Periventricular leukomalacia (PLM) is a term used to describe white matter damage to the brain of premature infants, with both a focal and diffuse component. The aim of the study was to analyze bibliographic data with reference to the causes, risk factors, clinical presentation and imaging criteria for the differential diagnosis of periventricular leukomalacia with other pathologies. The methodology for selecting bibliographic sources included accessing the medical databases PubMed - Medline, Hinari, using the keywords: “periventricular leukomalacia”, “magnetic resonance imaging”, “multiple sclerosis”, “cerebral microangiopathy”, “differential diagnosis”, for the last 25 years. From about 2000 publications, 25 scientific sources in English relevant to the studied subject were selected. Results: The word “leucomalacia” is derived from the greek “leukos” meaning white and “malacia” meaning softening. Periventricular leucomalacia is morphologically defined by 2 histopathological components - a focal necrotic component in the periventricular region of the cerebral white matter and a diffuse component characterized by reactive gliosis in the surrounding white matter. The “watershed” vascularization of the periventricular region determines increased sensitivity to hypoxic-ischemic events, with the subsequent development of periventricular lesions with ventricular wall deformation that can be diagnosed by transcranial ultrasonography in newborns or by magnetic resonance imaging (MRI) in patients of different ages. Periventricular lesions in T2w hypersignal are not characteristic only for periventricular leukomalacia, they are also evidenced in pathologies such as multiple sclerosis, cerebral microangiopathy, but can exist as a variant of the norm in the terminal myelination areas of the white matter. The challenges of the differential diagnosis of periventricular leukomalacia arise especially in cases when patients did not present clinical manifestations characteristic of the pathology in childhood, but being examined by cerebral MRI in adulthood for other reasons, imaging changes apparently similar to those in multiple sclerosis, cerebral lacunar infarcts, etc. are highlighted. When discrepancies appear between clinical and imaging manifestations, they should be treated with caution and require additional investigations. Conclusions: Knowledge of the typical radiological manifestations of PLM with changes in the periventricular region, associated with ventricular wall traction and local atrophy of the affected white matter, will allow avoiding the wrong diagnosis of this pathology. For a more accurate interpretation of the characteristic PLM lesions in the differential diagnosis with periventricular changes of other genesis, it is important to collaborate between the clinician and the imaging physician in order to provide data from the patient’s disease history, including data related to the antenatal and early postnatal period, for a correct therapeutic decision for the benefit of the patient.
Ocrelizumab, a humanized monoclonal antibody that targets CD20-positive B cells, has significantly advanced the treatment of multiple sclerosis (MS). Approved for both relapsing-remitting MS and primary progressive MS, it represents a novel approach in MS therapy. Since the end of 2023, Republic of Moldova has incorporated ocrelizumab into its national treatment guidelines, providing access to this innovative therapy for its population. This review provides a detailed analysis of ocrelizumab’s mechanism of action, clinical efficacy, safety profile, and long-term impact based on data from clinical trials and real-world studies. Additionally, the review explores ocrelizumab’s comparison with other disease-modifying therapies, its role in patient quality of life, and the future direction of MS treatment.
Introduction. Aortic stenosis is the most common valvular disease among elderly patients and carries a poor prognosis if left untreated. Transcatheter aortic valve implantation (TAVI) has emerged as an effective alternative to surgical valve replacement, particularly in high- and intermediate-risk patients. The type of valve implanted may significantly influence postoperative outcomes. Aim of study. To assess the efficacy and safety of TAVI based on the type of prosthesis used: self-expanding (SEV) versus balloon-expandable (BEV). Materials and Methods. A prospective study was conducted on 114 patients over 70 years old with severe aortic stenosis who underwent TAVI: Abbott valve (n=44), Medtronic (n=40), Edwards (n=30). Valve performance and safety were evaluated according to Valve Academic Research Consortium-3 (VARC-3) criteria. Results. No significant differences were observed between groups regarding age, BMI, sex, or comorbidities. Edwards valves showed the highest post-TAVI mean pressure gradients (16.2 ± 6.7 mmHg), followed by Abbott (12.4 ± 6 mmHg) and Medtronic (10.1 ± 3.5 mmHg, pless than 0.001). Vmax was significantly higher in the Edwards group at all followups (pless than 0.01), indicating greater residual stenosis risk. Left ventricular function was similar across groups. Paravalvular regurgitation was more frequent with Edwards (pless than 0.001 vs. Abbott, p=0.008 vs. Medtronic). High-grade AV block and permanent pacemaker implantation were more frequent in the SEV group. Mortality and rehospitalization rates were similar between groups. Conclusions. TAVI proved to be an effective and safe treatment for severe aortic stenosis in elderly patients. The type of prosthesis influences hemodynamic performance and complication profile, highlighting the need for individualized valve selection based on patient characteristics.
Introduction: Acute myocardial infarction remains a leading cause of cardiovascular mortality worldwide [1 ]. However, ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI) patients differ in clinical profile - STEMIs often cause greater acute myocardial damage, whereas NSTEMIs tend to occur in older patients with more comorbidities [1]. These differences may impact 12-month outcomes. Aim: To compare the clinical and functional characteristics of patients who died within 12 months after revascularized STEMI versus NSTEMI, identifying factors associated with 1-year mortality. Methods: We performed a retrospective observational study of 1,078 revascularized MI patients (528 STEMI, 550 NSTEMI) followed for one year. We identified 176 patients who died within 12 months (95 STEMI and 81 NSTEMI) and analyzed their baseline risk factors, clinical presentation (including Killip class), laboratory findings, echocardiographic parameters (left ventricular ejection fraction - LVEF), and comorbidities. Results: The two groups of deceased patients were similar in age (~70 years). Both had very high prevalence of hypertension (>90%) and a low proportion of active smokers (~12%). NSTEMI decedents more often had diabetes (~55% vs 44%) and hypercholesterolemia (~79% vs 57%) than STEMI decedents. NSTEMI decedents also had more frequently a history of prior MI (~50% vs ~36%), stroke (23% vs 12%), or peripheral arterial disease (16% vs 8%). By contrast, cardiogenic shock at presentation was more common in STEMI decedents (Killip class IV in 27% vs 16%). Severe left ventricular dysfunction (LVEF less than 30%) was present in about half of the patients in both groups. Acute atrial fibrillation occurred more often in STEMI (30% vs 18%). Conclusions: Within 12 months post-infarction, patients dying after STEMI had more severe acute presentations (more cardiogenic shock and arrhythmias), whereas those dying after NSTEMI had a higher burden of risk factors and comorbidities. Nonetheless, both cohorts exhibited significant left ventricular dysfunction and high complication rates, indicating that both the acute infarct severity and underlying chronic conditions contribute to 1-year mortality after MI.
The paper justifies its theme by highlighting the need for the integration of scientifically validated complementary therapies into oncological practice, in the context of current challenges related to the rehabilitation of cancer patients. The scientific foundations of using biotechnologies and phytotherapy in integrative oncological medicine are emphasized, through the definition of complementary treatment, the mechanisms involved (immunomodulation, antioxidation, regeneration), and the relevance of the gut-liver-immunity axis. The methodology included criteria for patient selection, administration methods for patented phytotherapeutic products, monitoring parameters (clinical, biochemical, qualitative), and the use of validated tools - functional scores, VAS scales, quality of life (QoL) questionnaires, and laboratory tests. The work is based on original patented contributions of the authors (Prof. Ion Mereuță, Dr. Vladimir Carauș), highlighting relevant patents (number, title, summary), the analysis of formulations (mechanism of action, indications, preclinical studies), and their potential integration into oncological support guidelines. Case studies describe the administration of these formulations to oncology patients during or after chemotherapy, monitoring parameters such as immunity, liver function, nutritional status, and clinical progress. Clinical results indicated a reduction in oxidative stress markers (MDA ↓, SOD and GPx ↑), improvement in liver function (ALT, AST, GGT ↓), enhanced quality of life and adaptability of patients, along with the safety and good tolerability of the treatment. The discussions incorporated scientific correlations with international literature, synergies between patented components, and the importance of standardizing phytopreparations. Arguments were made for including the patented therapies in oncological protocols, emphasizing the necessity of applied research and therapeutic innovation. Proposals were made for extended clinical trials, partnerships, and internationalization initiatives.
Hypertension remains the leading cardiovascular risk worldwide. The most recent World Health Organization (WHO) Global Report on Hypertension indicated that the number of hypertensive patients has almost doubled in the last three decades, with an annual increase in deaths, disability and related costs. It is also important to note that an increasing number of hypertensive patients, despite the use of three or more drugs, do not achieve normalization of blood pressure, thus defining the clinical scenario of resistant hypertension. To confirm the presence of resistant hypertension, various causes of pseudo-resistant hypertension and secondary hypertension must be excluded. Inadequate blood pressure control should be confirmed by measuring blood pressure outside the doctor's office. Resistant hypertension affects approximately 5% of the hypertensive population and is associated with increased cardiovascular morbidity and mortality. Management includes lifestyle interventions and optimization of current drug therapy. Additional drugs should be introduced sequentially if BP remains uncontrolled, and renal denervation may be considered as an additional treatment option. However, achieving optimal blood pressure control remains a challenge in this setting. The data presented are part of the literature review/ results obtained within the institutional project with the acronym DIAFEREZIS.
A large proportion of patients undergoing coronary angiography for angina pectoris do not have obstructive epicardial coronary arteries (ANOCA). In these patients, the prevalence of demonstrable ischemia (INOCA) varies between 10% and 30%, depending on the stress test performed. In recent years, research has focused on defining, classifying, and treating these patients according to INOCA endotypes. Inflammation and endothelial dysfunction play a key role in the onset and progression of chronic non-obstructive coronary artery disease (non-obstructive CAD), and identifying the correlation between these mechanisms and the disease itself may offer a targeted therapeutic strategy. This synthesis presents data from the last 10 years of the specialized literature, searched on Google Scholar and PubMed using keywords such as: inflammation in non-obstructive CAD, anti-inflammatory therapy in non-obstructive CAD. The selected studies, with scientific relevance, focused on the clinical importance, mechanism, evaluation, and management of non-obstructive CAD, with particular emphasis on the role of inflammation, endothelial dysfunction, and anti-inflammatory therapy
Multimorbidity has become a major public health issue, imposing a substantial burden on both patients and the healthcare system. Since multimorbidity is not a diagnosis, the phenomenon's prevalence remains unknown in daily clinical practice, and it's impact is underestimated. A retrospective cohort study included 2592 patients aged 18 years and older (58.2% women). Multimorbidity was identified in 59.4% of cases. Women were more affected by multimorbidity, and the number of multimorbid patients in the urban population was statistically higher than in rural areas.
The presented data are part of the literature review/results obtained within the institutional project with the acronym DIAFEREZIS. Hypertension and type 2 diabetes mellitus (T2DM) are among the most common chronic diseases with a significant impact on global health. The prevalence of these conditions has alarmingly increased in recent decades, being closely linked through common pathophysiological mechanisms. This paper aims to analyze the correlation between hypertension and T2DM, examine the effects of renal denervation on these conditions, and present data from specialized literature.
Introduction. Data from clinical trials suggest the effectiveness of renal denervation in improving cardiac function and exercise capacity in hypertensive patients with heart failure with preserved ejection fraction and reduced ejection fraction. The data presented are part of the literature review/results obtained within the institutional project with the acronym DIAFEREZIS. Aim. Comparative evaluation of the efficacy of renal denervation versus pharmacological treatment on exercise capacity and plasma NT-proBNP levels in patients with resistant hypertension, heart failure with preserved ejection fraction in association or without type 2 diabetes mellitus at two years of follow-up. Materials and methods. To achieve the research objectives, a prospective, open, randomized clinical trial was conducted that enrolled 250 eligible patients with resistant hypertension and heart failure with preserved ejection fraction. Patients were divided into two groups of 125 subjects each depending on the presence of type 2 diabetes mellitus, subsequently, each group was randomized into three evaluation groups in accordance with the treatment supplemented to the previously administered standardized one: groups I and IV - Moxonidine, groups II and V - Bisoprolol and patients in groups III and VI underwent renal denervation. Patients were evaluated for a period of 2 years. Results. Patients in all research groups demonstrated an authentic increase in the distance covered in the "6-minute walk" test already at 6 months of evaluation, this dynamic being comparable in the pharmacological and interventional treatment groups in patients without diabetes, while in the group of resistant hypertensive patients with type 2 diabetes, the group of patients undergoing RDN shows statistical superiority in improving this parameter. Increased at the initial stage in all six research groups, the plasma level of NT-proBNP recorded a statistical reduction when applying all three therapeutic approaches in both patients without and with type 2 diabetes already at 6 months of monitoring, the groups of patients undergoing RDN showing statistical superiority in improving this parameter, a notable event until the end of the surveillance period. Conclusions. Both pharmacological treatment with the SNS blockers Moxonidine and Bisoprolol, and the minimally invasive one with RDN improved the exercise capacity of patients with resistant hypertension, HF with preserved ejection fraction with or without type 2 diabetes mellitus already at 6 months of evaluation, the beneficial effect being amplified until the end of the surveillance period. Comparative analysis of the dynamics of the distance covered in the "6 min walk" test reveals a statistical superiority of RDN versus both pharmacotherapeutic regimens at the earlier stages in the group of patients with type 2 diabetes mellitus and starting with 12 months of evaluation in the group of non-diabetic patients, the trend manifesting until the end of the study. The authentic reduction of the plasma level of NT-proBNP was marked in all research groups from the first monitoring stage independently of the presence of type 2 diabetes mellitus when applying all three treatment schemes, RDN demonstrating a superior therapeutic efficiency compared to both therapeutic regimens.
Subclavian Steal Syndrome (SSS) is a vascular disorder characterized by occlusion or stenosis of the proximal subclavian artery, resulting in a compensatory retrograde blood flow through the ipsilateral vertebral artery. This altered hemodynamic state may lead to a variety of clinical manifestations, including neurological deficits, cardiovascular symptoms, and ischemia of the affected upper limb. Furthermore, SSS is recognized as a potential cause of syncope or presyncopal episodes due to cerebral hypoperfusion, particularly triggered by positional changes of the arm. The etiology of SSS is most frequently linked to atherosclerotic disease, though it may also result from congenital arteriovenous malformations or iatrogenic causes, such as postoperative complications following coronary artery bypass grafting (CABG), especially when the internal mammary artery is utilized as a conduit. The defining feature of SSS lies in the reversal of blood flow and the disruption of normal circulatory dynamics. This hemodynamic compromise can have significant cardiovascular implications, highlighting the importance of vigilant monitoring in patients with a history of coronary artery surgical interventions. Accurate assessment of postoperative blood flow is essential to prevent serious complications, including myocardial ischemia. Additionally, routine measurement of blood pressure in both arms in ambulatory settings should be emphasized, as significant inter-arm blood pressure differences may serve as clinical indicators of underlying vascular pathologies, including SSS, peripheral vascular disease, or other circulatory anomalies
The article contains a study about the morphological and functional specific features of the aortic valvular complex, which is at the base of reconstructive techniques elaboration in acquired aortic valve disease correction. Is presented the contemporary experience of performance in different surgical techniques of aortic valve preservation, the surgical results in the early and long time periods. Is recognized the fact, that the reconstructive correction of all anatomic elements with reestablishment of the aortic valve cusps cooptation, is a preferable alternative valve replacement.
Chronic atrophic gastritis is a pre-neoplastic condition defined by the loss of gastric glandular structures that are replaced by connective tissue (non-metaplastic atrophy) or by inappropriate glandular structures (metaplastic atrophy) with a reduction in gastric secretory function. Annual incidence rates of chronic atrophic gastritis range from 0% to 10.9%. The estimated annual risk of progression of chronic atrophic gastritis to gastric adenocarcinoma varies between 0.1% and 0.3%, an indicator that can be higher (0.5-1%), depending on the severity of the disease, the extent of atrophy, the presence of gastric intestinal metaplasia and other factors. Chronic atrophic gastritis is usually asymptomatic and largely underdiagnosed. Non-specific gastric (epigastric pain, epigastric heartburn, regurgitation, feeling of postprandial fullness and feeling of early satiety) and extra-gastric symptoms can appear in the later evolution of the disease, and the patients in whom the diagnosis is established usually have advanced stages of the disease. Three methods are used to establish the diagnosis and extent of chronic atrophic gastritis: endoscopic evaluation, histological evaluation of biopsy samples, and serological results. However, due to non-specific clinical manifestations and low tolerance to invasive examinations, early diagnosis of the disease remains difficult in clinical practice. Management of chronic atrophic gastritis includes testing and eradication of HP infection, endoscopic surveillance every 3 years of patients with OLGA/OLGIM stages III/IV to increase the likelihood of detecting gastric cancer at an early stage when resection with curative intent is possible, and effective management of co-existing conditions associated with this condition
The objective of the study was to evaluate the long-term efficiency of flexible endoscopic laryngeal surgery (FELS) for the treatment of early glottic carcinoma related to the applied method of anesthesia and ventilation. Ninety patients (males - 82, females - 8) aged 18-83 years (mean - 56.9±10.7) with early glottic carcinoma (T1a- 27, T1b- 24, T2- 39) who underwent FELS and could be followed up for 5 years after the endoscopic intervention were included in the study. Nd:YAG laser ablation of the tumor was performed in all the cases. In 1/3 of the cases, laser ablation was preceded by diathermy snare excision. Adjuvant radiotherapy was offered in 20 of the T2 cases. FELS under local anesthesia with spontaneous ventilation was performed in 57 patients (63.3%), the rest of the patients (n=33 (36.7%)) were operated on under general anesthesia with superimposed high-frequency jet ventilation (SHFJV). For the mentioned 2 groups of patients, respectively, the 5- year overall survival and ultimate disease control (including salvage treatment) were obtained in 93.0% and 87.9% of cases, cure with larynx preservation - in 91.2% and 84.8% of cases, disease-free survival - in 82.5% and 84.8% of cases, ultimate disease control by FELS alone - in 87.7% and 84.8% of cases. The evidence of superior oncological outcomes of FELS under general anesthesia with SHFJV compared to FELS under local anesthesia with spontaneous ventilation was not obtained. From the oncological perspective, FELS can be considered an efficient method of treatment of T1-T2 glottic carcinoma and an alternative to the traditional approaches. Concerning oncological efficiency, awake FELS does not demonstrate inferiority compared to CLEF under general anesthesia with HFJV and is a safe procedure that can be recommended for managing early glottic carcinoma in an outpatient setting.
Introduction: Acute pulmonary thromboembolism (PE) represents a major cause of cardiovascular morbidity and mortality. Assessment of right ventricular (RV) function after an PE episode is crucial for evaluating the risk of chronic thromboembolic pulmonary hypertension (CTEPH) and ventricular dysfunction. Three-dimensional echocardiography (3D TTE) and speckle tracking parameters are modern methods capable of assessing both systolic function and myocardial deformation of the RV, potentially providing additional diagnostic and prognostic value compared to two-dimensional echocardiography. Aim of the study: To identify the relationships between various echocardiographic parameters of RV dysfunction and clinical and biochemical markers in predicting pulmonary hypertension and right ventricular dysfunction in patients who have experienced PE. Material and method: The study included 42 patients with a history of PE, who underwent echocardiographic evaluation at 3-6 months post-acute event. Various right ventricular function parameters were assessed, including 3D RVEF and RV Strain. Additionally, biochemical markers NTproBNP and D-dimers were measured, and patients were stratified according to NYHA, MRC, PVT functional classifications, and grouped based on the echocardiographic probability of pulmonary hypertension (PH). Results: 3D RVEF showed significant differences among NYHA classes, with a p-value of 0.033 (ANOVA); however, no significant differences were observed between the echocardiographic probability of PH and RV deformation, measured by RV Strain (p = 0.3365) or 3D RVEF (p = 0.5992). Significant correlations were identified between RV Strain and TAPSE/sPAP Ratio - r = 0.51 (Pearson), 0.44 (Spearman); 3D RVEF and RV Strain - r = 0.35 (p = 0.014); and 3D RVEF and TAPSE/sPAP Ratio - r = 0.24. NTproBNP and D-dimers were negatively correlated with RV Strain (Pearson = -0.51 and -0.36, respectively). 3D RVEF proved to be a valuable marker for functional risk stratification according to NYHA classes, while RV Strain significantly correlated with pulmonary pressure parameters and RV contractility. Although biochemical markers NTproBNP and D-dimers showed negative correlations with RV deformation, they did not demonstrate a strong predictive value for PH in this study. Conclusions: The analyzed echocardiographic parameters (TAPSE/sPAP, RV A4C, RA Area, RV RVOT) and 3D RVEF and RV Strain demonstrate potential in evaluating right ventricular dysfunction and clinical risk stratification postPE, although validation in larger cohorts is necessary to confirm these findings.
This review aims to highlight the utility and applicability of cardiopulmonary exercise testing (CPET), providing a scientific reference intended to inform cardiologists about the practical considerations in its implementation. CPET is an objective, non-invasive, and comprehensive method for assessing exercise capacity and tolerance, facilitating the identification of pathophysiological and etiological mechanisms of dyspnea and functional limitations of cardiovascular, pulmonary, or idiopathic origin. Materials and Methods. A systematic analysis of approximately 50 scientific sources (original articles, practice guidelines, reviews) was performed by querying the PubMed database using the keyword "cardiopulmonary exercise testing." Selected and analyzed were those papers addressing the methodological, clinical, and prognostic aspects of CPET, with a focus on its applicability in clinical practice. Results. CPET provides objective data regarding aerobic capacity, causes of dyspnea, and prognosis in various cardiopulmonary diseases. It is applicable to patients with cardiac and pulmonary conditions as well as to healthy individuals, including athletes. Evaluated parameters include maximal oxygen uptake (VO2max), minute ventilation, gas exchange, ventilatory reserve, and cardiovascular response at rest, during exercise, and in the recovery phase. The choice of parameters for interpretation depends on the specific clinical indication. Conclusions. CPET offers a global and integrative assessment of the physiological responses to exercise from the pulmonary, cardiovascular, hematologic, neuropsychological, and muscular systems. This method supports clinical decision-making through a personalized approach, being valuable both in preventive medicine and medical rehabilitation.
Cardiovascular diseases (CVDs) are the leading cause of mortality and premature death in the Republic of Moldova, with a rate of 57-58%. This paper analyzes cardiovascular risk factors, particularly environmental ones: air pollution, noise, climate change, toxic substances, and passive smoking. Although some progress has been made, significant disparities between countries persist, highlighting the need to promote a healthier and cleaner environment in the Republic of Moldova.
Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been recommended in the practice guidelines for the treatment of patients with heart failure with reduced ejection fraction. However, only few studies are dedicated for patients with preserved ejection fraction (HFpEF). Among patients with HFpEF, SGLT2 inhibitors significantly reduced primary composite endpoints and heart failure hospitalization with the largest sample size thus far. This publication summarizes the most important studies dedicated to HFpEF.
Introduction. Schizoaffective disorder (SAD) is a rare psychiatric condition positioned at the intersection of schizophrenia and affective disorders. It is characterized by major affective episodes occurring simultaneously with persistent psychotic symptoms, leading to diagnostic and therapeutic challenges. Material and Methods. The study was conducted through a review of recent literature on diagnostic criteria, etiopathogenetic mechanisms, and therapeutic options for SAD, including three clinical cases. Results and Discussion. SAD is often underdiagnosed or mistaken for schizophrenia or bipolar disorder. Current treatments include atypical antipsychotics, mood stabilizers, and personalized psychological therapies. Its nosological classification remains controversial, with new research highlighting common genetic substrates with schizophrenia and affective disorders. Conclusions. Accurate diagnosis of SAD is essential for selecting an appropriate therapeutic strategy. Further studies are needed to optimize treatment guidelines and personalize therapeutic approaches.
Cardiac amyloidosis is a rare, often underdiagnosed condition characterized by the deposition of dysfunctional amyloid proteins in the cardiac interstitium, leading to progressive heart failure. Immunoglobulin light chain (AL) amyloidosis, wild-type transthyretin amyloidosis (ATTRwt), and hereditary/variant transthyretin amyloidosis (ATTRv) are common causes of amyloid cardiomyopathy. This presentation documents the case of a 64-year-old man who presented with symptoms and signs of heart failure and conduction disturbances. Initial diagnostic evaluation suspected cardiac amyloidosis, laboratory and imaging investigations confirmed the diagnosis of immunoglobulin light chain (AL) amyloidosis. The patient continued on heart failure therapy and chemotherapy as prescribed by hematologist.
