Institutional Repository in Medical Sciences of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
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Osteocalcin and metabolic dysfunction in young women with obesity
Get PDFIntroduction
Osteocalcin, a bone-derived hormone, has emerged as a potential regulator of energy metabolism, with roles in insulin sensitivity, glucose homeostasis, and lipid metabolism. Although an inverse association between osteocalcin and body mass index has been previously reported, data on its link with metabolic parameters in young, otherwise healthy women with obesity remain limited. The objective of this study was to investigate the relationship between circulating osteocalcin levels and key metabolic parameters in this specific population.
Material and methods
A cross-sectional observational study was conducted among 85 Caucasian women aged 18-45 years, without chronic disease or medication use. Participants were classified into two groups: normal weight (BMI 18.5-24.9 kg/m², n = 47) and with obesity (BMI ≥ 30 kg/m², n = 38). Anthropometric, hemodynamic, and biochemical parameters, including glucose, insulin, lipid profile, osteocalcin, and adiponectin, were assessed. Insulin resistance was evaluated using HOMA-IR and QUICKI. Group comparisons and Pearson correlation analyses were performed.
Results
Osteocalcin levels were significantly lower in the group of women with obesity compared to the normal weight group (12.99 ± 4.7 vs. 19.75 ± 4.09 ng/mL, p < 0.001). It was inversely correlated with BMI (r = – 0.56), waist-to-hip ratio, waist-to-height ratio, insulin, HOMA-IR, total and LDL cholesterol, and positively associated with QUICKI (r = 0.39) and adiponectin (r = 0.31) (all p < 0.001). A progressive decline in osteocalcin levels was observed across obesity grades.
Conclusions
Circulating osteocalcin is inversely associated with adiposity and metabolic dysfunction, suggesting its potential as an early biomarker of cardiometabolic risk in young women with obesity
Biomedical neuroenhancement and the pharmaceuticalization of the brain: bioethical dilemmas between autonomy and cognitive manipulation
Get PDFThis study explores the bioethical implications of innovative biomedical
technologies appliedto cognitive function, focusing on the boundary
between the rapeutic interventionanden hancement. It examines
autonomy risks arising in pharmacological and technological modulation
of the brain, especially in urbanized and performance-drivenhabitats
Introduction into culture and phenological study of varieties and subspecies of the genus Cynara
Get PDFUniversitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Chișinău, Republica MoldovaIntroducere. În Europa Centrală, speciile Cynara scoly-mus şi cardunculus sunt cultivate pentru conţinutul bogat în compuşi fenolici, fibre şi oligoelemente, responsabil de proprietăţile lor terapeutice, nutraceutice şi de biomasă prezentând interes ştiinţific în condiţiile pedo-climatice din Republica Moldova. Scop. Introducerea în cultură în Centrul Ştiinţifico-Practic în Domeniul Plantelor Medicinale a USMF ”N. Testemiţanu” şi studiul fenologic al varietăţilor şi subspeciilor genului Cynara. Material şi metode. Material seminifer certificat (Germania) - specia Cynara cardunculus; Cynara cardunculus var. scolymus; ssp. C. scolymus Imperial Star; C. scolymus ssp. Flavescens. Au fost evaluaţi parametri extrinseci de cultivare ca: panta terenului, distanţa între seminţe, regimul de irigare. Pentru Introducere. fenologică s-a utilizat scara BBCH. Rezultate. Dezvoltarea fenologică a speciilor de Cynara introduse în cultură, a fost caracterizată conform codificării standardizate pe întreg ciclu de dezvoltare al plantelor. Conform scării BBCH (Biologische Bundesanstalt, Bundessortenamt und Chemische Industrie) au fost descrise stadiile distincte de: 0. germinare; 1. dezvoltarea frunzelor; 2. formarea lăstarilor; 3. alun-girea tulpinii şi creşterea rozetei; 4: dezvoltarea părţilor recoltabile ale plantei; 5. apariţia inflorescenţei; 6. înflorire; 7. dezvoltarea seminţelor; 8. maturarea seminţelor; 9. se-nescenţă. Plantele demonstrând o dezvoltare mai bună pe panta cu unghiul de înclinare de 20°. Concluzii. Studiul de introducere în cultură şi cercetarea fenologică reprezintă o referinţă de bază pentru o cultivare sustenabilă şi evaluare ştiinţifică ulterioară a speciilor genului Cynara, contribuind astfel la valorificarea superioară a potenţialului agronomic, alimentar şi medicinal.Introduction. In Central Europe, the species Cynara scolymus and cardunculus are cultivated for their rich content in phenolic compounds, fibers and trace elements, responsible for their therapeutic, nutraceutical and biomass properties, presenting scientific interest in the climatic conditions of the Republic of Moldova. Objective. Introduction into culture in the Scientific-Practical Center in the Field of Medicinal Plants of the Nicolae Testemiţanu SUMPh and phenolog-ical study of varieties and subspecies of the Cynara genus. Material and methods. Certified seed material (Germany) - species Cynara cardunculus; Cynara cardunculus var. scolymus; ssp. C. scolymus Imperial Star; C. scolymus ssp. Flavescens. Extrinsic cultivation parameters such as: slope of the land, distance between seeds, irrigation regime was evaluated. For the phenological description the BBCH scale was used. Results. The phenological development of the Cynara species introduced into the culture was characterized according to the standardized coding for the entire plant development cycle. According to the BBCH scale (Biologische Bundesanstalt, Bundessortenamt und Chemische Industrie) the distinct stages of: 0. germination; 1. leaf development; 2. shoot formation; 3. stem elongation and rosette growth; 4: development of the harvestable parts of the plant; 5. inflorescence appearance; 6. flowering; 7. seed development; 8. seed maturation; 9. senescence, were recorded. Plants demonstrating better development on the slope with an inclination angle of 20°. Conclusion. The cultivation introduction study and codified phenological research represent a basic reference for sustainable cultivation and subsequent scientific evaluation of Cynara species, thus contributing to the superior exploitation of their agronomic, food and medicinal potential
The role of bone morphogenetic proteins in bone regeneration
Get PDFIntroducere. Proteinele morfogenetice osoase (BMP), membri ai superfamiliei factorului de creştere transformant P (TGF-P), sunt regulatori centrali ai dezvoltării scheletului şi regenerării osoase. Relevanţa lor clinică în ortopedie a generat interes ştiinţific extins şi examinare minuţioasă. Scopul este evaluarea caracteristicilor structurale, funcţiilor fiziologice şi aplicaţiilor terapeutice ale BMP-urilor în chirurgia osoasă, cu accent pe rezultatele clinice şi profilurile de siguranţă. Materiale şi metode. Acest rezumat se bazează pe o analiză narativă folosind bazele de date PubMed, Embase, Spine Journal, PMC şi Google Scholar. Include cercetări chirurgicale empirice pe animale efectuate în Moldova şi analizează studii clinice, meta-analize şi rapoarte FDA despre utilizarea BMP-2 şi BMP-7 în fuziuni spinale, pseudoartroze şi defecte osoase. Rezultate. BMP-2 recombinant a obţinut o rată de fuziune de 94%, comparativ cu 81-83% pentru grefa osoasă de la creasta iliacă (p<0,01). Concluzii. Ipoteza conform căreia BMP-urile stimulează regenerarea osoasă a fost confirmată. BMP-2 şi BMP-7 oferă alternative eficiente la autogrefe în indicaţii ortopedice selectate, însă preocupările legate de siguranţă justifică o utilizare restricţionată şi o evaluare continuă a raportului risc-beneficiu.Introduction. Bone morphogenetic proteins (BMPs), members of the transforming growth factor-p (TGF-P) superfamily, have emerged as central regulators of skeletal development and bone regeneration. Their clinical relevance in orthopedic procedures has generated extensive research and regulatory scrutiny. The aim is to evaluate the structural features, physiological functions, and therapeutic applications of BMPs in bone surgery, with a focus on current clinical outcomes and safety profiles. Material and methods. A narrative review was conducted using PubMed, Embase, Spine Journal, PMC, and Google Scholar databases. It includes empirical surgical research on animals performed in Moldova and analyzes key clinical trials, meta-analyses, and FDA reports on BMP-2 and BMP-7 use in spinal fusion, pseudoarthrosis and bone defects. Results. Recombinant BMP-2 achieved 94% of fusions, comparing with 81-83% when using iliac crest bone grafts (p<0.01). Conclusion. The hypothesis that BMPs enhance bone regeneration was confirmed through various studies. BMP-2 and BMP-7 offer effective and viable alternatives to autografts in select orthopedic indications, but safety concerns create a requirement for restricted use and continuous risk-benefit evaluation
COPD under the magnifying glass: does sex influence more than we think?
Get PDFUniversitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Chișinău, Republica MoldovaIntroducere. Bronhopneumopatia obstructivă cronică (BPOC) deşi tradiţional asociată bărbaţilor, a înregistrat în ultimele decenii o creştere a incidenţei în rândul femeilor, datorită schimbărilor comportamentale şi sensibilităţilor biologice diferite. Dovezile arată şi un fenotip clinic, funcţional şi inflamator distinct. Scop. Explorarea diferenţelor de sex în BPOC, cu accent pe caracteristicile clinice şi fenotipice ale bolii, factorii de risc implicaţi în dezvoltarea acesteia, precum şi particularităţile de management. Material şi metode. S-a realizat o revizuire narativă a literaturii de specialitate indexate în Google Scholar, Web of Science, Embase şi PubMed, folosind cuvintele cheie „BPOC” şi „diferenţe de sex”. Au fost incluse articole originale, me-ta-analize şi studii observaţionale publicate în perioada 2015-2025. Rezultate. Fumatul rămâne principalul factor de risc în BPOC. Deşi cândva stigmatizat, fumatul la femei a crescut odată cu schimbările sociale şi strategiile publicitare, alături de acesta, poluarea aerului interior şi expunerile profesionale contribuie semnificativ la diferenţele de sex în BPOC. Histologic, bărbaţii prezintă mai frecvent emfizem, iar femeile afectarea căilor respiratorii mici. Clinic femeile dezvoltă boala mai precoce, simptome mai severe şi scoruri mai mici ale calităţii vieţii comparativ cu bărbaţii la aceleaşi criterii funcţionale. Datele privind diferenţele de răspuns la terapiile convenţionale între sexe sunt limitate sau absente. Concluzii. BPOC reprezintă o problemă majoră de sănătate publică, iar interesul crescut pentru diferenţele de sex a permis o înţelegere aprofundată a vulnerabilităţilor specifice, a variaţiilor clinice şi a evoluţiei bolii. Indiferent de sex, renunţarea la fumat rămâne intervenţia non-farmacologică esenţială.Introduction. Chronic Obstructive Pulmonary Disease (COPD), although traditionally associated with men, has recorded an increase in incidence among women in recent decades due to behavioral changes and different biological susceptibilities. Evidence also shows a distinct clinical, functional, and inflammatory phenotype. Objective. To explore sex-related differences in COPD focusing on the clinical and phenotypic characteristics of the disease, the risk factors involved in its development, and specific aspects of its management. Material and methods. A narrative review of the specialized literature indexed in Google Scholar, Web of Science, Embase, and PubMed was conducted using the keywords “COPD” and “sex differences.” Original articles, meta-analyses, and observational studies published between 2015 and 2025 were included. Results. Smoking remains the main risk factor for COPD. Although once stigmatized, smoking among women has increased with social changes and advertising strategies. Alongside this, indoor air pollution and occupational exposures contribute significantly to sex differences in COPD. Histologically, men more frequently present emphysema, while women show small airway involvement. Clinically, women develop the disease earlier, have more severe symptoms, and lower quality of life scores compared to men at the same functional criteria. Data on sex differences in response to conventional therapies are limited or lacking. Conclusion. COPD represents a major public health issue, and the increased interest in sex differences has enabled a deeper understanding of specific vulnerabilities, clinical variations, and disease progression. Regardless of sex, smoking cessation remains the essential non-pharmacological intervention
Antibiotic resistance profile of Acinetobacter spp. strains
Get PDFIntroducere. Acinetobacter baumannii prezintă mai multe mecanisme de rezistenţă la antibiotice, inclusiv degradarea enzimatică, scăderea pătrunderii în celulă, modificarea ţintelor antibioticelor şi efluxul activ al lor, ceea ce reprezintă o provocare semnificativă în tratarea infecţiilor, în special în spitale. Scop. Analiza profilului de rezistenţă la antibiotice al tulpinilor Acinetobcter spp. izolate în cadrul IMU pentru a evalua riscurile pentru sănătatea pacienţilor infectaţi cu aceşti germeni Material şi metode. Între ianuarie 2024 şi ianuarie 2025 a fost efectuat un studiu retrospectiv, fiind analizate 57 de tulpini de Acinetobacter spp. izolate de la pacienţi cu infecţii septico-purulente. Identificarea şi testarea sensibilităţii la antibiotice s-au realizat cu sistemul Vitek 2 Compact, fiind evaluate şi date clinice relevante. Rezultate. Au fost analizate 57 de tulpini de Acinetobacter spp. izolate de la pacienţi cu vârsta între 17 şi 94 ani, 61,40% (n=35) bărbaţi şi 38,60% femei (n=22). Distribuţia pe biosbustrate şi secţii: sânge (n=50; 87,72%) şi doar 7 din LCR, terapie intensivă(n=52) şi doar 7 din secţii cu profil chirurgical. Cea mai înaltă rezistenţă a fost determinată faţă de: gentamicină (63,60%), tobramicină (66,10%), amikacină (89,1%), imi-penem (96,5%), meropenem (96,4%) şi 100% - ciproflox-acină şi levofloxacină şi sensibilitate 100% faţă de colistin. Acinetobacter spp. producător de carbapenemaze au fost 52 tulpini (91,22%) şi doar 7 nu au avut această enzimă. Concluzii. Studiul evidenţiază o pondere ridicată a rezistenţei la antibiotice în rândul tulpinilor de Acinetobacter, ceea ce afectează opţiunile terapeutice uzuale. Se impun măsuri urgente de control al infecţiilor şi optimizarea utilizării antibioticelor şi revizuirea protocoalelor de tratament empiric.Introduction. Acinetobacter baumannii expresses several mechanisms of antimicrobial resistance, including enzymatic degradation, decreased cell penetration, altered antimicrobial targeting and active antimicrobial efflux, which represent a significant challenge in treating infections, particularly in hospitals. Objective. Assessing the antibiotic resistance profile of Acinetobacter spp. strains from IEM to assess the potential health risks for patients infected with these strains. Material and methods. A retrospective study was conducted between January 2024 and January 2025 and 57 strains of Acinetobacter spp. isolated from patients with septic-purulent infections were analyzed. Identification and antibiotic susceptibility testing were performed with the Vitek 2 Compact system and relevant clinical data were evaluated. Results. A total of 57 strains of Acinetobacter spp. isolated from patients aged between 17 and 94 years, 61,40% (n=35) males and 38,60% females (n=22) were analyzed. Distribution by biological substrates and wards: blood (n=50; 87,72%) and only 7 from cerebrospinal fluid, intensive care unit (n=52) and only 7 from surgical wards. The highest resistance was determined against: gentamicin (63.60%), tobramycin (66.10%), amikacin (89.1%), imipenem (96.5%), meropenem (96.4%) and 100% - ciprofloxacin and levofloxacin and 100% sensitivity against colistin. Carbapenemase-producing Acinetobacter spp. were 52 strains (91,22%) and only 7 lacked this enzyme. Conclusion. The study draws attention to a high prevalence of antibiotic resistance among Acinetobacter strains, which affects the standardized therapeutic options. Highly urgent infection control measures and optimization of antibiotic use and revision of empiric treatment protocols are needed
Hemoragiile uterine anormale la adolescente
No full textRezumat
În prezent, hemoragiile uterine anormale (HUA) la adolescente
reprezintă o preocupare semnificativă în domeniul ginecologic, având în vedere
impactul negativ pe care îl au asupra sănătății fizice și psihice a tinerei
paciente. Acestea se manifestă în perioada de dezvoltare sexuală datorită
dereglărilor de sinteză a hormonilor ovarieni, în lipsa schimbărilor organice ale
sistemului reproductiv.
Indicența HUA la adolescente oscilează între 10-70% din afecțiunile
ginecologice iar aproximativ 95% dintre ele sunt anovulatorii și se întâlnesc
mai frecvent în primii ani postmenarhă din cauza maturizării incomplete a
axului hipotalamo-hipofizo-ovarian.
Pentru realizarea acestui articol au fost analizate cercetările din ultimii 5
ani privind HUA la adolescente. Au fost studiate metodele de diagnostic,
tratamentul, evoluția și consecințele acestei patologii asupra tinerei paciente.
Prezentarea de caz clinic cu HUA la adolescente. Tratamentul HUA are ca scop
efectuarea hemostazei cu administrarea acidului tranexamic, reechilibrarea
volemică și asigurarea unei dezvoltări ciclice a endometrului, cât mai apropiată
de cea fiziologică prin administrarea preparatelor hormonale.
Cauzele HUA la adolescente sunt diverse, cele mai intâlnite fiind stresul,
infecțiile și surmenajul. HUA au un rol negativ asupra vieții sociale și
psihoemoționale a tinerei paciente, astfel, pentru o diagnosticare corectă și o
evoluție favorabilă este necesară o evaluare minuțioasă a fiecărui caz în parte
de o echipă multidisciplinară, susținerea și implicarea familiei cât și a cadrelor
didactice.Summary
Currently, abnormal uterine bleeding (AUB) in adolescents is a
significant concern in the field of gynecology, considering the negative impact
it has on the physical and psychological health of the young patient. These
bleedings occur during the sexual development period due to disruptions in
ovarian hormone synthesis, in the absence of organic changes in the
reproductive system.
The incidence of AUB in adolescents ranges from 10% to 70% of
gynecological disorders, with approximately 95% of cases being anovulatory.
This is more commonly observed in the early postmenarchal years due to the
incomplete maturation of the hypothalamic-pituitary-ovarian (HPO) axis.
Research on AUB in adolescents from the past 5 years was analyzed.
Diagnostic methods, treatment approaches, evolution, and the consequences of
this pathology on young patients were studied. A clinical case of AUB in
adolescents was presented. The treatment of AUB aims to stop the bleeding
through hemostatic therapy with tranexamic acid, restore blood volume, and
ensure the cyclical development of the uterine endometrium using hormonal
preparations. Effective treatment requires the involvement of a
multidisciplinary team, family support, and the psycho-emotional well-being of
the young patient.
Recent studies highlight that AUB in adolescents is a complex
condition with multiple etiologies and multifactorial causes. The most common
causes are stress, infections, and excessive fatigue. AUB significantly affects
the social life of adolescents and has a strong psycho-emotional impact.
Therefore, accurate diagnosis and favorable outcomes require thorough
evaluation of each individual case, along with the support and involvement of
the family and educational staff
Endocrine comorbidities in patients with bipolar affective disorder
Get PDFIntroducere. Tulburarea afectivă bipolară a fost descrisă ca o maladie psihică severă, recurentă, cronică, caracterizată prin episoade maniacale şi depresive, care este frecvent însoţită de comorbidităţi endocrine: disfuncţii tiroidiene şi sindrom metabolic, cu impact clinic semnificativ în practica medicală. Scop. A fost urmărită identificarea prevalenţei şi tipologiei comorbidităţilor endocrine la pacienţii diagnosticaţi cu tulburare afectivă bipolară, precum şi impactul acestora asupra evoluţiei clinice. Material şi metode. A fost realizată o meta-analiză sistematică a literaturii ştiinţifice publicate între anii 2015-2025. În analiza cantitativă au fost incluse 10 articole relevante. Parametrii analizaţi au fost: prevalenţa disfuncţiilor tiroidiene, a sindromului metabolic, medicaţia utilizată, frecvenţa recăderilor afective, analizate prin testele x2 şi Pearson. Rezultate. Hipotiroidismul subclinic a fost identificat la 19,6% dintre pacienţii cu tulburare afectivă bipolară, iar hipertiroidismul în 6,2%. Sindromul metabolic a fost raportat în 47,3% din cazuri, mai frecvent la pacienţii trataţi cu quetiapină, olanzapină şi stabilizatori timici (acid valproic, lamotrigină). S-a constatat o asociere semnificativă între comorbidităţile endocrine şi recăderile afective (p < 0,01, test x2). Vulnerabilitatea endocrină a fost mai crescută la femei, într-un raport femei:bărbaţi de 1,8:1; ceea ce a demonstrat influenţa diferenţiată a devierilor hormonale în evoluţia bolii şi manifestărilor clinice. Concluzii. A fost confirmată prezenţa comorbidităţilor endocrine la pacienţii cu tulburare afectivă bipolară. Rezultatele au demonstrat necesitatea evaluării şi gestionării integrate a pacienţilor cu tulburare afectivă bipolară cu comorbidităţi endocrine în optimizarea managementului terapeutic.Introduction. Bipolar affective disorder is described as a severe, recurrent, and chronic mental illness, characterized by manic and depressive episodes. It is frequently associated with endocrine comorbidities such as thyroid dysfunctions and metabolic syndrome, which have a significant clinical impact in medical practice. Objective. This study aimed to identify the prevalence and types of endocrine comorbidities in patients diagnosed with bipolar affective disorder, as well as their impact on clinical evolution. Material and methods. A systematic meta-analysis of scientific literature published between 2015 and 2025 was conducted. Ten relevant articles were included in the quantitative analysis. The analyzed parameters were: prevalence of thyroid dysfunctions, metabolic syndrome, medications used, and frequency of affective relapses, assessed using x2 and Pearson tests. Results. Subclinical hypothyroidism was identified in 19.6% of patients with bipolar affective disorder, and hyperthyroidism in 6.2% of cases. Metabolic syndrome was reported in 47.3% of cases, more frequently in patients treated with quetiapine, olanzapine, and mood stabilizers (valproic acid, lamotrigine). A significant association was found between endocrine comorbidities and affective relapses (p < 0.01, x2 test). Endocrine vulnerability was higher in women, with a female-to-male ratio of 1.8:1, demonstrating the differential influence of hormonal deviations on the course and clinical manifestations of the disorder. Conclusion. The presence of endocrine comorbidities in patients with bipolar affective disorder was confirmed. The results highlight the need for integrated evaluation and management of patients with bipolar disorder and endocrine comorbidities in order to optimize therapeutic outcomes
Prevention of kidney stones: updated strategies and recommendations
Get PDFIntroducere. Introducere. Nefrolitiaza este în creştere la nivel mondial, în special la femei. Chiar şi în cazul intervenţiilor chirurgicale, recidivele pot duce la creşterea costurilor asistenţei medicale. Atât factorii genetici, cât şi cei de mediu joacă un rol important, astfel încât prevenţia e esenţială. Scop. Acest studiu oferă strategii recente de prevenire a nefrolitiazei, cu un accent deosebit pe pietrele de calciu, cu scopul de a oferi informaţii utile pentru îmbunătăţirea rezultatelor pentru pacienţi. Material şi metode. Această publicaţie sintetizează un deceniu de publicaţii, punând accent pe nefrolitiază şi, mai precis, pe strategiile de prevenire a calculilor de calciu. Acesta consolidează cele mai recente progrese din literatura ştiinţifică pentru a oferi o înţelegere actualizată a abordărilor eficiente în acest domeniu crucial al sănătăţii rinichilor. Rezultate. Ghidurile recomandă: 1) Aport de lichide de 2,5-3,0 L/zi pentru a asigura un debit urinar >2-2,5 L/zi. 2) Stil de viaţă: menţineţi un IMC sănătos, evitaţi deshidratarea (în special cu căldură/exerciţiu) şi nu fumaţi. 3) Dieta: 1000-1200 mg calciu/zi, reduceţi sodi-ul, alimentele bogate în oxalat, excesul de vitamine C/D şi proteinele animale; proteinele vegetale şi citrice. 4) Medicamente precum tiazide, citrat de potasiu sau alopurinol, în funcţie de tipul de calcul. 5) Infecţiile urinare recurente şi nefrolitiază infectată pot necesita antibiotice. 6) Probioticele ar putea reduce absorbţia oxalatului, dar sunt necesare mai multe date. Concluzii. Prevenirea calculilor renali trece de la tratamentul reactiv la reducerea proactivă a riscurilor. Accentul se pune pe strategii individualizate, bazate pe dovezi, care echilibrează eficacitatea, costurile şi siguranţa. Cercetările recente susţin atât strategiile consacrate, cât şi cele emergente.Introduction. Kidney stone disease (nephrolithiasis) is on the rise globally, especially in women. It's caused by mineral buildup in the kidneys. Even with surgery, recurrence is common, driving up healthcare costs and patient burden. Both genetic and environmental factors play a role, so prevention is key. Objective. This study provides an updated summary of recent strategies for preventing kidney stones, with a particular focus on calcium stones, aiming to offer actionable insights for improved patient outcomes. Material and methods. This review synthesizes findings from a decade of peer-reviewed publications, focusing on nephrolithiasis and, more precisely, calcium stone prevention strategies. It consolidates the latest advancements from the scientific literature to provide an updated understanding of effective approaches in this crucial area of kidney health. Results. Guidelines advise: 1) Fluid intake of 2.5-3.0 L/day to ensure urine output >2-2.5 L/day - simple and effective. 2) Lifestyle: maintain a healthy BMI, avoid dehydration (esp. with heat/exercise), and don't smoke. 3) Diet: 1000-1200 mg calcium/day, reduce sodium, oxalate-rich foods, excess vitamins C/D, and animal protein; increase plant protein and citrus for citrate. 4) Medications like thiazides, potassium citrate, or allopurinol, depending on the stone type. 5) Recurrent UTIs and infected stones may need antibiotics, but weigh the resistance risks. 6) Probiotics might lower oxalate absorption, but more data is needed. Conclusion. Kidney stone prevention is shifting from reactive treatment to proactive risk reduction. The emphasis is moving toward individualized, evidence-based strategies that balance efficacy, cost, and long-term safety. Recent research supports both established and emerging strategies
Electrocardiographic changes in patients with acute pulmonary embolism
Get PDFIntroduction. Pulmonary embolism is a life-threatening condition requiring prompt diagnosis. While contrast-enhanced
computed tomography is the gold standard, its limited availability and associated risks necessitate complementary diagnostic
tools. Recent studies suggest that combining multiple electrocardiographic abnormalities into a composite score
may enhance diagnostic performance.
Material and methods. We conducted a prospective, cross-sectional study involving 200 patients with suspected pulmonary
embolism admitted to two hospitals in the Republic of Moldova between 2022 and 2025. Among them, 168 had
confirmed pulmonary embolism based on computed tomography pulmonary angiography, while 32 patients with similar
symptoms but negative imaging served as the control group. All participants underwent a standard 12-lead electrocardiogram
upon admission. A composite electrocardiographic score was applied, incorporating 10 criteria (e.g., sinus tachycardia,
S1Q3T3 pattern, negative T waves in V1-V4, right bundle branch block, and right axis deviation), with a total score
ranging from 0 to 12. Diagnostic thresholds were defined as follows: 0-3 low risk, 4-6 intermediate risk, and ≥7 high risk.
Results. Electrocardiographic abnormalities such as negative T waves in V1–V4 (42.9% vs. 6.2%), atrial fibrillation (28.0%
vs. 6.2%), and S1Q3T3 pattern (21.4% vs. 3.1%) were significantly more frequent in pulmonary embolism patients. A
composite electrocardiographic score of ≥5 demonstrated excellent diagnostic performance: sensitivity 89.9%, specificity
93.8%, positive predictive value 98.7%, and overall accuracy 90.5%. The area under the ROC curve was 0.92, indicating
strong discriminative ability. Among combinations of electrocardiographic findings, the pairing of S1Q3T3 with negative T
waves in V1-V4 showed a statistically significant association with confirmed pulmonary embolism.
Conclusions. Our study confirms that a composite electrocardiographic score ≥5 is a highly effective, rapid, and noninvasive
tool for identifying pulmonary embolism, improving early triage, particularly in emergency settings where imaging
may be delayed. The model significantly outperforms isolated electrocardiographic findings and should be interpreted
within a broader clinical context, including symptomatology and imaging when available