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Targeting the biochemical signature of age-related macular degeneration: a preliminary study of potential diagnostic and prognostic biomarkers
No full textIntroduction. Age-related macular degeneration is a multifactorial, polyetiological condition, affecting individuals over
the age of 50, primarily characterized by progressive and irreversible loss of central vision. In the pursuit of a deeper understanding
of its etiopathogenesis, risk factors, associated biomarkers, and diagnostic metabolites, the omics approach
plays an essential role. The primary objective of this study was to evaluate selected omics biomarkers along with hematological
and clinical data and to establish their correlations with macular degeneration.
Material and methods A pilot retrospective study was conducted, analyzing medical records of 80 patients admitted to
the Ophthalmology Department of the Timofei Moșneaga Republican Clinical Hospital. Laboratory parameters were assessed
and statistically analyzed using the Statistical Package for the Social Sciences. Statistical methods included binomial
tests, Wilcoxon Signed-Rank tests, and One-sample tests. The data obtained were compared with the results of a comprehensive
analysis of the latest scientific literature on age-related macular degeneration.
Results. Omics approach analysis, particularly proteomic and metabolomic analyses, has contributed significantly to the
identification of metabolic pathways involved in age-related macular degeneration pathogenesis, facilitating the investigation
of novel biomarkers for early diagnosis and potential therapeutic targets. In our pilot study, we evaluated clinical
and biochemical data, including age, sex, laboratory values, and comorbidities, and compared them with currently published
research data. Statistically significant biomarkers identified included glucose, triglycerides, prothrombin, fibrinogen,
platelet count, and leukocyte count. Partially significant (dual) biomarkers included total cholesterol, erythrocyte
sedimentation rate, and lymphocyte count. No statistical significance was observed for HDL-cholesterol, LDL-cholesterol,
and international normalized ratio.
Conclusions. Omics approach represents a promising avenue for monitoring, diagnosing, and potentially treating age-related
macular degeneration. By identifying key biomarkers, this approach supports early detection and opens the path for
advanced therapeutic strategies such as gene therapy, cell-based treatments, complement pathway inhibitors, and nanotechnology-
based interventions
Phenotypic expression compatible with VACTERL syndrome in a newborn: cardiac, renal and vertebral aspects
No full textIntroducere. Sindromul VACTERL este o afecţiune rară, denumită după spectrul de malformaţii care o caracterizează: anomalii vertebrale, atrezie anală, malformaţii cardiace, fistulă traheo-esofagiană, anomalii renale, anomalii ale membrelor. Definit prin prezenţa a cel puţin trei caracteristici din fiecare categorie. Scop. Evaluarea caracteristicilor clinice şi paraclinice ale unui nou-născut cu semne fenotipice sugestive de sindrom VACTERL şi a suspiciunii prezenţei unor microdeleţii cromozomiale. Material şi metode. Studiu retrospectiv, realizat pe baza analizei datelor clinice şi paraclinice colectate din fişele maternă şi neonatală. Malformaţiile cardiace, renale şi vertebro-costale au fost investigate prin ecocardiografie, ecografie renală şi radiografii toracică şi lombară. A fost iniţiată evaluarea genetică pentru microde-leţii cromozomiale. Rezultate. Fetiţă născută la termen, I-a sarcină, I-a naştere, pe cale naturală, cu greutatea de 3196 g, scor APGAR 8/9. Obiectiv: La naştere auscultativ s-a depistat prezenţa suflului sistolic în proiecţia septului atrial. Pa-raclinic: Ecocardiografia a evidenţiat DSA tip ostium secundum de 4 mm, cu funcţia cardiacă păstrată. Ecografia renală a arătat agenezia rinichiului stâng. Radiografia a relevat anomalii vertebrale toracice şi absenţa coastei a II-a stânga. Fără malformaţii traheo-esofagiene, anus normal. Pe baza triadei de malformaţii specifice a fost stabilit diagnosticul de sindrom VACTERL şi s-a iniţiat tratament de susţinere. Concluzii. Sindromul VACTERL este complex, cu manifestări multisistemice. Cazul prezentat a evidenţiat asocieri congenitale compatibile cu acest sindrom şi a sugerat o posibilă etiologie genetică. Diagnosticul precoce pe baza a > 3 anomalii a facilitat iniţierea managementului multidi-sciplinar.Introduction. VACTERL syndrome is a rare condition named after the spectrum of malformations that characterize it: vertebral anomalies, anal atresia, cardiac malformations, tracheoesophageal fistula, renal anomalies, and limb anomalies. It is defined by the presence of at least three features from this spectrum Objective. To evaluate the clinical and paraclinical features of a newborn presenting with phenotypic signs suggestive of VACTERL syndrome and suspected chromosomal microdeletions. Material and methods. Retrospective study based on the analysis of clinical and paraclinical data collected from maternal and neonatal medical records. Cardiac, renal, and vertebro-costal malformations were investigated through echocardiography, renal ultrasound, and thoracic and lumbar radiographs. Genetic evaluation for chromosomal microdeletions was initiated. Results. Term female newborn, first pregnancy, first delivery, born vaginally, birth weight 3196 g, APGAR score 8/9. Clinical findings: At birth, auscultation revealed a systolic murmur in the atrial septal area. Paraclinical: Echocardiography showed a 4 mm ostium secundum atrial septal defect with preserved global cardiac function. Renal ultrasound indicated left kidney agenesis. Chest X-ray revealed thoracic vertebral anomalies and absence of the left second rib. No tracheoesophageal malformations, anus was normal. Based on the triad of specific malformations, VACTERL syndrome was diagnosed and supportive treatment was initiated. Conclusion. VACTERL syndrome is a complex condition with multisystemic manifestations. The presented case highlighted congenital associations compatible with this syndrome and suggested a possible genetic etiology. Early diagnosis based on the presence of > 3 anomalies allowed multidisciplinary management
The phagocytic system in children
No full textRezumat
Sistemul fagocitar include atât granulocite (neutrofile, eozinofile și
bazofile), cât și fagocite mononucleare (monocite și macrofage tisulare). Aceste
celule recunosc și ingeră particulele mari, elimină microorganismele și le
prezintă celulelor sistemului imunitar adaptive. Tulburările clinice moștenite și
dobândite ale funcției fagocitare rezultă din defectele uneia sau mai multor
etape implicate în distrugerea microbiană.
Scopul lucrării este evaluarea paraclinică de primă linie a copiilor
internați cu infecții respiratorii severe în diagnosticul posibil de
imunodeficiență primară (IDP).
Materiale și metode: S-a preconizat un studiu de diagnostic posibil al
IDP inițiat cu examinarea paraclinică a copiilor frecvent bolnavi internați în
secțiile Institutului Mamei și Copilului. Preclucrarea datelor și analizele
statistice au fost efectuate cu programa Epi Info.
Rezultate: Examinarea hemoleucogramei recomandate de primă linie în
diagnosticul posibil de IDP la copiii din studiu au relatat diferențe
semnificative între loturile de vârstă conform valorilor medii ale limfocitelor (F
stat = 2,94, p<0,05) și mai puțin după valorile medii ale leucocitelor (F stat =
1,05, p>0,05), neutrofilelor (F stat = 2,26, p>0,05).
Concluzii: Evaluarea sistemului fagocitar la copiii cu infecții recurente
este prima linie în diagnosticul posibil de imunodeficiențe primare.
Cuvinte cheie: Sistemul fagocitar, copil, Imunodeficiențe primare.Summary
The phagocytic system includes both granulocytes (neutrophils,
eosinophils, and basophils) and mononuclear phagocytes (monocytes and tissue
macrophages). These cells recognize and ingest large particles, eliminate
microorganisms, and present them to cells of the adaptive immune system.
Inherited and acquired clinical disorders of phagocytic function result from
defects in one or more steps involved in microbial killing.
The aim of this study is the first-line paraclinical evaluation of children
hospitalized with severe respiratory infections, in the context of a possible
diagnosis of primary immunodeficiency (PID).
Materials and Methods: A diagnostic-oriented, observational study
was conducted at the Mother and Child Institute, targeting frequently ill
pediatric patients admitted to various clinical departments with severe
respiratory infections. The study was initiated with first-line paraclinical
evaluations, including basic hematological, biochemical, and immunological
parameters, to assess the possibility of an underlying primary
immunodeficiency. Data preprocessing and statistical analysis were performed
using Epi Info software.
Results: The complete blood count (CBC), recommended as a first-line
investigation in the possible diagnosis of primary immunodeficiency (PID),
revealed significant differences in mean lymphocyte counts across age groups
in the study population (F-stat = 2,94, p<0,05). In contrast, less pronounced
differences were observed in mean leukocyte counts (F-stat = 1,05, p>0,.05)
and neutrophil counts (F-stat = 2,26, p>0,05), which did not reach statistical
significance.
Conclusions: Phagocytic system evaluation in children with recurrent
infections is a key step in the diagnosis of potential primary
immunodeficiencies. Early identification of abnormalities in innate immune
function is essential for guiding further diagnostic steps and improving clinical
outcomes
Variants of the facial nerve trunk
No full textIntroducere
Variabilitatea excesivă a nervului facial este una dintre cauzele principale ale erorilor medicale și leziunilor iatrogene ale acestuia.
Cunoașterea variantelor trunchiului nervului facial (TNF) este importantă pentru chirurgia OMF, ORL,
oncologică, reconstructivă și estetică a capului și gâtului.
Scopul lucrării a fost de a identifica particularitățile individuale de structură și traiect ale trunchiului nervului
facial în vederea diminuării leziunilor iatrogene.
Material și metode
Studiul a fost realizat în cadrul Catedrei de anatomie și anatomie clinică a USMF ,,Nicolae Testemiţanu”. Prin
metoda disecției fine, au fost confecționate o serie de piese anatomice, fiind evidențiate și ulterior descrise particularitățile individuale ale trunchiului și porțiunii extracraniene a n. facialis.
Rezultate
Variabilitatea trunchiului nervului facial a fost depistată în două cazuri. Într-un caz a fost determinată o variantă
de structură a TNF, acesta fiind constituit din câteva fascicole alăturate. În al doilea caz am identificat o variantă de
traiect, în care inițial TNF era descendent, iar după 0,8 cm și-a continuat traiectul orizontal, formând un unghi obtuz
între cele două segmente ale trunchiului.
Concluzii
Variantele descrise ale nervului facial prezintă interes atât teoretic, cât și aplicativ, deoarece variabilitatea TNF
crește riscul pentru iatrogenii.Introduction
Excessive variability of the facial nerve is one of the main causes of medical errors and its iatrogenic injuries.
Knowledge of facial nerve trunk (FNT) variants is important for OMF, ENT, oncology, reconstructive and aesthetic
surgery of the head and neck.
The aim of the study was to identify the individual structural and course specific features of the facial nerve
trunk in order to decrease iatrogenic injures.
Material and methods
The study was conducted at the Department of Anatomy and Clinical Anatomy of the Nicolae Testemiţanu State
University of Medicine and Pharmacy. A series of anatomical samples were prepared by anatomical dissection, highlighting and subsequently describing the individual peculiarities of the facial nerve trunk and of the extracranial part
of the facial nerve.
Results
The variability of the FNT was determined in two cases. In one case, a variant of the FNT structure was identified, when it consisted of several adjacent fascicles. In the second case, a variant of the FNT course was revealed, in
which, initially the FNT was descending and after 0.8 cm its course continued horizontally, forming an obtuse angle
between the two segments of the trunk.
Conclusions
The revealed variants of the FNT are of both theoretical and applied interest, as its variability increases the risk
of iatrogenic injuries
Basal cell carcinoma and pemphigus vulgaris: a complicated case under corticosteroid therapy
No full textIntroducere. Tumorile cutanate, benigne sau maligne, sunt frecvente la pacienţii vârstnici şi necesită evaluare clinică şi histologică minuţioasă. În anumite cazuri, acestea pot coexista sau pot fi urmate de afecţiuni autoimune severe, cu potenţial evolutiv grav şi prognostic rezervat. Scop. Prezentarea unui caz cu tumori cutanate multiple şi debut ulterior de pemfigus vulgar, subliniind necesitatea abordării integrate şi a monitorizării constante în patologia cutanată la vârstnici. Material şi metode. Datele au fost obţinute retrospectiv din fişa medicală a unui pacient de 71 de ani şi au inclus informaţii clinice, histopatologice şi citologice. Investigaţiile au cuprins examinări dermatologice şi oncologice, biopsii cutanate şi analiza citologică a bulelor. Evoluţia sub tratament şi complicaţiile au fost documentate şi corelate. Rezultate. În decembrie 2021 s-au excizat formaţiuni retroauriculare, diagnosticate histologic ca nev nevocelular pigmentat. În iunie 2024 s-a înlăturat o placă ulcerată de pe nas, confirmându-se carcinom bazocelular superficial, cu hiperplazie sebacee. În august 2024 au apărut leziuni buloase pe faţă, scalp şi torace, acoperite de cruste. Histologic s-a stabilit diagnosticul de pemfigus vulgar, cu 8-10 celule acantolitice/câmp şi eozinofile în bule - 15%. S-a iniţiat tratament sistemic cu glucocorticoizi şi hydroxyclorochină 400 mg/zi, cu răspuns lent. În septembrie, pacientul a dezvoltat cardiopatie ischemică şi a decedat. Concluzii. Pacienţii vârstnici cu antecedente de tumori cutanate necesită o supraveghere continuă, întrucât pot dezvolta patologii autoimune severe, cu evoluţie imprevizibilă. Tratamentul eficient trebuie adaptat la statusul biologic şi comorbidităţile existente pentru a reduce riscul de complicaţii fatale.Introduction. Cutaneous tumors, whether benign or malignant, are common in elderly patients and require thorough clinical and histological assessment. In certain cases, they may coexist with or be followed by severe autoimmune disorders, which carry a serious course and guarded prognosis. Objective. Presentation of a case with multiple skin tumors and subsequent pemphigus vulgaris, emphasizing the importance of integrated management and continuous monitoring in skin diseases in the elderly. Material and methods. Data were obtained retrospectively from the medical records of a 71-year-old patient and included clinical, histo-pathological, and cytological information. Investigations included dermatological and oncological exams, skin biopsies, and cytological analysis of blisters. The evolution under treatment and complications were documented and correlated. Results. In December 2021, retroauricular lesions were excised and histologically diagnosed as pigmented nevocellular nevus. In June 2024, an ulcerated plaque was removed from the nose, confirming superficial basal cell carcinoma with sebaceous hyperplasia. In August 2024, bullous lesions appeared on the face, scalp, and trunk, covered by crusts. Histological examination confirmed pemphigus vulgaris with 8-10 acantholytic cells per field and 15% eosinophils in the blisters. Systemic treatment with glucocorticoids and hydroxychloroquine 400 mg/day was initiated, with a slow response. In September, the patient developed ischemic heart disease and died. Conclusion. Elderly patients with a history of skin tumors require close and regular monitoring, as they may develop severe autoimmune diseases with unpredictable evolution. Effective treatment must be tailored to the biological status and existing comorbidities to reduce the risk of fatal complications
The long-term immunological and clinical outcomes of targeted immunotherapy in advanced-stage cancer patients
No full textUniversitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Chișinău, Republica MoldovaIntroducere. Rezultatele pe termen lung ale intervenţiilor imunomodulatoare în cancerul avansat variază în funcţie de strategia terapeutică şi de histologia tumorii. Beneficiul clinic susţinut observat la anumiţi pacienţi este adesea corelat cu markerii imunologici, determinând relevanţa lor prognostică. Scop. Cercetare rapoartelor de caz clinic din literatura de specialitate care evidenţiază rezultatele imunologice şi clinice pe termen lung asociate cu terapii imunomodulatoare ţintite în cancerul avansat. Material şi metode. A fost realizată o căutare bibliografică extinsă în PubMed, EMBASE şi Cochrane Library pentru studii publicate între ianuarie 2010 şi mai 2025. Au fost incluse studiile care au raportat rezultate imunologice şi/sau clinice la >12 luni după imunoterapii ţintite în malignităţi solide sau hematologice aflate în stadiu avansat. Rezultate. Au fost identificate şapte principii de imunoterapii. Ratele de supravieţuire, raportate în 5/7 studii, au variat între 4,0 şi 49,2 luni, în funcţie de tratament şi tipul de cancer. Tremelimum-ab a arătat supravieţuire la 5 şi 10 ani în melanom (20% şi 16%), iar ipilimumab un platou de 21% după 3 ani. Agenţii anti-PD-1 au atins până la 49,2 luni. FANG a crescut supravieţuirea mediană la 18,7 luni faţă de 4,0 în grupul de control. Markerii imunologici (sTIM3, IFNy, SLAN+, structuri limfoide) s-au corelat cu beneficii de durată. Datele despre siguranţă au fost limitate, dar unele studii au raportat toleranţă bună şi calitate a vieţii menţinută. Concluzii. Tremeli-mumab a arătat un răspuns median de 6,5 ani în melanomul avansat(15-20%); unele cazuri au depăşit 11 ani. Cazurile de NSCLC şi cancer ovarian au prezentat răspunsuri >12 şi 60 luni. Beneficiul a fost asociat cu monocite HLA-DR“ scăzute, celule SLAN+, T y-IFN+ şi reprogramare proinflam-atorie.Introduction. The Long-term outcomes of immunomodulatory interventions in advanced-stage cancer differ by therapeutic strategy and tumor histology. Sustained clinical benefit in selected patient subsets is often associated with distinct immune biomarkers, highlighting their prognostic relevance in therapeutic efficacy. Objective. Research of clinical case reports from the literature highlighting longterm immunological and clinical outcomes associated with targeted immunomodulatory therapies in advanced-stage cancer patients. Material and methods. A comprehensive literature search was conducted in PubMed, EMBASE, and Cochrane Library for studies published between January 2010 and May 2025. Studies were included if they reported immunological and/or clinical outcomes beyond 12 months following treatment with targeted immunotherapies in advanced-stage solid or hematologic malignancies. Results. Seven immunotherapy interventions were identified. Survival rates, reported in 5/7 studies, ranged from median of 4 to 49.2 months, varying by treatment and cancer type. Tremelimumab showed 5- & 10-year survival in melanoma (20% &16%), while ipilimumab reached a 21% plateau beyond 3 years. Anti-PD-1 agents showed survival up to 49.2 months across cancer types. FANG therapy improved median survival to 18.7 months vs. 4.0 in controls. Immune markers (sTIM3, IFNy, SLAN+ monocytes, tertiary lymphoid structures) correlated with long-term benefit. Safety data were limited, though some studies reported good tolerance and preserved quality of life. Conclusion. Tremelimumab achieved a 6.5-year median response in (15-20% advanced) melanoma; some exceeded 11 years. NSCLC and ovarian cancer cases showed responses >12 and 60 months. Long-term benefit correlated with low HLA-DR“ monocytes, SLAN+ cells, y-IFN-producing T cells, and pro-inflammatory reprogramming
Refractive lens exchange in a patient with high myopia and myopic astigmatism: a clinical case report
No full textIntroduction. Refractive lens exchange is increasingly utilized for visual rehabilitation in patients with high myopia unsuitable
for corneal refractive procedures. While effective, refractive lens exchange with intraocular lens implantation significantly
improves visual acuity in young patients with high myopia and astigmatism, while maintaining a low risk of
postoperative retinal complications, provided that thorough preoperative vitreoretinal assessment is conducted. However,
it carries potential risks, notably retinal complications.
Case presentation. We present a case involving a 45-year-old female with high axial myopia and myopic astigmatism
who underwent bilateral refractive lens exchange with the implantation of monofocal intraocular lenses. Comprehensive
preoperative assessments included optical biometry, tonometry, fundus examination, and visual acuity measurements.
Postoperative recovery was uneventful in the right eye. However, the patient developed a retinal detachment in the left eye
approximately one year post-surgery. This complication was successfully managed with pars plana vitrectomy, endolaser
photocoagulation, and silicone oil tamponade, resulting in an improvement of visual acuity to 0.3.
Conclusions. Refractive lens exchange can be an effective intervention for patients with high axial myopia but carries a
risk of retinal detachment. Thorough preoperative evaluation, meticulous surgical technique, and patient counseling are
essential. Prompt detection and management of complications like retinal detachment are crucial for preserving visual
outcomes
The role of open surgery in the management of gastric cancer in resource-limited settings: a literature-based review
No full textUniversitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Chișinău, Republica MoldovaIntroducere. Cancerul gastric continuă să fie una dintre principalele cauze de mortalitate prin cancer la nivel global. În ciuda paşilor majore în chirurgia minim invazivă, operaţiile deschise rămân esenţiale pentru tumorile avansate care necesită rezecţii largi şi limfadenectomie, mai ales în zonele cu resurse limitate. Scop. Scopul studiului a fost să evalueze eficienţa şi riscurile postoperatorii ale chirurgiei deschise în cancerul gastric, în contexte cu acces limitat la tehnici moderne. Material şi metode. A fost realizat un studiu amplu folosind PubMed, Google Scholar şi Science-Direct, analizând studii clinice şi meta-analize din perioada 2010-2024. Au fost colectate date privind recidiva, mortalitatea, riscurile postoperatorii şi supravieţuirea. Analiza Kaplan-Meier şi testul chi-pătrat au evaluat semnificaţia statistică (p < 0,05). Rezultate. Gastrectomia deschisă a realizat rezecţie R0 la 92% dintre pacienţi. Rata de supravieţuire la 5 ani a fost cuprinsă între 40% şi 60%, variind în funcţie de stadiul tumorii. Printre complicaţiile postoperatorii s-au numărat infecţiile plăgii (10%), fistulele anastomotice (5%), insuficienţa respiratorie (12%) şi mortalitatea periopera-torie (3%). Intervenţia a fost asociată cu pierderi de sânge crescute, durată operatorie mai lungă, recuperare întârziată şi un risc mai mare de complicaţii ale plăgii, indicând o morbiditate semnificativă. Totuşi, a adus beneficii în stadializa-rea corectă şi supravieţuirea pe termen lung. Concluzii. Chirurgia deschisă a demonstrat eficienţă ridicată în tratamentul cancerului gastric avansat, însă a fost asociată cu o rată importantă de complicaţii, evidenţiind rolul esenţial al experienţei chirurgicale şi al managementului perioperator, mai ales unde lipsesc tehnici moderne.Introduction. Gastric cancer remains one of the top causes of cancer-related mortality worldwide. Despite major progress in minimally invasive techniques, open surgery continues to be the primary treatment plan for advanced-stage tumors that require wide resection and lymphadenecto-my-notably in resource-limited settings. Objective. The aim of this study was to test the efficacy and the rate of postoperative risks tied to open surgeries for gastric cancer, noting their value in environments with poor access to modern surgeries. Materials and Methods. A comprehensive literature review was conducted using PubMed, Google Scholar, and ScienceDirect, focusing on clinical studies and meta-analyses published between 2010 and 2024. Data pertaining to recurrence rates, mortality, postoperative complications, and overall survival were extracted. Statistical significance was evaluated using Kaplan-Meier survival analysis and the chi-square test (p < 0.05). Results. Open gastrectomy achieved R0 resection in 92% of cases. The five-year survival rate ranged from 40% to 60%, depending on tumor stage. Reported postoperative complications included wound infections (10%), anastomotic fistulas (5%), respiratory failure (12%), and perioperative mortality (3%). The procedure was associated with increased intraoperative blood loss, prolonged operative time, delayed recovery, and a higher incidence of wound-related complications, indicating substantial morbidity. Nonetheless, it provided advantages in accurate staging and long-term survival outcomes. Conclusion. Open surgery demonstrated high effectiveness for advanced gastric cancer but was associated with considerable complication rates, showing the role of surgical expertise and perioperative management and how it remains as main treatment as other advanced techniques may not be widely available
Gender identity variation in a multidimensional context
No full textIntroducere. Identitatea de gen este influenţată de factori biologici, psihologici, sociali şi culturali, care inter-acţionează complex în formarea identităţii personale. Cercetările recente contestă validitatea modelului binar şi evidenţiază caracterul variabil, natural şi fluid al exprimării identitare. Scop. Scopul acestui studiu a fost de a analiza factorii care contribuie la variaţia identităţii de gen, utilizând o sinteză a cercetărilor teoretice şi empirice existente în literatura ştiinţifică. Material şi metode. A fost realizată o analiză narativă a 20 de articole ştiinţifice publicate între anii 2020 şi 2025, selectate în baza relevanţei pentru înţelegerea variaţiei identităţii de gen. Au fost incluse cercetări care explorează influenţele genetice, hormonale, neurobio-logice şi sociale, precum şi modelele teoretice actuale inter-disciplinare. Rezultate. Identitatea de gen a fost descrisă ca un spectru stabil şi divers, influenţat de variabile biologice şi interpersonale. Studiile analizate au evidenţiat corelaţii între incongruenţa de gen şi variaţii genetice rare, influenţe hormonale prenatale şi diferenţe structurale cerebrale, mai ales în ariile implicate în procesarea sinelui. Acceptarea socială şi sprijinul emoţional au redus riscurile psihologice, în timp ce mediile restrictive sau stigmatizante le-au amplificat. Genul a fost interpretat ca rezultat al comportamentelor internalizate şi al contextului sociocultural, subliniind caracterul său fluid şi adaptabil. Concluzii. Ipoteza multi-dimensionalităţii identităţii de gen a fost confirmată prin convergenţa datelor biologice, sociale şi psihologice analizate. Sunt necesare politici incluzive, intervenţii afirmative şi formarea profesioniştilor în domeniul sănătăţii pentru reducerea riscurilor psihosociale.Introduction. Gender identity is shaped by biological, psychological, social, and cultural influences that interact in complex ways during personal development. Recent studies question the validity of the binary model and highlight the fluid, diverse, and naturally occurring forms of gender expression. Objective. The aim of this study was to examine the factors contributing to gender identity variation, through a synthesis of current theoretical and empirical research in scientific literature. Material and methods. A narrative analysis was carried out on 20 scientific articles published between 2020 and 2025, selected based on their relevance to understanding gender identity variation. Included were studies exploring genetic, hormonal, neurobio-logical, and sociocultural factors, along with interdisciplinary contemporary theoretical frameworks. Results. Gender identity was described as a stable and diverse spectrum, shaped by various interpersonal and biological variables. The reviewed studies highlighted correlations between gender incongruence and rare genetic variants, prenatal hormonal influences, and structural brain differences, especially in areas related to self-identity processing. Social acceptance and emotional support significantly reduced psychological risks, while restrictive or stigmatizing environments exacerbated them. Gender was interpreted as the result of internalized behaviors and dynamic sociocultural context, emphasizing its fluid and adaptable nature. Conclusion. The hypothesis of gender identity multidimensionality was confirmed through convergence of biological, social, and psychological data. Inclusive policies, affirmative interventions, and professional training in healthcare are needed to reduce associated psychosocial risks
Exploring professionals' perceptions on fall management in older adults in Moldova
Get PDFIntroducere. Traumatismele prin cădere la vârstnici reprezintă o problemă majoră de sănătate publică. La nivel global, căderile sunt a doua cauză de deces accidental, cu peste 4,4 milioane de decese anual. Circa 30% dintre persoanele de 65+ ani suferă o cădere anual, 10% - severe, cu impact major asupra calităţii vieţii. Scop. Studierea practicilor curente în managementul traumatismelor prin cădere la vârstnici în vederea elaborării unui cadru intersectorial de acţiune şi consolidare a intervenţiilor medico-sociale. Material şi metode. În perioada ianuarie-iunie 2025, s-a realizat un studiu calitativ aprobat etic, prin interviuri semi structurate cu specialişti relevanţi (medici, asistenţi medicali, factori de decizie, reprezentanţi ai societăţii civile). Răspunsurile au fost înregistrate, transcrise şi analizate pentru identificarea barierelor sistemice şi a bunelor practici. Rezultate. Profesioniştii au semnalat lipsa unui protocol clinic standardizat pentru îngrijirea persoanelor cu risc şi evaluarea inconstantă a riscului de cădere în afara spitalului. Accesul la servicii sociale şi reabilitare este limitat de infrastructura neadaptată şi lipsa sprijinului la domiciliu. Ministerul Sănătăţii confirmă absenţa unei strategii naţionale dedicate, deşi problematica este reflectată în politici generale. Specialiştii în geriatrie şi reabilitare au evidenţiat fragilitatea şi comor-bidităţile ca factori de risc principali, iar reprezentaţii ONG-lor - despre nevoia de educaţie şi sprijin comunitar continu. Concluzii. Rezultatele preliminare confirmă necesitatea unei intervenţii coordonate şi intersectoriale în prevenirea căderilor la vârstnici, prin elaborarea unui cadru normativ aplicabil în comunitate, adaptarea infrastructurii şi consolidarea colaborării dintre sectorul medical, social şi societatea civilă.Introduction. Fall-related injuries in older adults are a major public health concern. Globally, falls are the second leading cause of accidental death, accounting for over 4.4 million deaths annually. Approx. 30% of individuals aged 65 and over had at least one fall each year, with 10% seriously impacting quality of life Objective. To study current practices in the management of fall-related injuries in older adults, to develop an intersectoral framework for action and strengthening medico-social interventions. Material and methods. Between January and June 2025, a qualitative, ethically approved study was conducted through semi-structured interviews with relevant professionals, including physicians, nurses, decision-makers, and civil society representatives. All interviews were recorded, transcribed, and thematically analyzed to identify systemic barriers and good practices. Results. Professionals reported the lack of a standardized clinical protocol for the care of at-risk individuals and the inconsistent assessment of fall risk outside hospital settings. Access to social and rehabilitation services is limited by inadequate infrastructure and the lack of home-based support. The Ministry of Health confirmed the absence of a dedicated national strategy, although the issue is mentioned in broader policy documents. Geriatric and rehabilitation specialists highlighted frailty and comorbidities as key risk factors, while NGO representatives emphasized the need for ongoing education and community support. Conclusion. Preliminary findings confirm the need for a coordinated intersectoral intervention, including the development of community-applicable guidelines, improved infrastructure, and strengthened collaboration between health, social, and civil society sectors