Medicine and Pharmacy Reports最新文献

In 2023 we celebrated 350 years since the birth, and 300 years since the death of Dimitrie Cantemir (1673-1723), scholar of European prominence, encyclopedic spirit, Prince of Moldavia, first Romanian member of the Berlin Academy of Sciences, and the first in Eastern Europe. Cantemir described for the first time the transperitoneal approach to inguinal hernia repair in his famous work "The History of the Growth and Decay of the Othman Empire". The work was written in Latin, revised in 1714-1716 and translated into English by N. Tindal and published in 1734. We briefly present a history of the main existing therapeutic procedures for inguinal hernia repair until the Cantemir's presentation. The description of the procedure is in "Annotationes", in the chapter entitled "Avlonia", a region from Albania. The Albanians were famous for their skill in repairing inguinal hernias. Cantemir witnessed a hernia repair performed on his secretary in his palace in Istanbul. He gives a detailed description of the procedure, the abdominal incision, reduction of hernial sac content, closing and cauterizing of the hernial orifice with the preservation of the testicle, and the evolution of the patient during the 30 days of follow-up. The postoperative mortality was 1-2%. The surgical technique presented was a progress towards the operations practiced at the time in Europe, mainly cautery and castration. The history of inguinal hernia repair is a mirror of surgical history. The presentation of the transperitoneal approach of the inguinal hernia by the Romanian scholar is of a great importance for the history of surgery and medicine.

Background and aims: Aortic stenosis (AS) often requires surgical aortic valve replacement (SAVR). Patient-prosthesis mismatch (PPM) can lead to suboptimal outcomes. Von Willebrand factor (VWF), crucial for hemostasis, is altered in AS patients. As part of an ongoing study, this research focuses on the impact of PPM on immediate postprocedural VWF levels in SAVR patients, building upon our previous publication on short-term VWF dynamics in SAVR and TAVR.

Methods: This prospective study included 31 consecutive patients with severe AS undergoing SAVR. Preoperative and postoperative VWF levels were measured. PPM was assessed based on the indexed effective orifice area of the implanted valve.

Results: PPM was observed in 61.29% of patients. Postoperative VWF antigen levels increased significantly (131.37 ± 64.82 IU/dL to 311.01 IU/dL, p<0.01). However, PPM did not significantly influence postoperative VWF antigen levels (285.43 IU/dL vs. 293.30 IU/dL, p=0.88), VWF activity (178.33% vs. 204.76%, p=0.56), or Factor VIII levels (100.38 IU/dL vs. 97.10 IU/dL, p=0.79).

Conclusions: While SAVR led to increased VWF levels, PPM did not impact short-term VWF dynamics. This study provides insights into PPM and VWF relationships in SAVR patients, informing valve selection and perioperative management strategies. A future paper will reveal long-term follow-up results, completing this comprehensive investigation of VWF dynamics in aortic valve interventions.

Background: The Moldovan health authorities introduced the 13 valent pneumococcal conjugate vaccine into the national immunization schedule for children in 2013. This study aimed to evaluate the cost-effectiveness of the pneumococcal conjugate vaccine compared to a no-vaccination strategy in children under 5 Years of age in the Republic of Moldova.

Methods: We used UNIVAC (version 1.7), a static decision model, to evaluate the health and economic outcomes of vaccination in a single-cohort of children under five years. We modeled vaccine introduction over 10 birth cohorts starting in 2013. We assumed a 2+1 (two doses + booster) schedule and a vaccination price of US$ 16.34 per dose. We used locally-specific data for pneumonia incidence, mortality, treatment, and costs. Model outcomes included pneumonia cases, hospitalizations, deaths, disability-adjusted life years, and costs presented in USD. Cost-effectiveness was reported as Incremental Cost Effectiveness Ratio. The Incremental Cost Effectiveness Ratio was calculated to estimate the additional cost to save an additional life year.

Results: From the governmental health sector the Incremental Cost Effectiveness Ratio was $5939 and from society perspective, $7272, respectively. Withal cost per disability-adjusted life years (DALY) averted was US$ 6311. PCV-13 was projected to prevent 2310 hospitalizations due to pneumococcal disease, including 118 deaths. Vaccination could potentially reduce the highest treatment cost from the payer perspective at $ 4 081 412 for the 13 valent pneumococcal conjugate vaccine.

Conclusion: This study evidenced that cost per DALY averted is US$ 6311, which is between one and three times Gross Domestic Product (GDP) per capita, these findings extrapolate PCV-13 as a cost-effective intervention. Considering the scenario of Republic of Moldova the PCV program is a cost effective intervention and justifies the introduction of PCV into routine immunization schedule throughout the country in order to reduce morbidity and mortality among the under-five-year-old children.

The case is presented of an elderly patient (DCP) with extensive medical history, including osteoporosis, who developed hypocalcaemia and hypophosphataemia whilst treated with denosumab, while prescribed concomitant calcium and vitamin D therapies. The management of this complex case involved a multidisciplinary team (MDT) approach, incorporating the patient's wishes. It included discontinuation of denosumab and intravenous (IV) and oral mineral supplementation that yielded gradual amelioration of calcium and phosphate levels. This case demonstrates the importance of vigilant monitoring and appropriate management in patients receiving denosumab, particularly those with multiple comorbidities. It carries important considerations for using denosumab for osteoporosis treatment in patients with complex medical backgrounds. Ethical clearance waiver was granted by the Trust Research Ethics Committee on 18/01/2024.

Background: Despite advancements in congenital heart surgery, long-term outcomes remain challenging, with many patients developing heart failure and requiring transplants at a young age. Stem cell therapy, particularly using umbilical cord-derived mesenchymal stem cells, is emerging as a promising adjunct treatment. Adult studies suggest functional improvements, but pediatric research remains sparse. This pilot study aimed to establish surgical and anesthetic protocols for elective cesarean section in an ovine model to enable umbilical cord blood collection.

Methods: Three pregnant sheep aged 2-6 years and weighing 40-45 kg underwent elective cesarean section. Gestational age was confirmed using ultrasound and clinical signs. Preoperative preparation involved fasting, dexamethasone administration to prevent respiratory distress, and shaving surgical sites. Local anesthesia and mild sedation (medetomidine) minimized fetal exposure to anesthetics. Two umbilical cord blood collection methods were tested: active aspiration and gravitational collection.

Results: We established efficient anesthetic and surgical protocols for elective cesarean section and described a safe and easy method for umbilical cord blood collection with minimal risk. Elective cesarean section ensures a sterile environment, crucial for stem cell isolation. Local anesthesia with mild sedation proved safe and provided proper comfort for animals and operators. Accurate gestational estimation and effective postnatal care were critical.

Conclusions: This study provides a reliable protocol for elective cesarean section and umbilical cord blood collection in an ovine model, offering a valuable foundation for research in stem cell therapy. However, larger sample sizes are needed to validate these methods and enhance their applicability in translational research.

Background: The infection with SARS-CoV-2 in children usually manifests as a mild respiratory tract infection. The aim of this study was to evaluate the severity, outcome and vaccination status in children hospitalized for COVID-19 in a single center during two pandemic waves determined by different SARS-CoV-2 variants of concern (VOCs).

Methods: A retrospective study on 656 consecutive pediatric patients was performed from September 1, 2021, to April 30, 2023. The study interval was divided into waves, according to official data on the circulation of Delta and Omicron VOCs. Data collected included sex, age, comorbidities, date of diagnosis, duration of hospitalization, vaccination status, clinical outcome.

Results: The Delta group consisted of 234 children with a mean age of approximately 9 years, while the Omicron group included 422 children with a mean age of around 2.5 years. Most cases were mild, although in the Omicron wave the hospitalization rate was higher and 41.7% of the cases were medium in severity. The presence of comorbidities was not linked to an increase in severity. Vaccination rates were low in both groups, with a mean of 4% for the total of eligible patients.

Conclusion: This pioneering study highlights the nature of COVID-19 in children, focusing on both clinical aspects and public health issues.

This review offers insight into the complex interplay between cytokines and vitamin D, with focus on its role in systemic lupus erythematosus (SLE) pathogenesis. It offers a helpful resource for researchers and clinicians seeking to better understand and treat SLE and related autoimmune conditions. The pathogenesis of SLE is complex and involves a wide range of cytokines, primarily of the Th2 type; these cytokines mediate hyperactivity in B lymphocytes and antibody production. Notably, vitamin D is found to suppress the activity of critical Th17-related cytokines like IL-23 and IL-6, which is pivotal for Th17 cell development and function. This ultimately leads to reduced IL-17 production, an increase in regulatory T lymphocytes, and subsequent secretion of IL-10. Supplementation with vitamin D is seen to have positive effects on SLE, leading to lower disease activity scores, decreased levels of autoantibodies, and a reduction of fatigue.

Introduction: The advent of Bruton's tyrosine kinase (BTK) inhibitors brought about a paradigm shift in the management of chronic lymphocytic leukemia (CLL), by offering a well-tolerated chemotherapy-free approach. Here, we share the experience with ibrutinib of a major Romanian regional cancer center.

Methods: We screened patients treated for CLL in our center over 6 years (2017-2022) and included those who were treated with ibrutinib either in the first line of therapy or in subsequent lines.

Results: We enrolled 61 patients, 40 with treatment-naïve (TN) CLL and 21 with relapsed/refractory (R/R) CLL, with a median age at treatment initiation of 65 years. Concerning the prognostic-predictive workup, IgHV mutational status was available for 78.7% of the patients, TP53 sequencing for 82%, assessment of 17p deletion for 82%, and CD38 marker analysis was performed for 70.5%. With a median follow-up period of 55 months, the overall response rate (ORR) was 90.2%, with a median progression-free survival (PFS) of 33 months and a median overall survival (OS) that has not been reached. In our cohort, albeit non-significant statistically, patients with TP53 mutation had a shorter OS and those with mutated IgHV, a shorter PFS. Rai 3-4 and Binet C stages at diagnosis were associated with a shorter PFS, but not OS. In our cohort, the correlation between survival and high Cumulative Illness Rating Scale (CIRS) index was not statistically significant. Ibrutinib was generally well tolerated in our cohort, as only 14.8% of our patients discontinued treatment due to adverse effects.

Conclusion: Our study suggests that ibrutinib is a valid therapeutic option for TN or R/R CLL patients, with a high ORR and a good safety profile.

Objective: The aim of our study was to evaluate the prevalence of cognitive decline in patients with diabetes in the clinical setting and to identify patient characteristics directly associated with this condition.

Methods: In our cross-sectional study, we applied the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to determine cognitive function in 172 diabetic patients, in the clinical setting. We included 120 patients with type 2 diabetes (T2DM), 42 cases with type 1 diabetes (T1DM) and 10 patients with confirmed secondary diabetes (SDM). The mean age of the participants was 62.4 years (±1.01, min: 26 years, Max: 87 years), with median diabetes duration of 15±11.8 years.

Results: More than half (55.23%) of the subjects presented cognitive deterioration, which was diabetes type-specific (p<0.05). Mild forms affected mostly T1DM and SDM cases (31.5% and 30% vs. T2DM: 14.5%, p=0.00), whereas moderate cognitive decline was more predominant in T2DM (21.9% vs. T1DM: 7.1%, p=0.1). A higher prevalence of severe cognitive impairment was present in T1DM (14.5% vs. T2DM: 8.7%, p=0.1).The middle-aged category (40-64 years) was characterized by a more significant reduction of cognitive function in comparison with other age groups (p=0.02).No gender-related difference in the prevalence of cognitive decline was found (female: 45.83% vs male: 45.71%, p=0.98), although severe forms were significantly more suggestive for men (15.27% vs. 4.18%, p=0.04).Diabetic ketoacidosis (DKA) at admission was more frequently associated with cognitive deterioration, in comparison with hypoglycemic events (p=0.03).In T2DM, cognitive decline (p=0.006, r=-0.342) was associated with the presence of anemia.In T2DM women, treatment with calcium-channel blockers facilitated cognitive decrement (p=0.01, r=-0.339), whereas in men, therapy for distal symmetric polyneuropathy resulted in higher MMSE/MoCA test scores (p=0.00, r=0.72).In T1DM, a higher glycemic burden evidenced by increased HbA1c (p=0.03, r=-0.364) and glycemia at admission (p=0.01, r=-0.389) was suggestive to a more severe form of cognitive impairment. Distal symmetrical polyneuropathy (p=0.05, r=-0.305) and diabetic retinopathy (p=0.03, r=-0.102) was often co-occurring with cognitive decline.Cognitive deterioration was associated with insulin therapy (p=0.05, r=-0.232).

Conclusion: The prevalence of cognitive decline is high in the diabetic population. Risk stratification must start at diagnosis and physicians should follow disease progression periodically, with special attention attributed to T1DM and the middle-aged population.