspid regurgitation velocity (TRV) and
additional signs suggestive of PH, into the echocardiographic protocol for the follow up
examination of patients who underwent CABG or PCI. These parameters have proven to be
prognostic determinants in the evolution of HF. Furthermore, the study highlighted the relevance
of integrating CPET into the evaluation protocol for patients who underwent myocardial
revascularization, both for characterization the evolution of exercise capacity and for the
assessment of gas exchange parameters with prognostic significance in this patient population.
As a result of the conducted study, five prognostic methods were developed. Two
prediction models estimate the risk of HF-related hospitalization during the first year after
myocardial revascularization. Given the negative prognostic impact of WHF, we developed the
prognostic method for evaluation the risk of WHF during the first year after myocardial
revascularization. Additionally, predictive models were created for assessing the risk of
unfavourable evolution of PH and RVD.
Publications related to the thesis topic. The findings of the study have been reflected in
26 publications, including 1 article in a journal with an impact factor of 16.9, 2 articles in SCOPUS
– indexed journals where the author is the first author, 5 articles in category B journals, 3 articles
in category C journals, 11 abstracts in the proceedings of international scientific congresses and 4
theses in the proceedings of national scientific conferences.
Approval of Scientific Results. The relevant results derived from this research have been
presented and discussed at numerous scientific forums, including: the Heart Failure Congress
(2020 – online, May 21-24, 2022 in Madrid, Spain; May 20-23, 2023 in Prague, Czech Republic;
May 11-14, 2024 in Lisbon, Portugal), ESC Preventive Cardiology Congress (2020 and 2022,
online), the National Cardiology Congress (September 21-24, 2022 in Sinaia, Romania); as well
as national conferences: the Annual Scientific Conference of USMF “N. Testemițanu” (2021 and
2022 in Chișinău), the scientific conference marking World COPD Day (November 22, 2019,
Chișinău), the scientific conference “Pulmonary Hypertension in Daily Clinical Practice” (October
7, 2023, Chișinău) and the Scientific Conference within the International Specialized Exhibition
“MoldMedizin & MoldDent” (September 27, 2024, Chișinău).
The results of the thesis were discussed and approved during the meeting of the Chronic
Heart Failure Laboratory of the Institute of Cardiology (no. 3 of 27.03.2025) and the Specialized
Scientific Seminar 321.03–Cardiology, 321.23–Cardiac Surgery (no. 2 of 02.05.2025)
Ultrasonografia la punctul de îngrijire a pacientului „POCUS” în managementul pacientului chirurgical acut
No full textContext: Ultrasonografia la punctul de îngrijire sau POCUS (Point of Care Ultrasonography)
reprezintă o metodă imagistică emergentă, utilizată direct de medicul clinician la patul pacientului.
În contextul suprasolicitării serviciilor de imagistică și al necesității decizionale rapide în chirurgia
acută, aplicarea POCUS devine esențială. În Republica Moldova, aplicarea metodei POCUS este
încă la un stadiu incipient, fiind utilizată ocazional în mod informal, fără o integrare sistemică în
practica medicală. Lucrarea evaluează utilitatea metodei POCUS în practica chirurgicală urgentă,
din perspectiva medicilor specialiști și a factorilor de decizie, și propune direcții de implementare
a acestei metode la nivel național.
Metode: Cercetarea este calitativă, de tip transversal, desfășurată în perioada noiembrie 2024-
februarie 2025. Au fost organizate 11 focus-grupuri cu medici specialiști în chirurgie, ginecologie
și urologie (2–8 participanți/grup) și 6 interviuri individuale cu factori de decizie (șefi de secții,
vicedirectori, manageri). Informațiile au fost colectate audio, transcrise integral și analizate prin
codificare tematică. S-a efectuat și o analiză a 69 de surse științifice (2014–2024) din PubMed,
Scopus și eLibrary privind eficiența metodei POCUS în context internațional și fezabilitatea în
sistemele sanitare cu resurse limitate. Rezultatele au fost comparate pe categorii profesionale și
organizate pe teme emergente.
Rezultate: Clinicienii din toate cele trei specialități – chirurgie, ginecologie și urologie – au
exprimat opinii pozitive privind utilitatea metodei POCUS. Chirurgii au subliniat rolul acesteia în
evaluarea rapidă a abdomenului acut, detecția hemoragiilor interne prin FAST, și monitorizarea
lichidului postoperator. Ginecologii au apreciat aplicabilitatea în diagnosticarea sarcinilor
ectopice, hemoragiilor uterine și apoplexiei ovariene. Urologii au evidențiat utilizarea POCUS în
retenție acută de urină, hidronefroză și torsiune testiculară. Pe lângă aplicabilitatea clinică, metoda
a fost considerată valoroasă pentru ghidarea procedurilor invazive și stabilirea rapidă a
diagnosticului diferențial. Medicii au subliniat și avantajul metodei de a fi repetabilă, neiradiantă,
portabilă și aplicabilă chiar și în condiții limitate de resurse. Au fost exprimate și rezerve privind
riscul de interpretare greșită în lipsa instruirii, ceea ce susține nevoia de formare profesională
continuă. Practicienii solicită includerea POCUS în curricula de formare postuniversitară și în
ghidurile naționale de urgență. Factorii de decizie au recunoscut eficiența economică a metodei,
însă au raportat bariere majore precum lipsa de echipamente, absența instruirii formale și lipsa
unui cadru normativ clar. Cu toate acestea, s-a constatat un consens larg privind necesitatea
extinderii utilizării POCUS în chirurgia acută, ATI și medicina de urgență.
Discuții: Implementarea POCUS în Republica Moldova este percepută ca utilă și fezabilă, dar
necesită reforme multidimensionale: instruire certificată, investiții în dotare, integrarea în ghiduri
clinice și reglementare oficială a competențelor. Integrarea metodei ar putea contribui și la
reducerea inegalităților în accesul la imagistică medicală, în special în spitalele raionale sau în
zonele rurale. Experiența altor țări (România, Polonia, Lituania) arată că implementarea POCUS
este posibilă chiar și în sisteme sanitare cu resurse limitate, dacă există voință instituțională și
suport normativ. Factorii de decizie susțin aplicarea etapizată, prioritizând secțiile de urgență.
Utilizarea POCUS ar contribui la reducerea timpului de diagnostic, a costurilor de spitalizare și a
morbidității asociate. Lucrarea evidențiază importanța abordării sistemice și sugerează politici de
integrare graduală a metodei în medicina de urgență din Republica Moldova
Congenital cytomegalovirus infection in infants: clinical, paraclinical features and antiviral treatment efficacy
No full textRezumat
Infecția congenitală cu citomegalovirus (CMV) constituie cea mai
frecventă infecție virală transmisă vertical și reprezintă o cauză importantă de
morbiditate neonatală, asociată cu afectare neurologică, hepatică și auditivă.
Studiul de față a avut ca obiectiv evaluarea comparativă a manifestărilor clinice
și paraclinice, precum și a eficienței terapiei antivirale cu valganciclovir la
sugari prematuri și la termen diagnosticați cu infecție congenitală cu CMV.
Lotul analizat a inclus 83 de copii, dintre care 28,9% prematuri și 71,1%
născuți la termen. Rezultatele au evidențiat o afectare multisistemică mai severă
în rândul prematurilor și o reducere semnificativă a încărcăturii virale după
tratamentul antiviral. Studiul susține necesitatea diagnosticării precoce prin
PCR și inițierea tratamentului simptomatic în toate cazurile confirmate.Abstract
Congenital cytomegalovirus (CMV) infection is the most common viral
infection transmitted vertically and a significant cause of neonatal morbidity,
particularly involving the central nervous system, liver, and hearing. This
comparative study evaluated clinical and paraclinical manifestations, as well as
the efficacy of valganciclovir therapy in both preterm and term infants diagnosed with congenital CMV infection. The study group included 83
children, of whom 28.9% were preterm and 71.1% were full-term. The findings
revealed more severe multisystem involvement in preterm infants and a
significant reduction in viral load following antiviral therapy. The study
supports early etiologic diagnosis via PCR and prompt initiation of antiviral
treatment in all symptomatic cases
The treatment of dental dyschromia by indirect methods
No full textIntroducere. În contextul societății moderne, accentul pe estetică și influența rețelelor de socializare au transformat
tratamentele stomatologice din necesități funcționale în soluții de îmbunătățire a imaginii personale. Discromiile dentare
reprezintă modificări anormale ale culorii dinților, determinate fie de factori extrinseci (consumul de alimente, băuturi,
fumat) fie de factori intrinseci (fluoroza, administrarea anumitor medicamente, traume), afectând 30–35% dintre pacienți,
cu o prevalență a cazurilor severe de 15–20%.
Scopul lucrării. Acest studiu analizează evoluția tratamentelor discromiilor dentare, evidențiind impactul acestora
asupra percepției sociale și a sănătății orale, comparând metodele tradiționale cu tehnicile inovatoare.
Material și metode. S-a realizat o revizuire a literaturii de specialitate, incluzând studii clinice și cercetări privind
albirea dentară (în cabinet și la domiciliu), restaurările protetice moderne prin tehnologia CAD/CAM, Digital Smile Design
și utilizarea materialelor ceramice avansate. Analiza a comparat eficacitatea metodelor tradiționale (curățare profesională,
paste abrazive) cu tehnicile contemporane (albire cu laser, fațete din zirconiu și disilicat de litiu).
Rezultate. Studiile recente indică o creștere cu 20–25% a cererii pentru tratamente estetice în ultimii 5 ani în
cazul discromiilor dentare. Metodele moderne au oferit rezultate estetice superioare, reducând petele vizibile cu până
la 70%, iar în cazul pacienților cu discromii severe, eficacitatea a fost de aproximativ 65%. În plus, aceste tratamente au
influențat pozitiv încrederea pacienților în domeniul social și profesional.
Concluzii. Inovațiile tehnologice din stomatologia estetică au revoluționat managementul discromiilor dentare,
integrând armonios funcționalitatea cu estetica. Abordarea interdisciplinară a condus la soluții eficiente, care nu doar
corectează deficiențele estetice, dar previn și complicațiile ulterioare.Background. In modern society, the emphasis on aesthetics and the influence of social media have transformed
dental treatments from purely functional necessities into opportunities for enhancing personal image. Dental discolorations
are defined as abnormal changes in tooth color, caused either by extrinsic factors (dietary habits, smoking, and
consumption of certain beverages) or intrinsic factors (fluorosis, certain medications, and trauma), affecting 30–35% of
patients, with severe cases reaching 15–20%.
Objective of the study. This study examines the evolution of dental discoloration treatments, highlighting their
impact on social perception and oral health by comparing traditional methods with innovative techniques.
Material and methods. A literature review was conducted, including clinical studies and research on both in-office
and at-home teeth whitening, modern prosthetic restorations via CAD/CAM technology, Digital Smile Design, and
advanced ceramic materials. The effectiveness of conventional methods (professional cleaning, abrasive pastes) was compared
with contemporary techniques (laser bleaching, zirconia and lithium disilicate veneers).
Results. Recent studies indicate a 20–25% rise in the demand for aesthetic treatments of dental dyschromia over
the past 5 years. Modern methods showed superior aesthetic outcomes, reducing visible stains by up to 70%, with approximately
65% of patients with severe discolorations. Additionally, these treatments have positively influenced patients’
social and professional confidence.
Conclusion. Technological innovations in aesthetic dentistry have revolutionized the management of dental discolorations
by seamlessly integrating functionality with aesthetics. The interdisciplinary approach has led to effective
solutions that not only address aesthetic deficiencies but also prevent future complications
Transferul competențelor clinice în formarea profesională: percepții și experiențe ale absolvenților de rezidențiat
No full textContext. În formarea profesională a medicilor, transferul eficient al competențelor din contextul
educațional în practica clinică este crucial pentru siguranța pacientului și calitatea serviciilor.
Evaluarea competenței clinice din perspectiva conceptului de transfer al învățării reflectă
capacitatea medicilor de a aplica eficient și durabil cunoștințele și abilitățile dobândite, în contexte
noi și variate. Literatura de specialitate subliniază caracterul complex și multidimensional al
acestui fenomen, influențat de factori precum motivația, metacogniția, modelele mentale formate
și oportunitățile reale de aplicare. Studiul de față explorează experiențele absolvenților privind
transferul învățării, în contextul sistemului de învățământ medical superior din Republica
Moldova.
Metode. Studiul, cu design calitativ exploratoriu, s-a desfășurat în perioada octombrie 2023–
septembrie 2024, vizând absolvenți ai programelor de rezidențiat, promoțiile 2020–2023. Selecția
participanților s-a realizat prin eșantionare intenționată, urmărind diversitatea specialităților și
statutul de angajat în practica clinică. Au fost incluși 10 participanți (4 femei, 6 bărbați), până la
atingerea saturației teoretice. Interviurile semi-structurate, au fost transcrise integral și analizate
prin metoda tematică abductivă, combinând coduri deductive (bazate pe teoria transferului) și
inductive (generate din date). Structura codificării a inclus cinci dimensiuni majore: (1)
particularități ale procesului de învățare (strategii și metode utilizate, relevanța conținutului), (2)
oportunități și provocări în aplicarea cunoștințelor clinice în practică, (3) caracteristicile sistemului
de evaluare, (4) influența experiențelor de învățare informală și neformală, (5) rolul și influența
formatorilor. Calitatea analizei a fost consolidată prin verificare inter-coder, reflexivitate continuă
și triangularea datelor prin integrarea constantă a codurilor emergente cu cele deductive provenite
din literatura de specialitate.
Rezultate. Participanții descriu programul universitar ca fundament al cunoștințelor teoretice,
apreciind relevanța clinică și utilitatea majorității disciplinelor studiate. Totuși, semnalează
dificultăți privind integrarea practică a conținuturilor și necesitatea intensificării activităților
interactive și clinice pentru a facilita transferul ulterior în practică. Rezidențiatul este perceput ca
fiind o etapă esențială în dezvoltarea profesională, în care sunt apreciate în mod special autonomia
clinică dobândită, oportunitățile reale de învățare prin practică directă și experiențele valoroase din
situații clinice neplanificate. Totodată, au fost evidențiate aspecte pozitive precum motivația
personală ridicată și maturizarea profesională generată de interacțiunile clinice reale. Pe de altă
parte, respondenții au identificat oportunități de îmbunătățire, precum necesitatea integrării mai consistente a practicii clinice în modulele educaționale și a unei structurări mai clare a obiectivelor
formative și evaluărilor. Participanții sugerează că mentoratul și sprijinul consistent din partea
supervizorilor joacă un rol important în facilitarea transferului competențelor clinice. În absența
acestora, se recurge adesea la adaptări personale. Experiențele informale, inclusiv colaborarea
spontană cu colegii și învățarea autodirijată, sunt percepute ca având o contribuție esențială la
dezvoltarea competențelor clinice.
Discuții. Rezultatele sugerează că eficacitatea transferului de competențe clinice nu este un proces
automatizat, ci unul dependent de interacțiunea complexă între designul instruirii, contextul clinic
de aplicare, caracteristicile individuale ale cursanților și calitatea relației formator–rezident.
Sistemele educaționale medicale care ignoră integrarea verticală a cunoștințelor și alinierea
explicită a competențelor cu realitatea practică riscă să creeze decalaje semnificative între formare
și exercitarea profesiei. Implicațiile pentru politicile educaționale sunt multiple: este necesară
standardizarea proceselor de supervizare, integrarea reală a feedbackului clinic formativ,
introducerea timpurie a abordărilor centrate pe pacient și consolidarea învățării prin simulare
clinică aplicată. Mai mult, sistemul trebuie să recunoască și să valorifice aportul învățării informale
și experiențiale în dezvoltarea medicului practician. Studiul oferă o bază solidă pentru formularea
de recomandări orientate spre transformarea sistemică a procesului de transfer în educația
medicală
Percepții ale funcționarilor publici în domeniul controlului de stat în sănătate privind integritatea instituțională
No full textContext: Integritatea în sănătate este un concept care se referă la respectarea principiilor etice,
legale și profesionale în toate activitățile din domeniul sănătății — atât pentru furnizarea de servicii
medicale, de cercetare, de management sanitar sau de politică publică. Potrivit unor studii, în
sistemul de sănătate se produc acte de corupție, iar Ministerul Sănătății și instituțiile subordonate
se clasează pe locul 4 în lista entităților afectate de corupție. În cadrul acestui studiu ne-am propus
să examinăm integritatea percepțiilor funcționarilor publici din domeniul controlului statului în
sănătate, pentru a înțelege potențialele riscuri și lacune în acest domeniu.
Metode. Cercetarea este de tip descriptiv, mix (cantitativ/calitativ). Studiul cantitativ a cuprins
totalitatea absolută a funcționarilor publici cu responsabilitatea de control de stat în sănătate (47
de persoane). Datele au fost colectate printr-un chestionar, elaborat în interesele studiului, în
perioada decembrie 2024-februarie 2025, în cadrul centrelor de sănătate publică teritorială ale
Agenției Naționale pentru Sănătate Publică. Chestionarul conține 30 de întrebări semideschise și
închise, cu selecție unică și multiplă, întrebări de tip scală, grupate în 3 categorii: Date sociodemografice, Date specifice și Practici, fără de colectarea datelor cu caracter personal. Pentru o
abordare amplă a tematicii, a fost realizat și un studiu calitativ, axat pe atitudinile, particularitățile
experienței și opiniile personale de conducere a instituțiilor teritoriale de sănătate publică. Ca
instrument de cercetare a fost utilizat interviul în profunzime, aplicat unui număr de câte două
persoane din conducerea fiecărei dintre cele trei regiuni geografice ale țării (nord, centru și sud),
care au acceptat să participe la acest studiu.
Rezultate: Conform datelor obținute, funcționarii publici implicați în controlul de stat în sănătate,
și anume 85% dintre răspunsuri, au beneficiat de multiple instruiri asupra aspectului legislativ
referitor de integritate instituțională. Peste 70% dintre răspunsuri arată că măsurile de promovare
a integrității instituționale sunt aplicate în volumul deplin. Apreciază nivelul integrității instituției
cu note de 4 și 5 peste 80% dintre respondenți, unde 5 este cel mai înalt nivel. Într-un stat de drept
și democratic, libertatea de exprimare și de participare a persoanelor în procesul decizional este
esențial, 44,7% dintre funcționarii publici afirmă că doar uneori se simt liberi în exprimare în
activitatea lor și 40,4% se simt mereu liberi de exprimare, totodată, doar 27,7% dintre respondenții
au declarat că sunt implicați în procesul decizional. Discuții: Datele obținute în cadrul cercetării reflectă o înțelegere relativ clară a conceptului de
integritate instituțională în rândul respondenților, majorității valorii susținând importanța
majorității valorilor precum meritocrația, transparența și echitatea în exercitarea atribuțiilor de
serviciu. Cu toate acestea, persistă anumite lacune în asigurarea unui climat instituțional bazat pe
integritate în cadrul structurilor responsabile de controlul statului în domeniul sănătății. Aceste
deficiențe sunt percepute atât de funcționari publici, cât și de personalul de conducere. Totodată,
organizarea periodică a sesiunilor de informare pentru angajați, precum și realizarea unor evaluări
independente ale nivelului de integritate, efectuate de structuri abilitate, ar putea contribui
semnificativ la consolidarea climatului etic din instituții. Astfel de măsuri preventive pot reduce
riscul apariției abaterilor și comportamentelor neconforme, contribuind la protejarea imaginilor
funcționale publice și la menținerea încrederii cetățenilor în onestitatea și responsabilitatea cu care
sunt exercitate atribuțiile serviciului în beneficiul sănătății publice