Institutional Repository in Medical Sciences of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Not a member yet
29298 research outputs found
Sort by
Медико-хирургическое ведение врожденных пороков и хирургических заболеваний гепатобилиарной системы у детей
No full textStructura tezei: Teza a fost expusă pe 300 de pagini: introducere, 6 capitole, concluzii și recomandări, bibliografia 279 surse, 8 anexe, 245 pagini text de bază, 178 de figuri, 29 de tabele. Rezultatele obținute au fost publicate în 74 de lucrări științifice, 4 brevete de invenție și 5 certificate de inovator.
Cuvinte-cheie: Colestază neonatală, atrezia căilor biliare, chistul congenital de coledoc, hipertensiune portală la copil, anomalii congenitale
Scopul studiului: Optimizarea tehnicilor de diagnostic și tratament în anomaliile congenitale și afecțiunile chirurgicale ale sistemului hepato-biliar la copii.
Obiectivele studiului: 1. Stabilirea incidenței anomaliilor congenitale și afecțiunilor chirurgicale ale sistemului hepato-biliar la copil. 2. Elaborarea procedeelor de diagnostic a pacienților cu anomalii congenitale și afecțiuni chirurgicale ale sistemului hepato-biliar în scopul selectării perioadei optime de tratament chirurgical.
3. Elaborarea algoritmilor de diagnostic și prognozare a complicațiilor în anomaliile congenitale ale sistemului hepato-biliar la copil. 4. Aprecierea modificărilor hemodinamice, metabolice în hipertensiune portală la copil. 5. Estimarea eficacității algoritmilor de diagnostic și tratament propuse, în comparație cu procedeele nestandardizate de management. 6. Optimizarea tehnicilor chirurgicale în afecțiunile și anomaliile congenitale ale sistemului hepato-biliar în baza evaluării clinico-imagistice și bioumorale.
Noutatea științifică: În premieră în Republica Moldova a fost elaborat un model integrat de diagnostic și tratament bazat pe stratificarea pacienților, algoritmi de predicție a complicațiilor și tehnici chirurgicale, optimizând conduita terapeutică și chirurgicală în patologiile hepato-biliare la copii.
Problema științifică importantă soluționată în teză: Lucrarea prezintă o analiză a anomaliilor congenitale și afecțiunilor chirurgicale hepato-biliare la copii, dezvoltând un algoritm inovator pentru diagnosticul și tratamentul hipertensiunii portale, cu impact pozitiv asupra prognosticului, hemoragiilor digestive, morbidității și mortalității pediatrice.
Semnificația teoretică: Cercetarea a identificat factorii de risc și particularitățile clinice ale afecțiunilor hepato-biliare pediatrice, optimizând diagnosticul diferențial, abordarea terapeutică personalizată și monitorizarea evoluției prin investigații biochimice și imagistice. Algoritmul propus a redus complicațiile și durata spitalizării.
Valoarea aplicativă: Implementarea algoritmului inovator a permis diagnosticarea și corectarea rapidă a malformațiilor hepato-biliare, îmbunătățind tratamentele. Tehnicile minim invazive, susținute de imagistică modernă, au redus complicațiile și au accelerat recuperarea, iar standardizarea intervențiilor și șuntarea porto-sistemică au optimizat gestionarea hipertensiunii portale la copii.
Implementarea rezultatelor: Rezultatele studiului sunt aplicate în activitatea Centrului Național Științifico-Practic de Chirurgie Pediatrică „Acad. Natalia Gheorghiu”, Spitalul Clinic Municipal de Copii nr. 3 „Valentin Ignatenco” și spitalele clinice din Bălți și Cahul.Structure of the thesis: The thesis consists of 300 pages, including an introduction, 6 chapters, conclusions and recommendations, a bibliography with 279 sources, 8 annexes, 245 pages of main text, 178 figures, and 29 tables. The results were published in 74 scientific papers, 4 patents, and 5 innovator certificate.
Keywords: Neonatal cholestasis, biliary atresia, congenital choledochal cyst, pediatric portal hypertension, congenital anomalies.
Study purpose: To optimize diagnostic and treatment techniques for congenital anomalies and surgical conditions of the hepato-biliary system in children.
Study objectives: 1. Establish the incidence of congenital anomalies and surgical conditions of the hepato-biliary system in children. 2. Develop diagnostic methods for patients with congenital anomalies and surgical conditions of the hepato-biliary system to determine the optimal timing for surgical treatment. 3. Create diagnostic algorithms and complication forecasting for congenital anomalies of the hepato-biliary system in children. 4. Assess the hemodynamic and metabolic changes in pediatric portal hypertension. 5. Evaluate the effectiveness of the proposed diagnostic and treatment algorithms compared to non-standardized management methods. 6. Optimize surgical techniques for congenital anomalies and hepato-biliary conditions based on clinical-imagistic and biochemical evaluations.
Scientific novelty: For the first time in Moldova, an integrated diagnostic and treatment model was developed, including patient stratification, complication prediction algorithms, and surgical techniques, optimizing therapeutic and surgical management of hepato-biliary pathologies in children.
Significant scientific problem solved: The study provides an analysis of congenital anomalies and surgical conditions of the hepato-biliary system in children, developing an innovative algorithm for the diagnosis and treatment of portal hypertension with a positive impact on prognosis, digestive hemorrhages, pediatric morbidity, and mortality.
Theoretical significance: The research identified risk factors and clinical features of pediatric hepato-biliary conditions, optimizing differential diagnosis, personalized therapeutic approaches, and disease monitoring through biochemical and imaging investigations. The proposed algorithm reduced complications and hospital stay duration.
Practical value: Implementing the innovative algorithm enabled rapid diagnosis and correction of hepato-biliary malformations, improving treatments. Minimally invasive techniques supported by modern imaging reduced complications and accelerated recovery, while standardizing interventions and porto-systemic shunting optimized the management of pediatric portal hypertension.
Implementation of results: The study results are applied in the activities of the National Scientific-Practical Center of Pediatric Surgery "Acad. Natalia Gheorghiu," the Municipal Children's Clinical Hospital No. 3 "Valentin Ignatenco," and the clinical hospitals of Bălți and Cahul.Структура диссертации: Работа изложена на 300 страницах, включая введение, 6 глав, рекомендации, библиографию с 279 источниками, 8 приложения, 245 страниц основного текста, 178 рисунков и 29 таблиц. Результаты были опубликованы в 74 научных работах, 4 патентах и 5 свидетельстве новатора.
Ключевые слова: Неонатальный холестаз, атрезия желчных путей, врожденная киста холедоха, портальная гипертензия у детей, врожденные пороки.
Цель исследования: Оптимизация методов диагностики и лечения врожденных пороков и хирургических заболеваний гепатобилиарной системы у детей.
Задачи исследования: 1. Определение распространенности врожденных пороков и хирургических заболеваний гепатобилиарной системы у детей. 2. Разработка методов диагностики пациентов с врожденными пороками гепатобилиарной системы для выбора оптимального времени хирургического лечения. 3. Создание алгоритмов диагностики и прогнозирования осложнений при врожденных пороках гепатобилиарной системы у детей. 4. Оценка гемодинамических и метаболических изменений при портальной гипертензии у детей. 5. Оценка эффективности предложенных диагностических и лечебных алгоритмов в сравнении с нестандартизированными методами. 6. Оптимизация хирургических техник при врожденных пороках и заболеваниях гепатобилиарной системы на основе диагностических данных.
Научная новизна: впервые в Республике Молдова разработана интегрированная модель диагностики и лечения, основанная на стратификации пациентов, алгоритмах и хирургических техниках, оптимизирующая терапевтический и хирургический подход при гепатобилиарных патологиях у детей.
Важная научная проблема, решенная в диссертации: Работа представляет собой анализ врожденных пороков и хирургических заболеваний гепатобилиарной системы у детей, разработав инновационный алгоритм диагностики и лечения портальной гипертензии, с положительным воздействием на прогноз, кровотечения из ЖКТ, детскую заболеваемость и смертность.
Теоретическая значимость: Исследование выявило факторы риска и клинические особенности гепатобилиарных заболеваний у детей, оптимизируя дифференциальную диагностику, персонализированные терапевтические подходы и мониторинг заболеваний через исследования. Предложенный алгоритм сократил осложнения и продолжительность госпитализации.
Практическая ценность: Внедрение инновационного алгоритма обеспечило быструю диагностику и коррекцию врожденных пороков гепатобилиарной системы, улучшив лечение. Минимально инвазивные техники, поддерживаемые современными визуализационными методами, снизили осложнения и ускорили восстановление, а стандартизация вмешательств и порто-системное шунтирование оптимизировали ведение при портальной гипертензии у детей.
Внедрение результатов: Результаты исследования применяются в работе Национального научно-практического центра детской хирургии “Acad. Natalia Gheorghiu”, Муниципальной детской клинической больницы № 3 “Valentin Ignatenco” и клинических больниц в Бельцах и Кагуле
Clinical and evolutionary aspects of neuroinfections: a study from 2019 to 2024
No full textBackground and objectives. Neuroinfections are significant due to their epidemiology, unpredictable nature, and
diverse clinical manifestations. This study aimed to determine the characteristic of neuroinfections in patients admitted to an infectious diseases hospital.
Materials and methods. The study was conducted on 106 patients with acute neuroinfections at the “T. Ciorba”
Hospital for Infectious Diseases in the Republic of Moldova from 2019 to 2024.
Results. Neuroinfections were suspected upon admission in 51 (48.1%) cases. The ratio of patients with aseptic CSF
to those with septic CSF was 66 (62.3%) to 40 (37.7%) cases. Significant differences between aseptic vs septic CSF
neuroinfections were observed for patient age 34.9±15.8 years and 19±18 years (p < 0.0001); headache 98.4% vs
67.5% (p < 0.0001); neck stiffness 72.7% vs 42.5% (p = 0.0021); vomiting 57.5% vs 77.5% (p = 0.0372); photophobia
37.8% vs 17.5% (p = 0.0280). The aetiology was identified or suspected in 28 (42.4%) patients with aseptic CSF compared to 36 (90%) with septic CSF. The disease progressed more severely in septic CSF cases – 92% (37 patients) vs
40.9% (27 patients) with aseptic CSF (p < 0.0001), and in children – 80.6% (25 cases) vs adults – 52% (39 cases) (p =
0.0064). Complications developed in 71 (66.9%) patients, primarily in septic meningitis. These included cerebral edema, toxic shock, pneumonia, reactive arthritis, and decreased cognitive abilities. A total of 10 patients (9.4%) died.
Conclusions. Neuroinfections are a medical emergency in the Republic of Moldova, associated with frequent and
potentially fatal sequelae. Timely management involves point-of-care diagnostics, including PCR tests, and early
pathogen-directed therapy. Prioritization should focus on enhancing vaccination coverage and strengthening surveillance networks
Epidemiology of healthcare-associated infections in children undergoing hematopoietic stem cell transplantation
Get PDFIntroduction. Approximately half a century ago, allogeneic hematopoietic stem cell transplantation
(HSCT) became an essential therapeutic option for treating severe conditions, thus offering a new
chance at life for children with various hematologic and oncologic diseases.
The purpose of this study is to analyze the epidemiological peculiarities of HCAIs in children
undergoing HSCT.
Materials and Methods. A systematic review of the literature was conducted with an overview of
epidemiological aspects of HCAIs in children undergoing HSCT, related to the incidence and mortality
of the disease, isolated pathogens and the risk factors that influence the development of IAAM.
Results. HCAIs are major complications in children undergoing HSCT, with incidence rates ranging
from 5% to 50%, being higher in allogeneic compared to autologous transplants.
Bloodstream infections (BSIs) are the most frequent, with an estimated incidence of 20%-44% and a
mortality rate between 10% and 50%. HCAIs caused by resistant Gram-negative bacteria increase
mortality to 45%, while fungal infections raise it to 75%. Pneumonia and gastrointestinal infections,
including Clostridium difficile infection, are other frequently encountered complications. Urinary tract
infections are rare and are usually associated with the presence of a urinary catheter. A retrospective
study conducted over 21 years showed that 41% of children who underwent HSCT developed at least
one bloodstream infection. Another study reported an incidence of 28.2% of HCAIs in children
undergoing HSCT, with a proportion of 32.8% for BSIs. Of these, 93.4% were associated with central
venous catheterization, and the mortality rate was 36.9%. A study conducted in Italy identified
Coagulase-negative staphylococci and Enterobacteriaceae as the most frequent pathogens, each
causing approximately 25% of BSI cases, followed by Enterococci and Pseudomonas aeruginosa. The
main identified risk factors include: prolonged immunosuppression; severe and prolonged neutropenia;
use of central venous catheters; mechanical ventilation and prolonged hospitalization.
Conclusion. Children undergoing HSCT have an increased vulnerability to HCAIs due to a
combination of risk factors related to immunosuppression and invasive medical procedures. Early
identification of these factors and the implementation of rigorous strategies for infection prevention
and control are essential to reduce the incidence and impact of these complications in this vulnerable
population
Surgical treatment of hemorrhoids through Doppler-guided hemorrhoidal artery ligation
No full textVahtang Gugava „Tratamentul chirurgical al hemoroizilor prin ligaturarea transanală a arterelor
hemoroidale cu utilizarea dopplerometriei ultrasonore”, teza pentru obținerea gradului științific de
doctor în științe medicale, Chișinău, 2025. Teza este expusă pe 141 pagini, constă din introducere, 4
capitole, sinteza datelor obținute, concluzii generale, recomandări practice, 53 tabele, 43 figuri, 126 surse
bibliografice. La tema tezei au fost publicate 18 lucrări științifice.
Cuvinte-cheie: Boala hemoroidală, hemoroizi, HAL-RAR, metoda combinată, hemoroidectomia clasică
Domeniul de studiu: 321.13 – Chirurgie
Scopul cercetării: Ameliorarea rezultatelor tratamentului chirurgical al hemoroizilor prin prisma evaluării
comparative a eficienței metodei de ligaturare transanală a arterelor hemoroidale cu utilizarea
dopplerometriei ultrasonore.
Obiectivele lucrării: (1) Implementarea în practică și evaluarea rezultatelor aplicării metodei de ligaturare
transanală a arterelor hemoroidale prin utilizarea dopplerometriei ultrasonore cu mucopexie (HAL-RAR).
(2) Determinarea particularităților vascularizării rectului de artera rectală superioară cu utilizarea
dopplerometriei ultrasonore. (3) Aprecierea rezultatelor utilizării metodei combinate (HAL și metoda
clasică de tratament chirurgical a BH). (4) Analiza comparativă a rezultatelor precoce și la distanță ale
metodelor de tratament chirurgical al hemoroizilor: metodei HAL-RAR, metodei combinate și metodelor
clasice (Milligan-Morgan, Whitehead, Ferguson sau Parks). (5) Precizarea indicațiilor și contraindicațiilor
către aplicarea metodei HAL-RAR, metodei combinate și metodelor tradiționale. (6) Elaborarea unui
algoritm diagnostico-curativ optimizat al pacienților cu hemoroizi în funcție de stadiul bolii.
Noutatea şi originalitatea cercetării: Studiul realizat oferă o abordare inovatoare în managementul bolii
hemoroidale, evidențiind o combinare între metodele minim invazive și cele clasice, care nu au fost aplicate
în acest mod într-un cadru clinic prospectiv anterior. Tehnologia Doppler utilizată în premieră în Republica
Moldova în anul 2014 la baza clinică a Catedrei de Chirurgie nr. 5, pentru a ghida procedeul HAL-RAR,
reprezintă o componentă cheie a studiului, iar aplicarea acesteia în combinare cu tehnici chirurgicale
tradiționale reflectă un pas semnificativ în dezvoltarea unei strategii terapeutice mai precise și mai eficiente.
Folosirea ultrasonografiei Doppler pentru identificarea și ligaturarea arterelor hemoroidale oferă o abordare
personalizată, în care intervenția nu mai depinde doar de estimarea vizuală, ci se bazează pe date obiective,
vizualizând direct fluxul sanguin patologic.
Problema științifică aplicativă de importantă majoră soluționată Studiul actual abordează o problemă
importantă în domeniul chirurgiei proctologice, și anume tratamentul bolii hemoroidale avansate, o
afecțiune cu o prevalență mare la nivel global și cu un impact semnificativ asupra calității vieții pacienților.
Deși există diverse opțiuni terapeutice, tratamentele clasice, cum ar fi hemoroidectomia, sunt adesea
asociate cu riscuri postoperatorii și recuperare îndelungată. Pe de altă parte, tehnica HAL-RAR, deși
eficientă în formele mai ușoare de boală, nu este suficientă în cazurile avansate. În acest context, problema
soluționată prin această cercetare este integrarea metodelor minim invazive cu tehnicile clasice pentru a
optimiza tratamentul bolii hemoroidale severe. Studiul a arătat că, combinarea HAL cu hemoroidectomia
clasică aduce îmbunătățiri semnificative ale rezultatelor, cu o scădere considerabilă a riscurilor
postoperatorii, o recuperare mai rapidă și o reducere a recidivelor. Astfel, algoritmul diagnostico-curativ
propus în teză permite abordarea individualizată a pacienților cu boala hemoroidală, care poate fi integrat
cu succes în practica curentă, aducând beneficii considerabile pacienților și reducând riscurile asociate
intervențiilor chirurgicale tradiționale.
Semnificaţia teoretică și valoarea aplicativă a lucrării: În premieră, s-a realizat un studiu prospectiv de
evaluare a metodelor clasice și minim invazive de tratament chirurgical a pacienților cu boala hemoroidală.
În studiului respectiv a fost obținută ameliorarea rezultatului tratamentului chirurgical prin aplicarea
metodei de ligaturarea transanală a arterelor hemoroidale cu utilizarea dopplerometriei ultrasonore (HALRAR). S-a demonstrat că, metoda HAL-RAR este o metoda minim invazivă eficace de alternativă în
tratamentul chirurgical a pacienților cu boala hemoroidală.
Implementarea rezultatelor ştiinţifice: În baza acestui studiu au fost implementate noi metode de
diagnostic și tratament al pacienților cu boala hemorodială, care au fost implementate în procesul didactic
al Catedrei de Chirurgie nr.5 a IP Universitatea de Stat Medicină și Farmacie „Nicolae Testemițanu” și la
Spitalul Privat „Terramed”.Вахтанг Гугава «Хирургическое лечение геморроя с использованием трансанальной перевязки
геморроидальных артерий с применением ультразвуковой допплерометрии», диссертация на
соискание ученой степени кандидата медицинских наук, Кишинев, 2025. Диссертация изложена на
141 страницах, состоит из введения, 4 глав, синтеза полученных данных, общих выводов,
практических рекомендаций, 53 таблиц, 43 рисунка, 126 библиографических источников. По теме
диссертации опубликовано 18 научных работ.
Ключевые слова: геморроидальная болезнь, геморрой, HAL-RAR, комбинированный метод,
классическая геморроидэктомия.
Область исследования: 321.13 – Хирургия.
Цель исследования: Улучшение результатов хирургического лечения геморроя на основе
сравнительной оценки эффективности метода трансанальной перевязки геморроидальных артерий
с применением ультразвуковой допплерометрии.
Задачи работы: (1) Внедрение в практику и оценка результатов применения метода трансанальной
перевязки геморроидальных артерий с использованием ультразвуковой допплерометрии с
мукопексией (HAL-RAR). (2) Определение особенностей васкуляризации прямой кишки верхней
прямокишечной артерией с использованием ультразвуковой допплерометрии. (3) Практическое
применение и оценка результатов использования комбинированного метода (HAL в сочетании с
классическими методами хирургического лечения геморроидальной болезни). (4) Сравнительный
анализ ранних и отдаленных результатов методов хирургического лечения геморроя: метода HALRAR, комбинированного метода и классических методов (Миллигана-Моргана, Уайтхеда,
Фергюсона или Паркса). (5) Уточнение показаний и противопоказаний для применения метода
HAL-RAR, комбинированного метода и традиционных методов. (6) Разработка оптимизированного
алгоритма диагностики и лечения больных геморроем в зависимости от стадии заболевания.
Новизна и оригинальность исследования: Проведенное исследование предлагает
инновационный подход в лечении геморроидальной болезни, сочетая минимально инвазивные и
классические методы, которые ранее не использовались в клинической практике. Технология
Допплера, впервые примененная в Республике Молдова в 2014 году на базе клиники кафедры
хирургии № 5 для проведения операции HAL-RAR, является ключевым компонентом исследования,
а ее использование в сочетании с традиционными хирургическими техниками представляет собой
важный шаг в разработке более точной и эффективной стратегии. Использование ультразвуковой
допплерометрии для выявления и перевязки геморроидальных артерий предоставляет более
индивидуальный подход, при котором вмешательство зависит не только от визуальной оценки, но
и от объективных данных, с прямым отображением патологического кровотока.
Решенная научная задача: Исследование решает важную проблему в области проктологической
хирургии — лечение поздних стадий геморроидальной болезни, заболевания с высокой
распространенностью и значительным влиянием на качество жизни пациентов. Несмотря на
наличие различных методов лечения геморроя классическими методами - геморроидэктомии, часто
сопряжены с рисками послеоперационных осложнений и длительным восстановлением. В то же
время, техника HAL-RAR, хотя и эффективна при более легких формах заболевания, недостаточна
для лечения тяжелых случаев. Таким образом, исследование решает проблему сочетания
минимально инвазивных методов с классическими техниками для оптимизации лечения тяжелых
форм геморроидальной болезни. Было показано, что комбинация HAL-RAR с классической
геморроидэктомией значительно улучшает результаты, снижает послеоперационные риски,
ускоряет восстановление и снижает частоту рецидивов.
Теоретическая значимость и практическая ценность работы: Впервые проведено
проспективное исследование оценки классических и минимально инвазивных методов
хирургического лечения пациентов с геморроидальной болезнью. Было достигнуто улучшение
результатов хирургического лечения с применением метода HAL-RAR. Доказано, что метод HALRAR является эффективной минимально инвазивной альтернативой для лечения пациентов с
геморроидальной болезнью.
Внедрение научных результатов: На основе этого исследования были внедрены новые методы
диагностики и лечения пациентов с геморроидальной болезнью, которые были применены в
учебном процессе кафедры хирургии № 5 Государственного университета медицины и фармации
«Николае Тестемицану» и в частной клинике «Террамед».Vahtang Gugava "Surgical treatment of hemorrhoids through Doppler-guided hemorrhoidal artery
ligation," Thesis for the degree of doctor of medical sciences, Chisinau, 2025. The thesis is presented on
141 pages and consists of an introduction, 4 chapters, synthesis of the obtained data, general conclusions,
practical recommendations, 53 tables, 43 figures, and 126 bibliographic sources. A total of 18 papers
scientific have been published on the topic of the thesis.
Keywords: Hemorrhoidal disease, hemorrhoids, HAL-RAR, combined method, classical
hemorrhoidectomy.
Field of Study: 321.13 – Surgery
Research Objective: Improving the results of surgical treatment of hemorrhoids through the comparative
evaluation of the effectiveness of the transanal ligation method of hemorrhoidal arteries using ultrasound
dopplerometry.
Objectives of the Thesis: (1) Implementation in practice and evaluation of the results of the application of
the method of transanal ligation of hemorrhoidal arteries using ultrasound dopplerometry with mucopexy
(HAL-RAR). (2) Determination of the peculiarities of the vascularization of the rectum by the superior
rectal artery using ultrasound dopplerometry. (3) Assessment of the results after using the combined method
(HAL and the classical method of surgical treatment of hemorrhoidal disease). (4) Comparative analysis of
the early and long-term results of the surgical treatment methods for hemorrhoids: HAL-RAR method,
combined method, and classical methods (Milligan-Morgan, Whitehead, Ferguson or Parks). (5)
Specification of indications and contraindications to the application of the HAL-RAR method, the
combined method and traditional methods. (6) Development of an optimized diagnostic and curative
algorithm for patients with hemorrhoids depending on the stage of the disease.
Innovation and Originality of the Research: The conducted study offers an innovative approach to the
management of hemorrhoidal disease, highlighting a combination of minimally invasive and classical
methods, which have not been applied in other prior prospective clinical setting. The Doppler technology,
used for the first time in 2014 in the Republic of Moldova at the base of the Surgery Department No. 5
clinic to guide the HAL-RAR procedure, is a key component of the study, and its application in combination
with traditional surgical techniques represents a significant step toward developing a more precise and
efficient therapeutic strategy. The use of Doppler ultrasonography to identify and ligate hemorrhoidal
arteries provides a more personalized approach, where the intervention is no longer solely dependent on
visual estimation but is based on objective data, directly visualizing the pathological blood flow.
Major Applied Scientific Problem Addressed: This study addresses an important issue in proctological
surgery, namely the treatment of advanced hemorrhoidal disease, a condition with high global prevalence
and a significant impact on patients' quality of life. Although various therapeutic options exist, classical
treatments such as hemorrhoidectomy are often associated with postoperative risks and prolonged recovery.
On the other hand, the HAL-RAR technique, while effective for milder forms of the disease, is insufficient
for advanced cases. In this context, the issue resolved by this research is the integration of minimally
invasive methods with classical techniques to optimize the treatment of severe hemorrhoidal disease. The
study demonstrated that combining HAL-RAR with classical hemorrhoidectomy results in significant
improvements in outcomes, with a considerable reduction in postoperative risks, faster recovery, and a
reduction in recurrence rates. Thus, the proposed diagnostic and curative algorithm allows for an
individualized approach to patients with hemorrhoidal disease, which can be successfully integrated into
current practice, offering considerable benefits to patients and reducing the risks associated with traditional
surgical interventions.
Theoretical Significance and Practical Value of the Work: For the first time, a prospective study was
conducted to evaluate the classical and minimally invasive methods of surgical treatment of patients with
hemorrhoidal disease. In this study, improvement in surgical treatment outcomes was achieved through the
application of the transanal ligation of hemorrhoidal arteries using ultrasonic dopplerometry (HAL-RAR).
It was demonstrated that the HAL-RAR method is an effective minimally invasive alternative for the
surgical treatment of hemorrhoidal disease.
Implementation of Scientific Results: Based on this study, new methods for the diagnosis and treatment
of patients with hemorrhoidal disease have been implemented, which were incorporated into the teaching
process at the Surgery Department No. 5 of the State University of Medicine and Pharmacy "Nicolae
Testemitanu" and at the Private Hospital "Terramed"
Stem cells in regenerative dentistry: actualities and future directions
Get PDFIntroduction. Stem cells are pluripotent cells capable of differentiating into various specialized cell
types, making them a promising tool in regenerative dentistry. Their potential to regenerate different
parts of the teeth, such as pulp, periodontal ligament, and alveolar bone, presents a biological
alternative to traditional dental treatments.
Materials and Methods. This paper is based on a literature review of regenerative medicine. We used
Google Scholar, PubMed, and other relevant databases to identify relevant documents about the
reconstruction of the teeth using stem cells. Out of 47 articles were selected 20 published within the
last 10 years.
Results. Stem cells used in regenerative dentistry include dental pulp stem cells (DPSCs), periodontal
ligament stem cells (PDLSCs), and stem cells from exfoliated deciduous teeth (SHEDs). These cells
are isolated via enzymatic digestion of dental tissues and cultured in specific media containing growth
factors such as epidermal growth factor (EGF) and fibroblast growth factor (FGF) for expansion. To
induce differentiation, DPSCs are cultured in mineralizing media for odontogenesis, while PDLSCs
are treated with factors like transforming growth factor-beta (TGF-β) to stimulate periodontal
regeneration. Biomaterial scaffolds, such as hydroxyapatite and collagen, are used to support cell
attachment and tissue formation. Animal models, including rodents and large mammals, are employed
to test the regenerative potential of stem cells in vivo, using histological analysis and molecular assays
to assess tissue integration, differentiation, and marker expression.
Preclinical studies have demonstrated the successful regeneration of dental tissues. DPSCs have been
shown to differentiate into odontoblast-like cells and form dentin-like structures, facilitating pulp
regeneration. PDLSCs have been used to regenerate periodontal tissues, including alveolar bone and
ligament fibers when combined with scaffolds. Early clinical trials also indicate favorable outcomes
in periodontal regeneration, with improved tissue healing and function.
Conclusion. Stem cell-based therapies in regenerative dentistry hold significant potential for tissue
restoration, providing a biological solution for dental tissue loss. While preclinical results are
promising, further refinement of cell differentiation protocols, scaffold design, and clinical trials is
necessary to establish standardized and effective therapies for broader clinical use
Anatomical variants of the deep brachial artery
Get PDFIntroduction. Lately, due to the gradual increase of interventional radiological procedures and
vascular reconstructive surgeries on the upper limb, knowledge about anatomical variants of the upper
limb blood vessels has become more important. Our goal was to establish the anatomical variants of
the deep brachial artery (DBA) in order to streamline the interventional procedures and surgical
techniques carried on the upper limb.
Materials and methods. The variability of the DBA, that is the main collateral branch of the brachial
artery (BA), was studied on 70 formolized adult upper limbs. The cadaveric material belonged to the
Department of Anatomy and Clinical Anatomy of Nicolae Testemitanu State University of Medicine
and Pharmacy, Chisinau, Republic of Moldova. Through anatomical dissection, the origin of the DBA,
its course and relationship to the radial nerve (RN) were studied.
Results. Anatomical variants of the DBA were identified in 14.3% of cases (95% CI [7.0-23.4]): in
8.6% (95% CI [2.6-15.8]) it presented number variants, and in 5.7% (95% CI [1.3-11.8]) – it was a
component of common arterial trunks (CAT). In cases of double DBA, the second artery in 5.71% of
cases, derived from the BA, having a various arrangement towards radial nerve (RN) when entering
the humeromuscular canal (posterior to the RN – 2.9%; anterior to the RN – 1.43%; lateral to the RN
– 1.43%); in the remaining 2.9% (95% CI [0.0-7.8]) – the second DBA had its origin in 1.43% (95%
CI [0.0-4.8]) from the posterior circumflex humeral artery (PCHA) and superior collateral ulnar artery
(SCUA). CAT with 3 branches were determined in 4.3% (95% CI [0.0-9.8]): 1) SCUA, subscapular
artery (SA) and DBA (1.43%); 2) DBA and two muscular branches – 1.43%; 3) DBA, SCUA and a
muscular branch were present in 1.43% of cases. CAT branching into two arteries: the DBA and SCUA
were determined in 1.43%.
Conclusions. The atypical origin of the DBA should be taken into consideration by surgeons when
harvesting the muscle flaps from the lateral region of the arm. Knowledge about the common arterial
trunks variation, particularly when the DBA appears as their component is necessary to increase the
efficiency in coronary bypass and in diagnostics and treatment of the brachial region surgical
interventions
Particularitățile asistenței anesteziologice a nou-născuților prematuri cu malformații congenitale și afecțiuni chirurgicale la nou-născuți prematuri
Get PDFBuilding a RAG system for tissue engineering: insights from domain specific text and sepsis management
Get PDFIntroduction: Tissue engineering (TI) is a complex field that requires access to specific domain
knowledge. Large Language Models (LLMs) are powerful but limited by their training data. Retrieval
Augmented Generation (RAG) addresses this limitation by integrating LLMs with external knowledge
sources. This work explores the design and implementation of a RAG system for TI, inspired by our
successful applications in specific domains, including sepsis management. Such a system can greatly
enhance the efficiency and accuracy of knowledge retrieval and generation in TI.
Materials and Methods: The RAG system for TI can be developed using a large language model
augmented by a vector database of TI literature. The knowledge base is to be curated from research
papers, textbooks, and other domain-specific texts. These texts can be processed to create embeddings
stored in a vector database for efficient retrieval. When a user submits a query, the LLM generates an
initial response and retrieves relevant information from the database to refine its output, ensuring
accuracy and relevance. The RAG-based sepsis management system that can serve as an example that
can be adapted to TI is available (after sending a request to [email protected]) at:
https://huggingface.co/spaces/LlmRAGbasedAPPs/LLM_MA_RAG_Sepsis.
Results: Our previous implementations of RAG in different domains have shown that integrating
external knowledge significantly enhances the accuracy and relevance of LLM-generated responses.
For TI, we anticipate this approach will similarly improve the system's ability to handle complex,
domain-specific queries.
Conclusions: The development of a RAG system for tissue engineering represents a significant step
forward in leveraging AI technologies for domain-specific applications. By combining the generative
capabilities of LLMs with the precision of a curated knowledge base, we can create a tool that not only
understands the language of TI but also possesses the depth of knowledge required to make meaningful
contributions to the field. This work outlines the design, implementation, and expected benefits of such
a system, drawing from our successful experiences in other domains
Gestionarea clinică a muscăturilor de şarpe veninos: o serie de cazuri
No full textIn tropical rural communities, snakebite envenomation is among the main causes of morbidity and
mortality. It results in shock, hemorrhage, tissue necrosis, and swelling. Diagnosing and identifying snake species is challenging, necessitating thorough clinical assessments and point-of-care
tests. Hence this case series examines follow up on the course of clinical care and management
of snake envenomation cases in Erode District, India, a location known for poisonous snakes such
as the spectacled cobra (Naja naja), Russell's viper (Daboia russelii), and common krait (Bungarus
caeruleus).
This case series summarizes the hospital experience of patients with snake envenomation who
were hospitalized to a local government medical college and hospital.
Five patients were confirmed or suspected of having been envenomated by a snake. Four patients
received antivenom. The regional venom response team offered management guidance and antivenom. One patient's hospitalization was protracted and worsened by respiratory failure and corneal dystrophies. All patients survived and were discharged.
This series emphasizes the necessity of early and comprehensive management measures to reduce morbidity and mortality from snake envenomation, as well as the need for ongoing research
and interventions to improve patient care in a variety of clinical settings.în comunitățile rurale tropicale, muşcătura de şarpe veninos este una dintre principalele cauze ale
morbidității şi mortalității. Aceasta duce la şoc, hemoragii, necroză tisulară şi edem. Diagnosticarea
şi identificarea speciilor de şerpi reprezintă o provocare, necesitând evaluäri clinice amănunţite şi
teste de diagnostic la unitatea medicala primară. Astfel, această serie de cazuri analizează evoluţia clinică şi gestionarea cazurilor de muşcături de şarpe veninos în districtul Erode, India, o zonă
cunoscută pentru şerpii de acest fel, precum Cobra indianä (Nojoa naja), Vipera lui Russell (Daboia
russelii) şi Krait-ul comun (Bungarus caeruleus).
Această serie de cazuri rezumă experiența clinică a pacienților muşcaţi de un şarpe veninos, care
au fost spitalizați la un Colegiu medical guvernamental şi spital.
Cinci pacienţi au fost confirmați sau suspectați că au fost muşcaţi de un şarpe. Patru pacienţi au
primit ser antiviperin. Echipa regională specializată a oferit ghidaj pentru gestionarea cazurilor şi
administrarea de ser antiviperin. Spitalizarea unui pacienta fost prelungită din cauza insuficienţei
respiratorii şi a distrofiilor corneene. Ca rezultat, toți pacienții au supraviețuit şi au fost externați.
Acest studiu subliniază necesitatea unor masuri de gestionare precoce şi completă pentru a reduce morbiditatea şi mortalitatea cauzată de muşcăturile de şarpe veninos, precum şi necesitatea
unor cercetări şi intervenții continue, pentru a îmbunătăți îngrijirea pacienţilor în diverse situaţii
clinice