Arta Medica

HYBRID TREATMENT OF INFRARENAL ABDOMINAL AORTIC ANEURYSM WITH INVOLVEMENT OF THE COMMON ILIAC ARTERY – CASE REPORT

Sorin Barat — 2023-12-24

Introduction. Endovascular abdominal aortic aneurysm repair (EVAR) has been extensively used in the treatment of abdominal aortic aneurysms (AAA). Over time, the indications have progressively expanded, and sometimes, when the aneurysm involves the iliac axis, exclusion of the internal iliac artery is necessary to ensure an appropriate landing zone.

Case presentation. A 63-year-old patient diagnosed with an infrarenal aortic aneurysm involving the right common iliac artery, confirmed by CT angiography. The decision was made to perform endovascular abdominal aortic aneurysm repair with extension into the left external iliac artery, followed by embolization of the main trunk of the right internal iliac artery and the installation of a femoro-femoral crossover bypass using an allograft. Angiographic control revealed no signs of endoleak in the endograft. At the 3-month follow-up CT angiography, the aneurysmal sac did not enhance, and the endograft showed no signs of endoleak.

Conclusions. Infrarenal abdominal aortic aneurysm with involvement of the unilateral iliac axis can be successfully resolved using a hybrid approach, involving coil embolization of the internal iliac artery trunk to prevent endoleak and femoro-femoral crossover bypass for the purpose of avoiding acute ischemia of the lower limb.

HYBRID TREATMENT OF ACUTE ON CHRONIC MESENTERIC ISCHAEMIA ASSOCIATED WITH TAKAYASU’S DISEASE. CLINICAL CASE

Aurel Turcan — 2023-12-24

Introduction. Mesenteric ischemia remains a currently underdiagnosed pathology with high mortality rates in hospitals. In recent years, endovascular and hybrid approaches have widely begun to be used in the treatment of these patients.

Clinical case. We present the case of a 56-year-old woman diagnosed with acute on chronic mesenteric ischemia associated with Takayasu's arteritis. Considering the worsened medical history and imaging data, the decision was made to resort to hybrid intervention for the revascularization of the superior mesenteric artery. The following procedures were performed: direct and indirect thrombectomy from the superior mesenteric artery, open retrograde mesenteric stenting, and autologous venous patch plasty of the arterial defect. Intraoperatively, due to difficulties in passing the endograft from the retrograde approach, a brachial artery puncture and negotiation of the lesion from antegrade and retrograde approaches were employed. Immediate postoperative angiographic findings: restoration of anterograde flow in the superior mesenteric artery with good perfusion of the arterial territory; upon abdominal cavity revision, the liver (right lobe) and intestine were viable throughout. The patient's preoperative symptoms disappeared upon the commencement of feeding. Intestinal transit remained intact. Follow-up at 1 and 5 months confirmed stent patency. Discharged home in a satisfactory condition with tab. Clopidogrel 75 mg and tab. Rivaroxaban 5 mg treatment.

Conclusions. Mesenteric ischemia represents a devastating event that requires a prompt strategy for diagnosis and treatment. Hybrid intervention for the revascularization of the superior mesenteric artery stands as a safe and effective method in treating this pathology.

THE USE OF CAROTID-BRACHIAL BYPASS IN SEVRE ISCHEMIA OF THE UPPER LIMB

A. Castravet — 2023-12-24

Introduction. In cases of occlusions in the subclavian-axillary arterial axis with severe upper limb ischemia, the use of endovascular methods or orthotopic bypass may be necessary. When technical limitations or the patient's condition make these options impossible, the carotid-brachial bypass serves as an alternative.

The aim of this study is to assess the feasibility of using extra-anatomic carotid-brachial bypass in revascularizing the upper limb in severe ischemia.

Materials and Methods. The study involves 5 patients with occlusion in the subclavian-axillary axis presenting severe upper limb ischemia. Among them, 3 had acute occlusion due to atherosclerotic stenosis, where initial thrombectomy (embolectomy) procedures failed; one patient had subclavian artery aneurysm thrombosis, and another had grade IV atherosclerotic occlusion with gangrene in the second digit, where endovascular intervention was unsuccessful. All patients underwent a carotid-brachial bypass using an inverted internal saphenous graft. The grafts were placed suprafascially above the clavicle.

Results. Complete resolution of ischemia was observed in all 5 patients. Distal pulses were restored in 4 patients. In the patient with chronic grade IV atherosclerosis and concurrent forearm artery involvement, the pulse was restored at the brachial artery bifurcation. This patient underwent finger amputation. No complications were recorded. Subjective discomfort due to the suprafascial and supraclavicular placement of the bypasses was also not reported.

Conclusion. Suprafascial and supraclavicular carotid-brachial bypasses represent an alternative to orthotopic bypasses, especially in cases where endovascular methods fail or are contraindicated.

IMPACT OF GUT MICROBIOTA ON ANKYLOSING SPONDYLITIS EVOLUTION

Lia Chislari — 2023-12-24

Introduction. Ankylosing spondylitis is the best-studied prototype of spondyloarthritis characterized by sacroiliitis and spondylitis, which can lead to bone ankylosis.

Objective. Predict their gut microbiota in patients with ankylosing spondylitis and identify their specific gut microbiota characteristics for ankylosing spondylitis phenotypes.

Material and methods. In this study, 60 patients were included in the study – 41 patients with ankylosing spondylitis and 19 – in control lot. Patients with ankylosing spondylitis were recruited from the rheumatology and arthrology departments of "Timofei Moșneaga" Republican Clinical Hospital, the clinical base of the Discipline of Rheumatology and Nephrology of "Nicolae Testemitanu" State University of Medicine and Pharmacy, during 2019-2022.

Results. From patients' fecal samples, 52 bacterial species were identified. The predominant genera were defined as comprising more than 1% of all gut bacteria. In the ankylosing spondylitis group, 12 predominant species were detected, of which only 8 species were detected in the control group, including 7 genera detected in both groups. Bacteroides were the species most commonly found in both groups, but with significant reduction in patients with ankylosing spondylitis.

Conclusions. Our study revealed specific changes in the gut microbiome in patients with different phenotypes of ankylosing spondylitis, and the classification model based on gut microbial characteristics could provide a new direction for early clinical diagnosis. What's more, discovering ankylosing spondylitis - associated microbes in the gut microbiome may help us seek more treatments for this severe and disabling pathology.

ADENOPROSIN – A DRUG WITH PATHOGENIC ACTION IN DISEASES OF THE PROSTATE GLAND. EXPERIMENTAL STUDY

Ion Dumbraveanu — 2023-12-24

Introduction. Prostate diseases, known and treated since ancient times, remain a major and controversial problem of urology. Etiopathologic theories of benign prostate disease have undergone major changes over the last decade. Hormonal involvement in the pathogenesis of benign prostatic hyperplasia is no longer considered paramount, the essential role in the occurrence and progression of hyperplasia being attributed to inflammatory processes.

The study aimed to review, in the light of new scientific theories, the anti-inflammatory activity of Adenoprosin, rectal suppositories 150 mg, on an experimental model of aseptic prostatitis compared to placebo.

Material and methods. The study was conducted based on the analysis of literature data on the role of inflammation in benign prostatic hyperplasia and the experimental compartment performed on 80 male white rats, in the Wistar line. The Adenoprosin drug, rectal suppositories 150 mg, was tested compared to placebo in models of acute and chronic abacterial prostatitis. In acute prostatitis, the drug was administered for 7 days, and in chronic prostatitis 15 days. Treatment efficacy criteria consisted of assessing general condition, prostate weight, and inflammatory and proliferative histological changes.

Results. In rats administered adenoprosin, the severity of the inflammatory process, in both acute and chronic abacterial prostatitis, was reduced. The surface of epithelial cells in the stromal area of the prostate was restored, decreasing the level of vascular congestion and decreasing epithelial desquamation. The histological picture of the prostate post-treatment was close to that of healthy rats, unlike rats given placebo where venous congestion and signs of inflammatory proliferation remained.

Conclusions. The entomological origin Adenoprosin drug, rectal suppositories 150 mg, demonstrated an obvious anti-inflammatory effect in the experimental model of acute aseptic or chronic abacterial induced prostatitis on Wistar line rats, significantly compared with Placebo (р<0,05).

The study opens new perspectives on pathogenesis and methods of treatment of benign pathologies of the prostate.

COMORBIDITIES IN PSORIATIC ARTHRITIS AND PSORIASIS: CONSIDERATIONS FOR THE CLINICIAN

Lucia Dutca — 2023-12-24

Objectives: to assess the practical clinical value of comorbidities in psoriasis and psoriatic arthritis.

Material and methods. A group of 92 patients, with psoriatic arthritis, established in accordance with the CASPAR diagnostic criteria (2006) was selected with a prospective study with retrospective components. The average age of patients with psoriatic arthritis was 42.9±9.6 years, the average duration of psoriasis was 11 (7; 25.8) years, the average duration of psoriatic arthritis was 7 (2; 11.8) years. Among the patients included in the study were 42 (45.7%) men and 50 (54.3%) women.

Results. The most common pathology was hypertension with a frequency of 38%, exertional angina – in 5.4% and postinfarct cardiosclerosis – in 2.2%, chronic heart failure – in 6.5% of patients. Cardiovascular pathology combined with diabetes mellitus, dyslipidemia, etc., was observed in 16.3% of patients. Cerebrovascular disorders were detected in 3.3%.

Conclusions. A holistic approach to patients with PsA and Ps is recommended – focusing not only on skin or joint symptoms, but also on all aspects of the disease, including comorbidities, can improve the management of the disease and prevent long-term mental and physical impairment.

SARCOPENIC OBESITY – THE DIAGNOSTIC PARADIGM

Natalia Taran — 2023-12-24

Introduction. Sarcopenic obesity is a multifactorial condition characterized by the simultaneous presence of sarcopenia and obesity. Obesity and insulin resistance have been shown to be a risk factor for sarcopenia, and sarcopenic obesity is considered a condition in which skeletal muscle is replaced by fat. Sarcopenic obesity can lead to frailty, disability and increased morbidity and mortality, which is a significant burden on health and social care systems. Studying sarcopenic obesity and effective treatment management are important in relation to the continued growth of the obese population.

Objectives. Analysis of the contemporary literature in view of the etiology, mechanisms of development of sarcopenic obesity, stages, criteria and evaluation methods of sarcopenic obesity.

Material and methods. Contemporary literature analysis focused on the main databases: PubMed, SpringerLink and Scopus (Elsevier) was performed. The keywords used were obesity, sarcopenia, sarcopenic obesity. Inclusion criteria served clinical practice guidelines, scientific articles on current knowledge addressed in the last 10 years: pathophysiology, hormonal changes, management of sarcopenic obesity. Exclusion criteria were articles that did not meet the current requirements and information provided for patients.

The study was realized in the terms of National Programm „Chronic liver and pancreatic diseases: nutritional and surgical aspects” 20.80009.8007.37.

Results. The study includes the etiology and evolutionary mechanisms of sarcopenic obesity, metabolic research, oxidative, inflammatory, hormonal and nutritional stress. The diagnostical approach, criteria and evaluation methods of sarcopenic obesity are presented.

Conclusions. Sarcopenic obesity requires evaluation in persons with increased risk of obesity or who have other clinical comorbidities. The peculiarities of sarcopenic obesity, as well as the methods of treatment and nutritional correction, require further study.

FEATURES OF THE ECONOMIC IMPACT OF ANTIMICROBIAL RESISTANCE ELUCIDATED IN SCIENTIFIC PUBLICATIONS

Larisa Pantea — 2023-12-24

Objectives. Highlighting the particularities of the economic impact of resistance to antimicrobial preparations and establish the methodologies used in estimating the antimicrobial resistance burden exposed in scientific publications.

Methods. The current study is a synthesis with the evaluation of 19 scientific articles selected from PubMed. The review of the scientific publications included in the study has revealed that the economic impact of antimicrobial resistance entails a series of costs, assignable to hospitals, to patients and to society as a whole.

Results. The most common approach applied in the analyzed publications consists in referring to antimicrobial resistance as an externality. Studies performed on the basis of a hospital, focus mainly on the direct costs induced by antimicrobial resistance. Studies that analyze the economic impact of the antimicrobial resistance on a global level or the macroeconomic one, offer forecasts regarding the main macroeconomic indicators – global domestic product, international trade, livestock production etc., on the basis of different scenarios of development of antimicrobial resistance. About a third of the scientific articles focus not only on measuring the impact of antimicrobial resistance, but also suggest policies, mechanisms and instruments to diminish antimicrobial resistance spread and, thus, decrease the costs associated with antimicrobial resistance.

Conclusions. The wide spread of antimicrobial resistance in time will increase the economic burden, by increasing healthcare costs, decreasing labor productivity and Gross Domestic Product, livestock production and external trade, and inducing not only quantitative, but also qualitative effects on global economy. Developing countries face deeper problems regarding the economic impact of antimicrobial resistance, it is observed especially on macroeconomic level.

THE INTRICATE PATHWAYS IN AGEING

Angela Platon — 2023-12-24

Background. Researchers tried to find out how age-related pathologies can be prevented by keeping the biomarkers levels under control since their changes might induce abnormalities. The purpose was to analyze aspects that might accelerate, and fight off the action of endogenous and exogenous factors on the metabolism of aging.
Material and methods. This study is based on the critical analysis of 35 literature sources out of 74 selected from PubMed, NCBI, Google Scholar data that highlight the most essential concepts.
Results. Biological age represents the modified aspects of metabolism and physiological processes. The antioxidant system and reactive oxygen species play a key role in slowing down, and accelerating the aging metabolism; genetic markers detect the aging factors; genome mutations are responsible for premature aging.
Conclusions. Hence, it’s important to make a balance between a healthy lifestyle, a proper skincare routine, and maintaining cognitive functions, in order to hope for a “successful aging” by preventing diseases and increasing life expectancy.

THE PROBLEM OF ENDOCRINE DISRUGGERS IN THE REPUBLIC OF MOLDOVA

Iurie Pinzaru — 2023-12-24

Objectives. There are environmental factors and risks associated with human exposure to synthetic chemicals, and there is growing concern due to the health risks posed by endocrine disruptors. In this regard, the aim and objectives of the study were to identify the endocrine disrupting phytosanitary agents used in agriculture in the Republic of Moldova, the levels of their use and their contamination of agricultural products and surface waters used for drinking water supply, as well as to assess the morbidity and mortality of the population caused by endocrine disruptors.

Materials and methods. An analysis was made of the level of use in agriculture of the Republic of Moldova of phytosanitary products, including chemicals that disrupt the functioning of the endocrine system. The levels of pollution of agricultural products and surface waters of the Dniester and Prut rivers by endocrine disruptors were studied. The morbidity and mortality of the population of the Republic of Moldova from endocrine diseases were studied.

Results. The population of the Republic of Moldova is exposed to a wide range of phytosanitary chemicals, including those that disrupt the functioning of the endocrine system, contained in agricultural products and in the surface waters of the Dniester and Prut rivers. The content of endocrine disruptors in fruits, vegetables and cereals ranged from 1,2 to 6,0 maximum allowable levels.

A tendency of 2,2-fold increase in the prevalence rate of endocrine diseases, including diabetes mellitus 1,9-fold, as well as population mortality from diabetes mellitus more than 2-fold in the years of COVID-19 pandemic was revealed.

Conclusions. Understanding the presence of health risk factors from endocrine disruptors will help to apply a number of effective preventive measures aimed at reducing morbidity and mortality from endocrine diseases.

CYTOPROTECTIVE EFFECT OF MELDONIUM ON CARDIOMYOCYTE

Olga Chetruș — 2023-12-24

Background. The use of myocardial cytoprotectors (meldonium) in patients with exertional angina is a scientific-practical dilemma.

Material and methods. An open randomized clinical trial was conducted involving 160 patients with chronic heart failure (117 men and 43 women) aged 37 to 81 years. Of them, 142 patients had angina pectoris of stable effort from different functional classes, and 21 – unstable angina pectoris. Study groups were comparable according to the frequency of indication of background drugs and meldonium.

Results. The results of our study indicate the activation of oxidative stress in patients with stable angina pectoris, relevant in this regard being the changes of malonic dialdehyde, catalase and superoxide-dismutase, which become more pronounced in the first 24 hours after the start of the treatment and, although, by the 6^th month an attenuation of the activity of the prooxidant status is detected, it intensifies by 12 months it intensifies.

Discussions. All results completes the vision based on the link between the antioxidant defense and the aggravated cardiovascular evolution. Another consolidated aspect is to demonstrate the superior effectiveness of meldonium administration. There was demonstrated the effectiveness feasibility of meldonium vis-à-vis the markers of oxidative stress, endothelial dysfunction and comparable systemic inflammation.

Conclusions. The inclusion of metabolic drugs in the complex treatment of patients with stable angina increases the clinical effectiveness of basic pharmacotherapy 4 times when prescribing meldonium (p <0,001), mainly due to increased antianginal actions.

EVALUATION OF RESISTANCE PATTERNS OF PRIORITY GRAM-NEGATIVE BACCILI ISOLATED FROM CLINICAL BIOSUBSTRATES

Maria Anton — 2023-12-24

Objectives. Antimicrobial resistance is listed among the top ten health threats, according to WHO reports. In addition to the fact that it has already reached alarming proportions in many regions of the world, this phenomenon is constantly increasing, causing enormous social and economic damage. The purpose of the study is to evaluate the resistance profiles of priority Gram-negative bacilli.

Material and methods. An experimental microbiological study was carried out with the examination of a total of 2062 strains of E. coli, K. pneumoniae, A. baumannii and P. aeruginosa isolated from blood, cerebrospinal fluid and urine, during 2022, using the cultural method as well as the Vitek-2 Compact automated system, and the susceptibility testing to antimicrobial preparations was performed by the disc-diffusimetric (KirbyBauer) and automated (Vitek-2 Compact) method. The interpretation of the results was carried out based on the EUCAST standard.

Results. The highest level of resistance of E. coli strains isolated from blood and cerebrospinal fluid was registered to ampicillin/amoxicillin (83.8%), followed by third generation cephalosporins (3.9%). The resistance of K. pneumoniae reached alarming percents to practically all groups of antimicrobials tested: fluoroquinolones (98.7%), aminoglycosides (94.7%), cephalosporins (94.7%), penicillins (93.7%). The resistance structure of P. aeruginosa strains isolated in 2022 was decreasing compared to previous years, but an increased level was still recorded in the carbapenem group (53.3%). Absolutely all strains of A. baumannii were resistant to fluoroquinolones and to carbapenems and aminoglycosides the resistance percent of these strains exceeded 90.0%.

Conclusions. In 2022, a slight decrease in the resistance of the isolated strains is recorded for most of the tested antimicrobials, compared to the years 2020 and 2021, but the situation remains worrisome, because of the high levels of resistance that are found in more than 50% of the researched strains.