Moldova State University of Medicine and Pharmacy
Stefan Voda, Moldova
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Mathioudakis A.G.,University of Manchester | Chatzimavridou-Grigoriadou V.,General Hospital of Nikaia St Panteleimon | Corlateanu A.,Moldova State University of Medicine and Pharmacy | Vestbo J.,University of Manchester
European Respiratory Review | Year: 2017

Challenges in the differentiation of the aetiology of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have led to significant overuse of antibiotics. Serum procalcitonin, released in response to bacterial infections, but not viral infections, could possibly identify AECOPD requiring antibiotics. In this meta-analysis we assessed the clinical effectiveness of procalcitoninbased protocols to initiate or discontinue antibiotics in patients presenting with AECOPD. Based on a prospectively registered protocol, we reviewed the literature and selected randomised or quasi-randomised trials comparing procalcitonin-based protocols to initiate or discontinue antibiotics versus standard care in AECOPD. We followed Cochrane and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidance to assess risk of bias, quality of evidence and to perform meta-analyses. We included eight trials evaluating 1062 patients with AECOPD. Procalcitonin-based protocols decreased antibiotic prescription (relative risk (RR) 0.56, 95% CI 0.43-0.73) and total antibiotic exposure (mean difference (MD) -3.83, 95% CI (-4.32--3.35)), without affecting clinical outcomes such as rate of treatment failure (RR 0.81, 0.62-1.06), length of hospitalisation (MD -0.76, -1.95-0.43), exacerbation recurrence rate (RR 0.96, 0.69-1.35) or mortality (RR 0.99, 0.58-1.69). However, the quality of the available evidence is low to moderate, because of methodological limitations and small overall study population. Procalcitonin-based protocols appear to be clinically effective; however, confirmatory trials with rigorous methodology are required. © ERS 2017.

Raba T.I.,Moldova State University of Medicine and Pharmacy
Voprosy Prakticheskoi Pediatrii | Year: 2017

The specificity of this clinical case is late diagnosis of portal hypertension when confirming the diagnosis in a 12-year-old boy with a history of an acute icteric form of hepatitis G. Against the background of treatment prescribed in accordance with the practice guidelines of the World Gastroenterology Organisation for treatment of hepatitis B (2015) - M.Pevzner diet No 5; hepatoprotective drugs, recombinant human interferon alpha-2 - the boy's general wellbeing improved, total bilirubin nor maised, ALT and AST levels decreased from 1547 and 1265 IU/ml to 78 and 58 IU/ml, respectively; prothrombin index increased from 54% to 72-80%. The diagnosis of disease was considerably complicated by an outright refusal of the patient's parents to undergo liver biopsy, and unauthorized early withdrawal from the antiviral drug worsened the course of disease: 3 months later the boy felt worse. Later on, disease took a wave-like course and was associated with development of asthenic and dyspeptic syndromes, lesions of the bile ducts, intrahepatic cholestasis, persistent cytolysis and severe liver fibrosis (according to elastography - stage F4). Immunological dynamic examination found only positive total antibodies to the surface antigen of the hepatitis B virus, whose titer 12 years after primary vaccination against hepatitis B virus increased from 20 to 40 and 72.2 IU/L. Scanty immunological changes without histological confirmation have not allowed the final verification of diagnosis. Dynamic observation and broadening of the spectrum of differential-diagnostic measures at this stage offer little material to explain the causes of recurrent cytolysis or early formation of liver cirrhosis and portal hypertension. We do not exclude a combined course of chronic hepatitis G against the background of undiagnosed diffuse chronic disease of the liver.

Siafakas N.,University of Crete | Corlateanu A.,Moldova State University of Medicine and Pharmacy
COPD: Journal of Chronic Obstructive Pulmonary Disease | Year: 2017

Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous and complex disease with great morbidity and mortality. Despite the new developments in the managements of COPD, it was recognized that not all patients benefit from the available medications. Therefore, efforts to identify subgroups or phenotypes had been made in order to predict who will respond to a class of drugs for COPD. This review will discuss phenotypes, endotypes, and subgroups such as the frequent exacerbator, the one with systemic inflammation, the fast decliner, ACOS, and the one with co-morbidities and their impact on therapy. It became apparent, that the “inflammatory” phenotypes: frequent exacerbator, chronic bronchitic, and those with a number of co-morbidities need inhaled corticosteroids; in contrast, the emphysematous type with dyspnea and lung hyperinflation, the fast decliner, need dual bronchodilation (deflators). However, larger, well designed studies clustering COPD patients are needed, in order to identify the important subgroups and thus, to lead to personalize management in COPD. © 2017 Taylor & Francis Group, LLC.

Agency: European Commission | Branch: FP7 | Program: CSA-CA | Phase: HEALTH-2007-4.1-8 | Award Amount: 679.12K | Year: 2009

The EECAlink is a coordination action aimed at identification of joint research priorities of the EU and EECA countries and strengthening scientific collaboration among them. International Cooperation Partner Countries targeted by our proposal are: Armenia, Belarus, Georgia, Kazakhstan, Moldova, Russia, Ukraine and Uzbekistan. EECAlink represents (i) a measure of active encouragement of the international Health research related cooperation and allows (ii) strengthening of the existing bi-lateral scientific collaboration of all participating university/academia partners. Project consortium was balanced to be able to act as a pipe-line for communication of the (iii) research priorities of EECA countries to relevant EU policy makers and vice versa, (iv) help to coordinate future joint calls relevant to the Health Theme. Last, but not least, (v) to build capacities for proposal submission in FP7. EECAlink is proposed to run for 30 months. For the project communication and impact evaluation purposes, we have defined three major target stakeholder groups: 1. Policy makers this target group is further divided into (i) European and (ii) national. The first stakeholder group represents a key element for creation of European added value through identification of joint research opportunities for future calls in the area of Health research 2. Universities and academia partners the project is coordinated by the Charles University in Prague and represents a consortium of ten academic partners, who wish to both strengthen and extend their international collaboration in topics identified in FP7-TP Health programme 3. Wider RTD public research and innovation managers and individual scientific group leaders from participating countries interested in submitting own FP7 proposals

Cutolo M.,University of Genoa | Zampogna G.,University of Genoa | Vremis L.,Moldova State University of Medicine and Pharmacy | Smith V.,Ghent University | And 2 more authors.
Journal of Rheumatology | Year: 2013

Objective. Systemic sclerosis (SSc) is characterized by microvascular injury, fibrosis, and hypoxia of involved tissues. The vasoactive peptide endothelin-1 (ET-1) seems to be implicated in these events. Using nailfold videocapillaroscopy (NVC), we evaluated longterm effects of ET-1 antagonist treatment on nailfold microvascular damage in patients with SSc, over a 3-year followup period. Methods. Thirty patients with SSc (mean age 64 ± 5 yrs, mean disease duration 8 ± 1 yrs) were recruited during their programmed standard treatment protocols. At baseline (T0), 15 patients with SSc (mean age 63 ± 15 yrs, mean disease duration 7 ± 3 yrs), already receiving cyclic intravenous infusion of iloprost (5 continuous days, average 80 μg/day, every 3 mo), continued the treatment for a further 3 years (ILO group). The remaining 15 patients with SSc (mean age 68 ± 13 yrs, mean disease duration 8 ± 4 yrs), although they continued the same cyclic intravenous iloprost treatment as the previous group, also received bosentan 125 mg twice a day for 3 years (ILO+BOS group). Qualitative analysis (scleroderma patterns) and semiquantitative scoring of the microvascular damage were performed by validated routine NVC methods. Results. During followup, a statistically significant increase of capillary number was observed in the ILO+BOS group (p < 0.02), with a significant and progressive increase of angiogenesis (p < 0.01). In contrast, the ILO group showed a statistically significant decrease of capillary number (p < 0.05). After 3 years the number of capillaries was significantly higher in the ILO+BOS group than in the ILO group (p < 0.05). The score for giant capillaries decreased significantly in both groups of patients with SSc (p < 0.05). Conclusion. In this open study, longterm treatment with ET-1 receptor antagonist in combination with iloprost was found to interfere with progression of nailfold microvascular damage in patients with SSc, as assessed by NVC over a 3-year followup period. The Journal of Rheumatology Copyright © 2013. All rights reserved.

Agency: European Commission | Branch: FP7 | Program: CP-FP | Phase: HEALTH.2011.1.4-1 | Award Amount: 6.65M | Year: 2012

Acquired and congenital heart disease can necessitate heart valve replacement. However, current heart valve substitutes are not considered ideal as they need anticoagulation, bearing the risk of bleeding when manufactured from non-organic material, or they degenerate when they derive from animals or human tissue donators (homografts) thereby leading to frequent reoperation especially in the young population. An ideal heart valve substitute would overcome these limitations and even have the potential to grow when implanted in pediatric patients. Haverich et al. have developed an implant for heart valves, which is better tolerated than the known alternatives and which has the potential for regeneration by autologous recellularization. Implants derive from donated homografts, which are chemically treated to inactivate potential microorganisms and viruses. The heart valves then are decellularized chemically, so that only connective tissue remains, the matrix of the decellularized heart valve (DHV). DHV has been examined in extensive animal studies, including immunological and toxicological analysis, long term and growth models, all of which have shown that the implant is well tolerated and spontaneously recellularized by the recipient. The proposed ESPOIR project is based on auspicious early clinical results in 45 children and young adults. In order to drive translation of this promising regenerative approach towards practical clinical use and to reduce the burden of congenital heart defects in particular, the ESPOIR consortium will undertake a prospective multi-centre trial to include at least 200 patients from 8 leading European Centres for Congenital Heart Surgery, for robust statistical evaluation of DHV in direct comparison to conventional heart valve substitutes.

Tofan G.,Moldova State University of Medicine and Pharmacy | Bodolica V.,American University of Sharjah | Spraggon M.,American University of Sharjah
Health Expectations | Year: 2013

Background: The physician-patient relationship is a critical component of the integrated approach to excellence in health-care delivery. Although commonly modelled within the boundaries of the agency theory and regarded as synonymous to an agent-principal interaction, there exists only a sparse understanding about the most effective ways of governing it. Objective: This article undertakes a selective review of the growing body of research on the governance of the physician-patient relationship to discuss the current state of the knowledge in the field and suggest promising avenues for further exploration. Findings: On the basis of an extensive analysis of the relevant literature, we identify two emerging streams of inquiry on the trust-based (i.e. trust and ethical oversight) and distrust-based (i.e. patient information-empowerment and decision-making authority) governance mechanisms of the physician-patient relationship and discuss the key findings within each stream. Discussion: To conciliate the on-going scholarly debate concerning the efficacy of trust- and distrust-based mechanisms, we draw the foundations of a conceptual framework which might serve as a guide for more integrative research endeavours on the governance of the physician-patient relationship. © 2012 Blackwell Publishing Ltd.

Casian D.,Moldova State University of Medicine and Pharmacy
Chirurgia (Bucharest, Romania : 1990) | Year: 2013

The objective of this study was a psychometric evaluation of the Romanian translated version of ABC-V (Assessment of Burden in Chronic - Venous Disease) questionnaire in patients with uncomplicated varicose disease of lower limbs. All components of the questionnaire were translated from the English version into the Romanian language and after that backwards, discussed, adopted and pre-tested. Evaluation of the final version of the translated questionnaire demonstrated acceptable results: missed questions in 3% of forms, no ceiling effect and low floor effect, good split-half reliability (rs = 0.61,p < 0.01) and significant correlation between test and re-tests cores (rs = 0.86, p < 0.01). There was no significant influence of age and sex upon average ABC-V scores. Study results support the application of ABC-V questionnaire for assessing the severity of chronic venous disease as well as for quantitative evaluation of patient satisfaction and health status improvement after varicose vein treatment in the Romanian-speaking population.

Wallace L.S.,Alcoa | Brinister I.,Moldova State University of Medicine and Pharmacy
Journal of the American Board of Family Medicine | Year: 2010

Background: As part of the former Soviet Union, the Moldovan health system was highly centralized and geared toward inpatient care. The objective of this study was to explore the personal experiences of female family physicians in Chişinǎu, Moldova. Methods: A purposeful sample of female family physicians was recruited to participate in this study. A professional translator conducted in-depth interviews using an 8-item semistructured questionnaire to capture personal practice experiences, scope of practice, and beliefs. Verbatim responses were summarized using a continuous iterative process. Results: Twenty female family physicians (mean age, 42.4 ± 7.2 years; mean clinical experience, 12.2 ± 7.9 years) were included in the sample. Analysis of the data illuminated 4 key themes: (1) family medicine, as a specialty, offered much diversity and personal satisfaction; (2) appointment time restraints and paperwork demands posed significant challenges to providing care to patients; (3) problems faced by patients were complex and went far beyond the leading causes of morbidity and mortality; and (4) patients generally have a limited amount of health-related knowledge, but increased access to health information was bridging this gap. Conclusion: Although family medicine is a rewarding career, system-related factors posed significant challenges, not only in providing quality care but in day-to-day satisfaction.

Ghidirim G.,Moldova State University of Medicine and Pharmacy
Chirurgia (Bucharest, Romania : 1990) | Year: 2011

Primary iliac vein aneurisms are extremely rare being described as anomaly, without any history of trauma, cardiovascular pathology or arteriovenous fistula. This clinical condition has a high rate of potentially fatal complications: pulmonary embolism; ruptured aneurism; deep vein thrombosis. There are only 7 cases of iliac vein aneurism described in the literature. We describe an additional case of a 59-year old patient presented with abdominal pain, right lower limb edema and palpable mass in the right iliac area. Ultrasound (US) revealed a liquid formation, confirmed by computed tomography (CT). Surgical removal of the aneurism with lateral venorrhaphy was performed. Postoperative evolution was uneventful. The patient is asymptomatic during 36 month follow-up.

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