Abstract Book - MedEspera · 2018. 7. 12. · Abstract Book MedEspera 2018 The 7th International...

MINISTRY OF HEALTH, LABOUR AND SOCIAL

PROTECTION OF THE REPUBLIC OF MOLDOVA

Nicolae Testemitanu State University of Medicine

and Pharmacy of the Republic of Moldova

Association of Medical Students and Residents

Abstract Book

MedEspera 2018

The 7th International Medical Congress

for Students and Young Doctors

May 3-5, 2018

Chisinau

The 7th International Medical Congress for Students and Young Doctors ____________________________________________________________________________________

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MedEspera 2018: 7th Intern. Medical Congress for Students and Young Doctors,

May 3-5, 2018, Chisinau, Republic of Moldova

Chairman of Editorial Board: Gheorghe Rojnoveanu

Organizing committee: Valeria Turcan

Descrierea CIP a Camerei Naționale a Cărții

"Medespera 2018", International Medical Congress (7 ; 2018 ; Chisinau). MedEspera 2018:

7th International Medical Congr. for Students and Young Doctors, May 3-5, 2018, Chișinău:

Abstract Book / chairman of the ed. board.: Gheorghe Rojnoveanu ; org. com.: Valeria Turcan.

Chișinău: S. n., 2018 (Tipografia Editurii “Universul”. — 327 p.

Antetit.: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of

Moldova, Assoc. of Med. Students and Residents — 550 ex.


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CONTENTS

MESSAGE OF THE RECTOR ……………………………………………………………………….

WELCOME MESSAGE OF THE ORGANIZING COMMITTEE …………………………………..

ABSTRACTS ………………………………………………………………………………………….

CLINICAL CASES ……………………………………………………………………………………

ORAL PRESENTATIONS ………………………………………………………………………….

POSTERS …………………………………………………………………………………………….

INTERNAL MEDICINE I …………………………………………………………………………….

ORAL PRESENTATIONS …………………………………………………………………………

POSTERS ……………………………………………………………………………………………

INTERNAL MEDICINE II …………………………………………………………………………….


POSTERS ……………………………………………………………………………………………

SURGERY SECTION I …………………………………………………………………………………

ORAL PRESENTATIONS …………………………………………………………………………..

POSTERS …………………………………………………………………………………………….

SURGERY SECTION II …………………………………………………………………………………


POSTERS …………………………………………………………………………………………….

PUBLIC HEALTH ………………………………………………………………………………………

ORAL PRESENTATIONS …………………………………………………………………………..

POSTERS …………………………………………………………………………………………….

FUNDAMENTAL SCIENCES ………………………………………………………………………….

ORAL PRESENTATIONS …………………………………………………………………………...

POSTERS ……………………………………………………………………………………………..

DENTAL MEDICINE SECTION ………………………………………………………………………..

ORAL PRESENTATION …………………………………………………………………………….

POSTERS ……………………………………………………………………………………………...

PHARMACY SECTION …………………………………………………………………………………

ORAL PRESENTATIONS …………………………………………………………………………...

ETHICS SECTION ……………………………………………………………………………………….

INDEX …………………………………………………………………………………………………….


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MESSAGE OF THE RECTOR

At Nicolae Testemitanu State University of Medicine and Pharmacy of the

Republic of Moldova we always encourage youth in their initiatives. It is our

responsibility to inspire them to create, to develop

and surpass their own limits. MedEspera

International Congress for Students and Young

Doctors serves as proof of our commitment in this

regard. The Association of Students and Residents

in Medicine organizes it bi-annually. We

appreciate them for their inexhaustible force and

idealistic desire to execute at this level.

This year, Nicolae Testemitanu SUMPh will

host the 7th edition of the Congress. We hope this

will be a great opportunity for students and young

doctors to exchange ideas and research experience.

The number of foreign MedEspera participants

highlights the fact that medicine has no boundaries.

We hope this year won’t be an exception and our foreign colleagues will attend

this event and will be fully satisfied with the obtained results and experience.

We wish you all good luck! Don’t forget to follow your dreams and work hard

to achieve your goals. Take full advantage of this event and feel free to share your

experience and learn something new from your colleagues.

I wholeheartedly hope your impressions of Moldova and Nicolae Testemitanu

SUMPh will be unforgettable!

Rector Ion Ababii

MD, PhD, Professor


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WELCOME MESSAGE

OF THE ORGANIZING COMMITTEE

Dear colleagues and friends,

We have the honor and pleasure to welcome you to MedEspera International

Congress for Students and Young Doctors. Welcome to Nicolae Testemitanu State

University of Medicine and Pharmacy of the Republic of Moldova! Beside the new

experience, this 7th edition of MedEspera will bring you the most recent

achievements in the fields of medicine, dentistry, pharmacy and public health. We

hope you will enjoy the program we’ve prepared, which includes conferences,

workshops, discussions as well as a social program to familiarize you with the

hospitality of our country and the beauty of our traditions.

The idea of organizing this Congress sparked among a group of our senior

colleagues several years ago. Since the very 1st edition, MedEspera became

popular among medical students and young doctors from the Republic of Moldova

and abroad.

It is our duty to uphold the reputation, popularity and quality of this event. We

are fully committed to make everything in our power to continuously increase the

quality of this event, and we sincerely wish for you to make the best of it!


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President of Honour

Ion ABABII, Rector of Nicolae Testemitanu State University of Medicine and

Pharmacy of the Republic of Moldova, MD, PhD, Professor, Academician of

Academy of Science of Moldova

Members of Honour

Christoph LANGE, MD, PhD, FISA, FERS, Head of Clinical Infectious

Diseases Research Center in Borstel, Professor at International Health/Infectious

Diseases department, University of Lübeck, Germany

Martin COATH, BS, MS, PhD in Neuroscience, Associate lecturer at the

University of Plymouth, Research Fellow at the University of Lapland, United

Kingdom

Benjamin R. THOMAS, DDS, MPH, Periodontist at Sierra Dental Partnership,

Alberta, Canada

Stephen B. MACKLER, DDS, MS, Adjunct Faculty Dept of Periodontics,

UNC School of Dentistry, Chapel Hill, NC, USA

Lenuta PROFIRE, PharmD, PhD, Professor, Head of the Pharmaceutical

Chemistry Department at Grigore T. Popa University of Medicine and

Pharmacy, Iasi, Romania

Viorica CHELBAN, MD, MSc, MRCP, Research Fellow at the University

College London Institute of Neurology, United Kingdom

Organizing Committee

Head of Organizing Committee:

Valeria TURCAN

President of Association of Medical Students and Residents:

Gheorghe BURUIANA

Executive Secretary:


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Olga CLIPII

Staff:

Gheorghe Buruiana, Valeria Turcan, Olga Clipii, Ana-Maria Buliga, Olga

Blobstein, Mihaela Turcanu, Galina Dobrostomat, Elena Ciumac, Dumitrita

Nichiforeac, Camelia Calistru, Sergiu Gavriliuc, Mihaela Taraburca, Alexandrina

Cenusa, Cristina Ermurachi, Nicoleta Florea, Galina Panus, Nicoleta Damian,

Marina Cisa, Laura Tarlapan, Corina Darii, Ana Tabarcea, Vlad Filimon, Nicu

Ribac, Rodion Cujba, Varvara Naghita, Eugenia Dumbravanu, Diana Tambala,

Pavel Chior, Valentin Butnari, Ana Picalau, Radu Cazacu, Igor Gusev, Emanuel

Haig Dikran, Irina Sirbu, Marin Foteniuc, Ion Ernu, Lina-Andreea Robu, Petru

Dodita, Nicoleta Pricop, Sergiu Calancea, Iurie Noroc, Constantin Tataru, Victoria

Taralunga, Anastasia Melnic, Olga Rosu, Alexandrina Buruiana, Mariana Brunchi,

Dumitru Cartaleanu, Alexei Antoci, Mihail Balan, Tudor Gulica, Tudor

Ostapovici, Sorina-Mihaela Rojnita, Corneliu Ursu, Victor Schiopu, Corina

Condur-Scerbatiuc.

Chairman of the Editorial Board

Gheorghe ROJNOVEANU

Vice-Rector for Scientific Activity, Nicolae Testemitanu State University of

Medicine and Pharmacy of the Republic of Moldova

MD, PhD, Professor

Members:

Olga Cernetchi, MD, PhD, Professor

Mihail Gavriliuc, MD, PhD,

Professor

Evghenii Gutu, MD, PhD, Professor

Emil Ceban, MD, PhD, Professor

Marcel Abras, MD, PhD, Associate

Professor

Victoria Cravet

Didina Nistreanu, PhD, Associate

Professor


9

Silvia Stratulat, MD, PhD, Associate

Professor

Gheorghe Placinta, MD, PhD,

Associate Professor

Mircea Betiu, MD, PhD, Associate

Professor

Sergiu Ciobanu, MD, PhD, Associate

Professor

Nicolae Ciobanu, MD, PhD,

Associate Professor

Serghei Suman, MD, PhD, Associate

Professor

Ludmila Bologa, MD, PhD,

Associate Professor

Ina Pogonea, MD, PhD, Associate

Professor

Angela Cazacu-Stratu, MD, PhD,

Associate Professor

Igor Cemortan, MD, PhD, Associate

Professor

Stela Cojocaru, MD, PhD, Associate

Professor

Stepco Elena, MD, PhD, Associate

Professor

Livia Uncu, MD, PhD, Associate

Professor

Dumitru Harea, MD, PhD,

University Assistant

Angela Babuci, MD, University

Assistant

Andrei Mostovei, MD, PhD

Adrian Hotineanu, MD, PhD,

Professor

Boris Topor, MD, PhD, Professor

Eugen Bendelic, MD, PhD, Professor

Evghenii Gutu, MD, PhD, Professor

Gheorghe Ciobanu, MD, PhD,

Professor

Igor Misin, MD, PhD, Professor,

Researcher

Ilia Cateriniuc, MD, PhD, Professor

Jana Bernic, MD, PhD, Professor

Larisa Spinei, MD, PhD, Professor

Liliana Groppa, MD, PhD, Professor

Minodora Mazur, MD, PhD,

Professor

Ninel Revenco, MD, PhD, Professor

Oleg Lozan, MD, PhD, Professor

Valeriu Revenco, MD, PhD,

Professor

Victor Ghicavii, MD, PhD, Professor

Victor Vovc, MD, PhD, Professor

Vitalie Lisnic, MD, PhD, Professor

Vladimir Valica, MD, PhD, Professor

Adela Turcan, MD, PhD, Associate

Professor

Adriana Paladi, PhD, Associate

Professor

Ala Paduca, MD, PhD, Associate

Professor

Ala Pascari-Negrescu, MD, PhD,

Associate Professor

Alexandra Grejdieru, MD, PhD,

Associate Professor


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Alexandru Betisor, MD, PhD,

Associate Professor

Alexandru Corlateanu, MD, PhD,

Associate Professor

Alexandru Jalba, MD, PhD,

Associate Professor

Andrei Oprea, MD, PhD, Associate

Professor

Andrei Padure, MD, PhD, Associate

Professor

Andrian Cotelea, MD, PhD,

Associate Professor

Angela Corduneanu, MD, PhD,

Associate Professor

Angela Paraschiv, MD, PhD,

Associate Professor

Angela Peltec, MD, PhD, Associate

Professor

Artiom Jucov, MD,PhD, Associate

Professor

Aureliu Bodiu, MD, PhD, Associate

Professor

Boris Sasu, MD, PhD, Associate

Professor

Corina Cardaniuc, MD, PhD,

Associate Professor

Corina Scutari, MD, PhD, Associate

Professor

Cornelia Talmaci, MD, PhD,

Associate Professor

Diana Manea, MD, PhD, Associate

Professor

Diana Uncuta, MD, PhD, Associate

Professor

Dumitru Casian, MD, PhD,

Associate Professor

Dumitru Sirbu, MD, PhD, Associate

Professor

Elena Bodrug, MD, PhD, Associate

Professor

Elena Deseatnicova, MD, PhD,

Associate Professor

Elena Manole, MD, PhD, Associate

Professor

Eugen Gorgos, MD, University

Assistant

Eugen Melnic, MD, PhD, Associate

Professor

Galina Obreja, MD, PhD, Associate

Professor

Georgeta Mihalache, MD, PhD,

Associate Professor

Ghenadie Curocichin, MD, PhD,

Associate Professor

Grigore Verega, MD, PhD, Associate

Professor

Ianos Coretchi, MD, PhD, Associate

Professor

Ilie Suharschi, MD, PhD, Associate

Professor

Ion Codreanu, MD, PhD, Associate

Professor

Jana Chihai, MD, PhD, Associate

Professor


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Larisa Rotaru, MD, PhD, Associate

Professor

Lilian Saptefrati, MD, PhD,

Associate Professor

Livi Grib, MD, PhD, Associate

Professor

Lorina Vudu, MD, PhD, Associate

Professor

Lucia Turcan, MD, PhD, Associate

Professor

Lucian Danilov, MD, PhD, Associate

Professor

Luminita Gutu, MD, PhD, Associate

Professor

Marina Sangheli, MD, PhD,

Associate Professor

Marin Vozian, MD, PhD, Associate

Professor

Oleg Arnaut, MD, PhD, Associate

Professor

Oleg Solomon, MD, PhD, Associate

Professor

Oleg Zanoaga, MD, PhD, Associate

Professor

Olga Cirstea, MD, PhD, Associate

Professor

Olga Tagadiuc, MD, PhD, Associate

Professor

Oxana Maliga, MD, PhD, Associate

Professor

Oxana Munteanu, MD, PhD,

Associate Professor

Pavel Banov, MD, PhD, Associate

Professor

Polina Ababii, MD, PhD, Associate

Professor

Rodica Catrinici, MD, PhD,

Associate Professor

Rodica Comendant, MD, PhD,

Associate Professor

Ruslan Baltaga, MD, PhD, Associate

Professor

Sergiu Berliba, MD, PhD, Associate

Professor

Stela Adauji, MD, PhD, Associate

Professor

Svetlana Agachi, MD, PhD,

Associate Professor

Svetlana Diacova, MD, PhD,

Associate Professor

Svetlana Lozovanu, MD, PhD,

Associate Professor

Tamara Tudose, MD, PhD, Associate

Professor

Tatiana Calalb, MD, PhD, Associate

Professor

Tatiana Chiru, MD, PhD, Associate

Professor

Tatiana Tazlavan, MD, PhD,

Associate Professor

Toader Timis, MD, PhD, Associate

Professor

Valentina Vorojbit, MD, PhD,

Associate Professor


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Valentin Bendelic, MD, PhD, Associate Professor

Valeriu Cobet, MD, PhD, Associate

Professor

Vasile Culiuc, MD, PhD, Associate

Professor

Viorel Nacu, MD, PhD, Associate

Professor

Viorica Ochisor, MD, PhD, Associate

Professor

Vitalie Chirila, MD, PhD, Associate

Professor

Vitalie Ojovan, PhD, Associate

Professor

Uliana Tabuica, MD, PhD, Associate

Professor

Svetlana Turcan, MD, PhD, Senior

Scientific Researcher

Andrei Romancenco, MD, Director

of University Center for Simulation in

Medical Training

Corina Iliadi-Tulbure, MD, PhD,


Cristina Scerbatiuc, MD, PhD,


Diana Boleac, MD, PhD, University

Assistant

Diana Calaras, MD, PhD, University

Assistant

Irina Sagaidac, MD, PhD,


Svetlana Plamadeala, MD, PhD,


Zinaida Alexa, MD, PhD,


Alexandru Garbuz, MD,


Andrei Bradu, MD, University

Assistant

Constantin Ceclu, MD, University

Assistant

Cristina Ciobanu, MD, University

Assistant

Cristina Postaru, MD, University

Assistant

Daniela Cepoi-Bulgac, MD,


Daniela Rusnac, MD, University

Assistant

Ecaterina Carpenco, MD,


Elena Chitan, MD, University

Assistant

Egor Porosencov, MD, University

Assistant

Iulia Emet, MD, University

Assistant

Lilia Tacu, MD, University

Assistant


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Natalia Bivol, MD, University

Assistant

Natalia Scurtov, MD, University

Assistant

Olga Cheptanaru, MD, University

Assistant

Radu Rusu, MD, University

Assistant

Rodica Stratu, MD, University

Assistant

Sergiu Ursul, MD, University

Assistant

Valentina Vilc, MD, University

Assistant

Victor Cazac, MD, University

Assistant

Victoria Simon, MD, University

Assistant

Vitalii Pintea, MD, University

Assistant

Vladislav Badan, MD, University

Assistant

Ion Banari, PhD, University

Assistant

Ludmila Rubanovici, PhD,

Lecturer


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ABSTRACTS

CLINICAL CASES

DEPARTMENT OF SURGERY AND SEMIOLOGY no.3

1. PRIMARY HYDATID CYST OF SKELETAL MUSCLE: A CASE REPORT

Authors: Gutu Serghei, Predenciuc Alexandru

Scientific adviser: Popa Gheorghe, Associate professor, Department of General Surgery and

Semiology no.3

Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Background. Hydatid cyst, also called hydatidosis, is caused by Echinococcus granulosus. It is

still a major health problem in many parts of the world with 2-3 million cases confirmed each

year. Most of these cases involve liver (50-70%) and lungs (20-30%), but some of them have

rare locations, such as skeletal muscles (0.7-5%). The absence of specific clinical signs and

symptoms makes it difficult to establish a diagnosis, while first signs may appear as

neurovascular lesions due to compression. The most useful method of diagnosis is ultrasound

with high sensitivity (93-98%), followed by CT and MRI. There are two types of treatment: open

surgery and percutaneous drainage, both associated with Albendazole and Mebendazole or

Albendazole and Praziquantel administration.

Case report. A 33-year-old patient was admitted to Department of general surgery with a lump

on the inner proximal part of the right thigh that patient discovered six month ago, which

interfered with the patients daily activities. The patient underwent ultrasound exam of the lump

and internal abdominal organs, plain chest X-ray, lump puncture for bacteriological test and

general blood and urine analysis. All results came normal and with no imagistic findings, except

a multicystic lesion separated by septae that can be attributed to Gharbi type III hydatid cyst. The

patient underwent surgical treatment with no early postoperative complications and received

chemotherapy with Albendazole and Mebendazol.

Conclusions. Hydatid cyst should be included in the differential diagnosis of a patient with slow

growing subcutaneous masses. Imaging data are required when cystic mass are suspected.

Surgical treatment associated with chemotherapy must always be a fist priority for better results

with minimal recurrence.

Key words: hydatid cyst, ultrasound, differential diagnosis.

DEPARTMENT OF INTERNAL MEDICINE, CARDIOLOGY

2. LEFT ATRIAL MASS IN A PATIENT WITH MITRAL STENOSIS AND ATRIAL FIBRILLATION-THROMBUS OR MYXOMA?

Author: Timbur Natalia

Scientific advisers: Tasnic Mihail, Batrinac Aureliu, MD, PhD, Associate professor

Medpark International Hospital, Cardiology and Interventional Cardiology Department, Cardiac

Surgery Department of the Republic of Moldova


Background. The discovery of a large left atrial mass through echocardiography obliges the

clinician to perform a differential diagnosis to distinguish tumor from thrombus. In fact,

magnetic resonance imagery could be useful to identify the mass but it could not distinguish

tumor from organized thrombus. Certainly, surgery is the best solution for a successful diagnosis.

http://cardiologie.usmf.md/en/


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Case report. The 67-year-old woman was admitted to cardiology department with dyspnea,

orthopnea, palpitations, and fatigue. Anamnesis: 10 years of atrial fibrillation and type 2 diabetes

and 15 years with arterial hypertension. By the time of addressing, the patient has been

administering anticoagulants for several months with warfarin while maintaining INR-2.

Physical examination revealed an irregular pulse, at a rate of 110 beats/min. The

electrocardiogram revealed an atrial fibrillation with rate 150-100 b/min. The chest X-ray -

pulmonary congestion. TTE - revealed a severe mitral stenosis (GPmax – 33 mm/hg, area - 0,6

cm2) with third degree mitral regurgitation and left atrial mass (50*36 mm), third-degree

tricuspid regurgitation. Left atrium was enlarged (67*84 mm), severe pulmonary arterial

hypertension. These findings were confirmed by TEE. The preoperative coronarography showed

neovascularization among the mass and huge fistula from the circumflex artery in the tumour

mass and left atrium. We strongly suspected a vascular tumor, especially myxoma. Preoperative

decision was made to perform cardiac MRI - “hook”- shaped mass formation, fixed to the upper

rear wall of the LA, 7 cm long, massive thrombus. Cardio-surgical intervention was performed:

MV prosthesis MDT “Hancock-II ultra” N29, complex plastic repair of TrV, removing the

massive thrombus from the LA. After surgery, the patient had uncomplicated recovery.

Conclusions. Atrial mass management will be based on clinical history (mitral stenosis,

permanent atrial fibrillation) and echocardiographic data. If atrial mass persists during treatment

with anticoagulants, cardiac MRI and coronarography are useful for diagnosis. However, the

final diagnosis is established during cardiac surgery.

Key words: atrial fibrillation, atrial mass, MRI, coronarography, surgery

3. SITUS INVERSUS WITH DEXTROCARDIA AND AORTIC VALVE REGURGITATION: A CASE REPORT

Authors: Victoria Vatamanu-Paiu, Darciuc Radu

Scientific adviser: Batrinac Aureliu, MD, PhD, Associate professor




Background. Dextrocardia with situs inversus is a rare congenital condition with less than 1

person in 10 000, in wich the internal organs are mirrored inside the human body. The majority

of the patients with dextrocardia and situs inversus are phenotypically normal and have a normal

life without any complications related to their congenital condition. About 5-10% of the these

patients develop another congenital defects. There are only few published cases of the patients

with situs inversus with dextrocardia associated with aortic valve regurgitation.

Case report. The 33 years old male with dextrocardia and situs inversus diagnosed in the

childhood was consulted during routine medical examination. Chest radiography showed

dextrocardia and situs inversus. The electrocardiogram showed sinus rhythm with right axis

deviation and reverse R-wave progression in the precordial leads. He was examined by

transthoracic echocardiography and third degree aortic regurgitation was found, moderate

dilatation of the sinus of Valsalva – 43 mm, and no dilatation of the ascending aorta – 35 mm.

There were no data for aortic dissection. The ejection fraction of the left ventricle was 55%.

Computer tomography (CT) showed reversed positioning of mediastinal and abdominal organs –

complete situs inversus and dextrocardia. On CT there were no signs of stenosis or dissections of

the thoracic and abdominal aorta. The patient was referred to cardiac surgery for correction of

valvular pathology. A complex aortic valve repair was performed. Postoperative period was

without complications. On control echocardiography after one month there was no important

aortic regurgitation.


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Conclusions. Dextrocardia with situs inversus and aortic valve regurgitation is a very rare

cardiac pathology. If cardiac surgery is necessary it can be challenging but feasible with good

results.

Key words: dextrocardia, situs inversus, aortic regurgitation, CT, cardiac surgery

4. CEREBRAL COMPLICATIONS OF ATRIAL FIBRILLATION

Author: Victoria Panfili

Scientific adviser: Angela Tcaciuc, MD, PhD, Associate professor, Department of Cardiology


Background. Atrial fibrillation is one of the great problems that cardiologists around the world

are trying to solve, according to the World Heart Federation (WHF) between 1990 and 2013. The

total number of diagnosed AF cases has increased globally from less than 7 million to over 11

million, and this number continues to grow. The prevalence of AF varies between 0.5% and 1%

in the general population and increases in relation to age, exceeding 6% among subjects over 80

years old. The incidence of AF is between 0.21 and 0.41 per 1 000 persons/year. It is estimated

that by 2030, 14 - 17 million patients in the European Union will suffer from AF, plus 120 000 -

215 000 newly diagnosed patients per year. Taking into account th upper mentioned data, we

decided to examine atrial fibrillation complications, evaluate anticoagulant treatment and

maintenance of therapeutic INR importance in patients with AF, as well as the value of

kinetotherapy in patients with stroke.

Case report. We will present a clinical case, about a 65 years old female, who has been

suffering from AF for 5 years and who maintained INR (between 2 – 3) within the normal limits.

She had interrupted the administration of the anticoagulant treatment, prior to a mini-invasive

intervention, and as a result, the value of the INR has decreased < 1.1 in 4 days. The patient

underwent a cardioembolic stroke. We examined this patient, clinically and paraclinically. She

was examined before and after stroke, the following instrumental examinations being performed:

electrocardiogram, echocardiography, doppler of carotid arteries, and cerebral Computed

Tomography before and post fibrinolysis. We used CHA2DS2-VASc scores for AF stroke risk

(that was at that moment 4 points from 9), HAS-BLED scores for bleeding risk assessment (that

was at that moment 4 points from 9), and MMSE (Mini-Mental state Examination), for mental

status examination, that at the moment of stroke was 5 out of 30 points. Now the patient's

MMSE scores is 27 points because at the moment of the stroke the correct and fast measures

were taken the right pharmaceutical and kinetotherapeutical treatment were administered.

Conclusions. The risk of cardioembolic stroke to the patient with AF is very high and depends

on age and the presence of other comorbidities. Anticoagulant treatment in AF patients is

paramount, cessation of anticoagulant treatment leads to serious complications such as stroke.

Fibrinolytic therapy in stroke patients that is included in the therapeutic window significantly

reduces post-thromboembolic sequelae. Kinetotherapy has to be performed and individualized as

early as possible, which will allow the patient to recover spectacularly.

Key words: atrial fibrillation, stroke, anticoagulant treatment

5. TREATMENT FOR VENTRICULAR TACHYCARDIA IN THE ABSENCE OF STRUCTURAL HEART DISEASE.

Authors: Radu Darciuc1, Daniela Ivanov1, Eraslan Hakan2, Diker Erdem2 1Medpark International Hospital, Cardiology and Interventional Cardiology Department,

Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova 2TOBB University of Economics and Technology Hospital, Cardiology Department, Ankara,

Turkey


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Background. According to the recent data in up to 10% of the patients with ventricular

tachycardia (VT) there is an absence of structural heart disease. Several types of VT could be

present in such patients: right ventricular outflow tract (RVO T) VT, caticholaminergic

polymorphic VT, idiopathic left VT, Brugada syndrome, long QT syndrome. According to the

VT type the management can be pharmacological therapy, radio-frequency ablation,

implantation of cardioverter defibrillator or a combination of them. The decision about the

management is based on the type of VT, data obtained from echocardiography, magnetic

resonance imaging (MRI) and electrophysiological study (EPS).

Case report. We present a case of a 48 years old female who had frequent attacks of palpitations

with presyncopes. On Holter ECG monitoring there were 32066 premature ventricular

complexes (PVCs) and 493 non-sustaned episodes of VT during 24 hours with left bundle

branch block morphology, inferior axis and transition zone in V4. The patient could not receive

amiodarone because of an allergic reaction. Treatment with beta-blockers, verapamil and

propafenone was tried but with no sufficient improvement. On echocardiography and MRI she

had no structural heart disease. We suspected RVOT VT and evaluated the patient during EPS,

where RVOT VT was induced. The earliest activation point was find to be in postero-septal

RVOT area and several applications of radio-frequency energy were performed. Immediately

after ablation there were no more PVCs, with solitary PVCs in next days. She continued the

medical treatment with bisoprolol 5mg/day and propafenone 300 mg/day. We evaluated the

patient after one month on Holter ECG. There was a decrease of PVCs number to 4123, but were

137 non-sustained paroxysms of VT during 24 hours. We decided to repeat the ablation. On

basal ECG during second EPS there were no PVCs, but they appeared after dobutamine infusion.

Radio-frequency energy was applied in postero-septal RVOT area with disappearance of PVCs.

The patient continued the treatment with metoprolol 100mg/day. On Holter ECG monitoring

after one month there were 5195 PVCs during 48 hours and no more paroxysms of VT. We

recommended to continue the treatment with metoprolol 100md/day only.

Conclusions. Electrophysiological study is an important tool in evaluating ventricular

tachycardia and radio-frequency ablation is a therapy of choice is selected patients.

Key words: ventricular tachycardia, structural disease.

6. A CASE OF CHAGAS CARDIOMYOPATHY IN REPUBLIC OF MOLDOVA

Authors. Mihail Tasnic, Eraslan Hakan




Background. Chagas disease (CD) (American trypanosomiasis) is generated by the protozoan

parasite Trypanosoma cruzi (T.cruzi) and transmitted by the reduviid bug in Latin America.

Approximately 8-12 million people are infected with T.cruzi in Central and South America.

Estimates of the number of annual deaths are around 50,000, 60% being related to sudden

cardiac death. Overall, 4.2% of Latin American individuals living in European countries are

chronically infected with T.cruzi.

Case report. We present the case of a young man of 29 years old, professional football player

originating from Brazil. The patient was admitted for establishing the cause of the patient

syncope developed during physical activity. The past medical history was without particularities.

We evaluated the patient by basic ECG, echocardiography, and effort test – all without

abnormalities. Holter ECG monitoring revealed multiple episodes of unstained ventricular

tachycardia and several episodes of complete atrioventricular block – maximal pause 3.5 sec. We

have also found frequent polymorphic ventricular extrasystole, disappearing during physical


18

effort. Biochemical panel was without abnormalities. Heart MRI showed multiple regions of

myocardial infiltration, and cardiosclerosis. The heart MRI image was typical for Chagas

cardiomyopathy, considering the patient origin. Because of the absence of experience with CD in

Republic of Moldova, we have sent the patient for serological evaluation in European cardiac

centers. Given the concomitant episodes of complete atrioventricular block, we couldn’t

prescribe any antiarrhythmic drug for the ventricular tachycardia. The patient was recommended

to avoid any physical activity. For arrhythmia control we indicated implantation of device with

pacemaker and ICD functions. Serological diagnosis of CD was thereafter confirmed. Patient got

recommendation to return in Brazil to the national center for Chagas disease, because of their

huge experience. In Brazil, during physical effort – playing football, patient suffered syncope

and died, probably because of malignant ventricular arrhythmia.

Conclusions. Heart diseases caused by different germs, atypical for Republic of Moldova or this

part of the Europe, should be taken in consideration in all causes of unexplained heart functional

or morphological abnormalities, especially in patients who are coming from other geographical

regions or travelling abroad.

Key words: Chagas disease, cardiomyopathy

7. PARTICULARITIES OF ACUTE MYOCARDIAL INFARCTION APPROACH IN A PATIENT WITH CORONARY ARTERIES ANOMALY

Authors. Constantin Cozma, Hakan Eraslan, Mihail Tasnic


Surgery Department


Background. Acute myocardial infarction among the young population is rare and presents

diagnostic and approach difficulties that lead to treatment delay in emergency cases and worse

outcome for patients. This case focuses on a young man who developed an inferior myocardial

infarction as a result of embolization of the left coronary artery system associated with the right

coronary anomaly.

Case report. A 25 year old man presented in the emergency room with a 4 hours history of

severe retrosternal crushing pain, radiating down his left arm and associated with sweating,

nausea, and breathlessness. He had never previously experienced chest pain at rest or on

exertion. He was a smoker. The last 2 weeks have been really stressful so the patient smoked

more than usual. He didn’t have a family history of ischaemic heart disease or sudden cardiac

death. At first examination he was pale and sweaty with a tachycardia of 110 beats/min. His

blood pressure was 140/100 mm Hg. Transthoracic echocardiography revealed hypokinesia of

the inferior wall. A coronary angiogram showed the absence of right coronary ostium (ostial

trombosis?) and filling of the right coronary artery through collateral vessels from the left

coronary system; LAD and OM I distal thrombosis. No right coronary ostium was observed in

the aortogram. None of the coronary arteries showed any sign of atherosclerosis. We performed

thrombolysis (Actilyse) with clinical and ECG improvement. After 72 hours angiography - LAD

and OM I successful total trombolysis, couldn't find RCA origin - suspicion of anomalous origin

of the right coronary artery. The patient was discharged on the 5th day of hospitalization in good

condition. Recommended: hereditary screening thrombophilia panel and Coronary CT

Angiography (CTA). CTA showed - Anomalous Right Coronary Artery From the Left Coronary

Sinus With an Interarterial Course, as well as right coronary artery ostial and proximal

hypoplasia, and a fistule LAD pulmonary artery RCA.

Conclusions.


19

1. Congenital ostial coronary artery atresia/hypoplasia should be a part of the differential

diagnosis particularly in young patients presenting with a totally occluded coronary artery and no

cardiovascular risk factors.

2. Thrombolysis can be a good choice for treatment of STEMI if primary PCI has failed.

3. Patients with suspicion of anomalous coronary arteries should perform CT angiography (CTA)

to confirm originated sites, anatomic route and whether complicated with other congenital

malformation.

Key words: myocardial infarction, coronary anomaly

8. SWITCHING THE LITTLE KIDS LIVES ON

Authors. Gratiana-Andreea Lates, Roberta Angheleanu, Anamaria-Romina Jugariu, Tímea

Katona, Razvan-Gabriel Budeanu

Scientific advisers: Valentin-Ionut Stroe, MD, PhD; Horatiu Suciu, MD, PhD, Professor

University of Medicine and Pharmacy of Targu Mures

Background. Cormatrix is an innovation in bioengineering, introduced in the medical world in

2013. The material is based on the extracellular matrix derived from the porcine intestine

submucosa, allowing for tissue restructure and growth in the "site" where it is used. The

composition consists of collagen, glycosaminoglycans, glycoproteins, proteoglycans and growth

factors VEGF, FGF. The superior characteristics are given by acellularity, resistance to infection,

anti-inflammatory effect and immunomodulator, the most important element being the reactivity

depending on the impulse from the tissue where it is involved.

Case report. At the Institute of Cardiovascular and Transplant Diseases in Targu Mures,

Cormatrix has been in used since 2013 and has been useful as a biocompatible tissue in arterial

switch procedures of transposition of great vessels. A 12 days old patient diagnosed with

transposition of great vessels was received by Institute of Cardiovasculare and Transplant

Diseases from Targu Mures for a arterial switch surgery. The surgery implies total

cardiopulmonary by-pass and at 26 Celsius degrees in the operating theater the great vessels are

cut from their emerging. The coronary arteries are excised from the future pulmonary artery and

reimplanted in neo-aortic wall; the resulting parietal defect after the coronary arteries excision is

repaired with a Cormatrix patch plasty. Literature showed that in 30% of cases where pericardial

patch was used it led to a pulmonary supravalvular stenosis. The post-surgery echographics at 3

months, 6 months and 1 years where Cormatrix was used showed no change in circulatory flow

in the pulmonary cormatrix patch segment.

Conclusions. In conclusion Cormatrix patch seems to have better results in reconstruction of the

pulmonary artery wall defects in transposition of great vessels surgery because it has a high level

of biocompatibility and a better reintegration in the vessel tissues .

Key words: cormatrix, bioengineering

9. SLEEP APNEA SYNDROME AS A CAUSE OF SEVERE PULMONARY HYPERTENSION

Author: Vlad Filimon

Scientific advisers: Filimon Silvia, David A., Sircu V., Institute of Cardiology, Institute of

Phtisiopneumology Chiril Draganiuc


Background. Sleep apnea is a disorder characterized by pauses in breathing or periods of

shallow breathing during sleep. There are three forms of sleep apnea: obstructive (OSA), central


20

(CSA), and a combination of the two called mixed. OSA affects 1 to 6% of adults and 2% of

children, but CSA affects less than 1% of people.

Case report. Patient X, 58 years old, of female, was admitted at the Institute of Cardiology with

mixed (inspiratory and expiratory) dyspnea at minimal effort, ankle swelling, general weakness,

dizziness. The patient suffers from arterial hypertension during 14-year with maximum levels

180/90 mmHg, working blood pressure being - 130/80 mmHg. At home regular treatment with

tab. Bisoprolol 2.5 mg in the morning, tab. Aspirin 75 mg/day, tab. Losartan 50 mg in the

evening, tab. Torasemidi 10 mg in the morning, over a day. The general condition worsened the

last month when signs of congestive heart failure progressed. The echocardiographical

examination revealed severe cardiomegaly (LA - 50 mm, LV - 60 mm, RA - 51 mm, RV - 40

mm), preserved left ventricular function (EF - 58%), reduced right ventricular function (TAPSE -

16 mm), severe pulmonary hypertension (PASP - 140 mmHg). To determine the cause of the

pulmonary hypertension, a number of investigations were performed. Pulmonary artery

angiography by computed tomography revealed pulmonary artery enlargement (40 mm) and

dilated intrapulmonary arteries, but no data on thrombosis. Spirography has revealed severe

changes in the function of external respiratory organs, being restrictive. Laboratory analyzes

excluded the systemic sclerodermia (ANA-negative, Anti Scl-70 antibodies – 1.5 U/ml, Anti

Centromer B antibodies – 0.3 U/ml) and normal values of D-dimers (0.24 ng/ml) excluded the

presence of venous thrombosis. To exclude the presence of Sleep Apnea Syndrome, cardio-

respiratory polygraphy was performed. A severe form of Sleep Apnea-Hypopnea Syndrome was

recorded, with the Apnea-Hypopnea Index (AHI) – 84.3/hour, with severe intermittent and

continue nocturnal hypoxemia in close correlation with respiratory events, having a Desaturation

Index (DI) – 82 6/hour. Average SaO2 – 69.6%, SaO2 minimum – 42%, SaO2


21

sphincterotomy was performed. Percutaneous transhepatic cholangiography and cannulation

guide wire technique was used, with a modified Burhenne technique. Stones were pushed into

the duodenum with Fogarty Balloon, stent inserted. Post interventional radiology revealed that

CBD was cleared. Patient made good recovery.

Conclusions. Elective methods in the diagnosis of choledocholithiasis are MRCP in

colangiographic regime, ERSP and percutaneous transhepatic cholangiography. Modified

Burhenne technique can be used in treating choledocholithiasis.

Key words: choledocolithiasis, biliary lithiasis, surgery

11. TRAUMATIC RECTAL WOUND AND CONSEQUENCES OF DIAGNOSTIC AND MANAGEMENT ERRORS

Author: Varvara Naghita

Scientific adviser: Rojnoveanu Gheorghe, MD, PhD, Professor, Department of Surgery no.1

Nicolae Anestiadi


Background. “Hopkins Medicine” medical journal reports medical error as the third cause of

patients’ death. Meanwhile, WHO determined that 23% of European citizens state that they have

suffered from a medical error, while 18% say that they still have complications from them. Also,

WHO established that one of 20 patients got a nosocomial infection during their hospital

admission. Several studies highlighted a rate of 15% to 30% of rectal postoperative infection,

retrospectively linked to delayed diagnosis, fecaloid infection, inefficient primary treatment and

inadequate drainage. This affects the wound’s regeneration rate and leads to complications such

as perirectal abscesses and fistulas, suture inconsistency, sepsis etc., which can result in

prolonged hospital stay, hospital readmission, home nursing wound care needs, and the

expenditure of significant medical costs.

Case report. Patient R, age 52 years, is hospitalized with a perianal wound following a 1m fall

on a metal nail. Clinical and instrumental examinations showed stable hemodynamics, painless

palpation of the abdomen, no pneumoperitoneum. Status localis: perianal, on the right a wound 4

cm x 8 cm depth was detected. Primary surgical wound debridement was performed under

general anesthesia, and no lesions of the pelvic organs were discovered. Laparoscopy revealed a

retroperitoneal hematoma, which was drained, and no penetration into the abdomen cavity was

seen. The patient’s condition worsened on the second day and an exploratory laparotomy was

performed, where a second retroperitoneal hematoma and color changed blood in recto-sigma

was detected. A terminal sigmostoma was applied for the exclusion of the extraperitoneal lesion

of the rectum without succeeding in suturing the rectum wound. Subsequently, the evolution of

the patient was negative and a retroperitoneal phlegmon developed. A second laparotomy

followed with the suture of rectal wound and debridement of putrid retroperitoneal phlegmon.

The postoperative period evolves severely but favorably with the formation of the pararectal

fistula, which imposes multiple cares and readmissions over a period of 2 years with the intent of

closing the fistula (rectum stenting, reconstructive surgeries for rectum extirpation and the

transanal colon dissension, protection ileostoma) and, finally, a permanent terminal colostoma

was applied.

Conclusions. In the presented case, the severity of rectum wound, the delayed and wrong

diagnosis as well as the errors in patient approach had increased the severity of the disease, with

multiple postoperative complications, high medical costs and had led to disability.

Key words: traumatic rectum wound, diagnostic and tactical errors, complications, treatment.

12. A COMPLEX CASE OF PANCREATIC CANCER COMPLICATED WITH GASTRIC VARICES AND DEEP VEIN THROMBOSIS


22

Authors: Elena-Lavinia Pastramoiu, Viorel Moise

Scientific adviser: Motoc Radu


Background. Pancreatic cancer is a highly lethal malignancy with few effective therapies.

Pancreatic cancer is often associated with thromboembolic disease, as the malignant condition

induces a prothrombotic and a hypercoagulable state.

Case report. This is a case of a 63 years old patient, diagnosed with pancreatic cancer with

hepatic and splenic metastasis detected on CT, with a level of Carbohydrate antigen (CA) 19-9

of 2556 UI/ml and several associated comorbidities: a moderate form of iron deficiency anemia (

Hb -7.4 g/dL, Ht - 25.2%, serum iron - 3.28 µmol/L), large gastric varices at the level of the

fornix secondary to segmental portal hypertension, but with no signs of bleeding, incomplete

intestinal metaplasia and Helicobacter Pylori infection at the level of the antrum and type 2

diabetes insulin dependent. The patient presented in our Medical Clinic complaining pain and

functional impotence of the right inferior limb. We performed a Doppler ultrasound that revealed

femoral-popliteal-tibial thrombosis of the right inferior limb and thrombosis of the internal

saphenous vein. Due to the association of the thrombotic disease with the gastric varices, the

initiation of antithrombotic therapy was questioned because of the high risk of variceal rupture

and massive bleeding. The patient was recommended endoscopic injection sclerotherapy, but the

procedure could not be performed due to the lack of compliance. A treatment the with low

molecular weight heparin (Fragmin 2500 IU) and Vessel Due F was initiated. The patient

condition was ameliorated during the admission and she was discharged with oncological and

gastroenterological follow-up.

Conclusions. The peculiarity of this case consists in the association of the thrombotic condition

with the gastric varices, both as complications of pancreatic cancer. The treatment in this case

has to be carefully chosen, as the patient is at high risk of developing both gastric bleeding and

thrombotic embolism.

Key words: pancreatic cancer, thromboembolism, gastric varices

DEPARTMENT OF PEDIATRICS

13. HIGH SERUM UNCONJUGATED BILIRUBIN LEVELS IN A PATIENT WITH MUTATIONS IN THE UGT1A1 GENE – CLINICAL CASE PRESENTATION

Author: Elena Ciumac

Scientific adviser: Donos Ala, MD, PhD, Professor, Department of Pediatrics


Background. The UGT1A1 gene plays a significant role in the glucuronidation of bilirubin, and

the mutations of this gene lead to limitations in the synthesis of the glucuronyltransferase

enzyme, which contributes to the increase in free serum bilirubin. This clinical condition is

called Gilbert's syndrome. The patient with Gilbert syndrome has no clinical manifestations until

the second decade of life. Scientific studies demonstrate that free serum bilirubin in patients with

Gilbert syndrome is almost entirely unconjugated. We present the case study of a 17-year-old

patient with Gilbert's syndrome, confirmed by molecular genetics tests.

Case report. Patient was born from the first pregnancy with satisfactory evolution. Weight at

birth was 3500g, height 52 cm, Apgar score 8/8. She was breastfed until the age of 1.5 years.

Growth and development was within normal values, but after 4-5 years of age, she began to

manifest periodically poor appetite, vomiting, abdominal pain, constipation. The dynamical

assessment of clinical and paraclinical examinations revealed reactive pancreatitis episodes, “S”-


23

type gall bladder deformity, biliary stasis, hepatosplenomegaly (on ultrasonography non-

homogeneous aspect of parenchyma with mild to moderate increased echogenicity). At the age

of 10, she was diagnosed with left nephroptosis, secondary chronic pyelonephritis and chronic

cystitis. She was diagnosed with adenoiditis and chronic sinusitis, episodes of otitis. On July 20,

2015, patient presented with jaundice. The hemoleucogram revealed mild anemia (hemoglobin

was 112 g/l, erythrocyte 3.8 mln/mcl). The biochemical examination revealed increased bilirubin

levels, mainly on the basis of free bilirubin: total bilirubin was 36.0 mmol/l, conjugated bilirubin

was 9.0 mmol/l, free bilirubin 27.0 mmol/l. Serum glucose was at normal level (4.9 mmol/l),

thymol test - 1.0 (normal value). The transaminase levels were normal (ALT 13.6 IU, AST 20.1

IU). From the history, serum bilirubin levels were normal until adolescence. At the age of 17, the

level of bilirubin increased considerably, leading to suspected viral hepatitis, which could be

present considering that hepatitis was present in the family. For differential diagnosis purpose,

markers of viral hepatitis were tested: anti-HBs antibodies


24

which were successfully treated. On the 25th day of life, the newborn was transferred to the

neurosurgical unit for reservoir implant, cerebrospinal fluid (CSF) drainage and further

treatment. Due to the favorable evolution, after 20 days he was transferred back to the premature

care unit.

Conclusions. Recognition of early signs of intraventricular hemorrhage with catastrophic or

saltatory pattern, proper prenatal and neonatal care is essential in order to reduce mortality

among preterm newborns.

Key words: intraventricular Hemorrhage, ventriculomegaly, preterm infants

15. CLINICAL MANAGEMENT IN PREGNANCY COMPLICATED WITH HELLP SYNDROME. CLINICAL CASE PRESENTATION

Author: Valentina Gurau

Scientific adviser: Corina Iliadi-Tulbure, MD, PhD, Associate professor; Victor Petrov, MD,

PhD, Associate professor; Zinaida Sarbu, MD, PhD, Associate professor; Department of

Obstetrics and Gynecology no.2


Background. Preeclampsia complicates 2-3% of all pregnancies (5-7% in nulliparous women)

and remains a leading cause of maternal and perinatal mortality and morbidity. HELLP

syndrome is a rare manifestation of hypertensive diseases of pregnancy and represents the most

severe end of the pre-eclampsia spectrum. It occurs in 0.5 to 1% of all pregnancies and in 10-

20% of cases with severe preeclampsia. Although variable, the onset of the HELLP syndrome is

usually rapid.

Case report. Patient X, 31y.o, primigesta, 39 w.g. was admitted to the maternity unit

complaining of amniotic fluid leakage. She was not in labor on admission and her vital signs

were normal: blood pressure (BP) was 130/80 mm Hg, pulse - 76/min. Her antenatal history was

uneventful before this admission. Physical examination revealed peripheral edema, pathological

weight add + 17 kg. Vaginal delivery according to the protocol was established. Over one hour,

suddenly, the patient accused pronounced epigastric pain, occipital headache associated with

high BP 180/110 mm Hg. Laboratory investigations included: thrombocytopenia - 120×109 g/l,

leukocytosis - 12.4×109g/l. Liver function tests included increased concentrations of alkaline

phosphatase - 126 u/l, LDH - 4886 u/l, ALAT - 317 u/1, ASAT - 500 u/1. Urinalysis for protein -

4.32 g/l. On the background of hypotensive therapy, the 150/100 mm Hg BP and symptoms of

organ damage persisted. At this stage a diagnosis of HELLP syndrome was considered. In view

of the rapid progression of the disease and the gestational age, it was decided to proceed to

urgent delivery by caesarean section. One infant was delivered, with intrauterine growth

restriction (weight - 2390g). In dynamics, hemolysis syndrome is also associated (haemoglobin -

90 g/l, erythrocytes - 2.9×1012g/l, haematocrit - 0.27%). Postoperative period was complicated

by CID syndrome and acute renal failure. Clinical management was performed according to the

protocols and patient was discharged in satisfactory condition at 11th postpartum day.

Conclusions. HELLP syndrome is a severe complication of pregnancy, fulminant evolution

being frequently evaluated in primiparous without pre-existing medical conditions. Due to

maternal and fetal impact, HELLP syndrome needs an urgent delivery by caesarian section,

which is the essential method indicated in the severe form.

Key words: HELLP syndrome, pregnancy.

16. MANAGEMENT OF GIANT OVARIAN CYST IN PREGNANCY. CLINICAL CASE REPORT

Authors: Cristina Mursiev, Munteanu Igor


25

Scientific adviser: Iliadi-Tulbure Corina, MD, PhD, Associate professor; Sarbu Zinaida, MD,

PhD, Associate professor, Departement of Obstetrics and Gynecology no.2


Background. Ovarian cysts are met in women of various ages, most commonly occurring during

a woman's childbearing years, pregnant women not being an exception. Moreover, studies

conclude that ovarian cancer is among top five types of cancers detected during pregnancy. The

latest data show that the incidence of ovarian cysts in pregnancy varies from 0.15 to 5.7%

malignancies ranging from 0.8 to 13%. Their evolution is frequently hard to predict, some cysts

stop growing or disappear, while other may rupture, torsion or cause the obstruction of the

delivery pathways. Only ovarian cysts at risk of complication are to be considered. These are

mainly ovarian cysts, which, whatever their echogenic features, have a size ≥5 cm. Their

prevalence is estimated between 0.5 and 2 per thousand of pregnancies.

Case report. Patient X, 21 y.o., primigesta, pregnant 36-37 w. a., underwent a routine

gynecological and ultrasonographic examination, during which she was firstly diagnosed with a

giant 195x115 mm cyst in the projection of the right adnexa, supposedly originating from the

ovary. Considering the gestational term and the lack of data for cyst complications, an

expectative management was chosen and a re-evaluation was scheduled in two weeks.

Consequently, the woman was admitted to the IMSP IM and C 3rd level hospital for further

monitoring, investigations and establishing the optimal birth management. The next performed

USG showed that the dimensions of the cyst have grown to 223x123 mm, it was mainly situated

in the subhepatic space, it’s precise origin was hard to determine. It was decided to finish the

pregnancy via caesarean section and invite a general surgeon to the intervention, in case other

surgical manipulations would be needed. The tumoral markers were determined, with no

deviations found: CA125 – 13,5 (N≤ 35); HE4 – 35 (N≤70); ROMA index – 3,4 (N 0 – 11,4%).

At the term of 38-39 w.a. an elective caesarean section was performed. It was established that the

cyst had an ovarian origin and was fully extracted. The abdominal cavity was drained. Total

haemorage-800 ml. The woman and the newborn were discharged home on the 4th postoperatory

day. The histological exam revealed an ovarian dymorphus sero-mucinous cystadenome, with a

2+ to 3+ mucin reaction, follicular cysts and lonely, distrofic primordial follicles.

Conclusions. Though ovarian cysts are seldom met in pregnancy, their presence may have

serious repercussions on the evolution of the pregnancy and on the fetus. This is why, even in the

absence of symptoms, an USG supervision combined with other methods for diagnostic is

necessary. The decision upon the optimal birth way should be taken individually in each case,

the histological exam being crucial for establishing the final diagnosis.

Key words: ovarian cyst, pregnancy

DEPARTMENT OF INFECTIOUS DISEASES

17. DENGUE INFECTION: A CASE PRESENTATION

Author: Corina Pocnea

Scientific adviser: Gheorghe Placintă, MD, PhD, Associate professor, Department of Infectious

diseases


Background. Dengue disease is an acute viral illness with the common symptoms, such as: high

fever, muscle and joint pain, myalgia, cutaneous rash, hemorrhagic episodes. According to the

WHO, the number of cases increased to 390 million per year in more than 100 countries,

especially in the tropical and subtropical regions.


26

Case report. A 35-year-old woman from Chisinau, Republic of Moldova presented to the

Hospital of Infectious Diseases “T. Ciorba” with weakness, rash, fever 39C and pronounced

sweating. The first symptoms appeared on 21.01.2016 including strong headache and fever

38.4C. Then scarlatiform maculopapular rashes occurred on the upper chest, on the sternum, and

on shoulders. The eruption was red, confluent and without hemorrhagic component. On the fifth

day appeared myalgia in the thoracic region and in the iliac region. On the sixth day of illness,

the scarlatiform maculopapular rashes spread throughout the body. Bleeding signs were not

detected. On 26th January the patient addressed at Medpark hospital, where she had her blood

tests taken and was directed to the Hospital of Infection Diseases “T. Ciorba”. Epidemiological

anamnesis: on the 18th January 2016 the patient returned from Bali, Indonesia, where she spent

12 days with her girlfriend and girlfriend’s husband, who are from Moscow. She reported that

they were bitten by mosquitoes. Exactly the same day as the patient got sick, her girlfriend

started having fever and skin rash. On 27th January she addressed to the Infectious Disease

Hospital in Moscow, where the diagnosis of Dengue Fever was established to her. Laboratory

investigations: General blood analysis-erythrocytopenia (2.9*1012/L),

leucocytopenia(2.3*109/L) and lymphocytosis (51.7%). The biochemical analysis of the blood

didn’t show any pathological changes, as well as didn’t the general urinalysis.

Conclusions. Dengue Virus belongs to the same family of Flaviviridae as Zika Virus, also both

of them are tropical infections, spreaded in the same areas and transmitted by the same

mosquitoes. The vaccine was developed, but it’s not available in our country so for this patient

it’s important to avoid reinfection with other serotypes of the virus, which can therefore lead to

the development of Dengue shock syndrome. Early diagnosis of travel-imported cases is

important to reduce the risk of localized outbreaks of tropical arboviruses such as Dengue Virus

and the risk of local transmission from body fluids or vertical transmission.

Key words: dengue Virus, case report, infection.

DEPARTMENT OF NEUROSURGERY

18. ISOLATED POST STROKE EPILEPTIC SEIZURES IN WOMEN

Author: Victoria Duca

Scientific adviser: Mihail Gavriliuc, MD, PhD, Professor, Department of Neurology and

Neurosurgery.


Introduction. Seizures are a known complication of stroke. They may increase the cerebral

lesions and induce epileptic status or encephalopathy. The correlation between brain structural

damage, epileptic foci, antiepileptic drugs and clinical outcome is unknown. Late-onset seizures

are thought to be caused by gliosis and the development of a meningocerebral cicatrix. Changes

in membrane properties, deafferentation, selective neuronal loss, and collateral sprouting may

result in hyperexcitability and neuronal synchrony strong enough to cause seizures. Can we

consider as Epilepsy one grand-mal seizure after a massive ischemic stroke?

Case report. A 41 year – old woman with a history of thrombosis of the right coronary artery,

myocardial infarction at the age of 35, was confirmed with primary antiphospholipid syndrome.

After two years, she developed cerebral infarction in MCA territory, and with mild left

hemiparesis she was hospitalized at the Neurological Institute. The 3T cerebral MRT was

performed on Siemens Magnetom Skyra 3T, and confirmed a large cerebral infarction in the right

hemisphere with a density of 12 UH, dimensions 9.0 x 5.0 x 6.0 cm without mass effect. She

continued anticoagulation therapy – warfarin – under the INR (2.0 - 2.5) control. At the age of 39

the patient developed a single generalized tonic - clonic epileptic seizure. Routine EEG,

prolonged EEG (2 hours) at the Nicolet EEG Wireless Amplifier System were performed. EEG


27

data showed focalized slow spike – wave: theta waves right F – C – T and T posterior spike.

Hyperventilation has induced F bilateral extension, without secondary generalization. Photic

stimulation test maintains focalized epileptic activity. Lamotrigine was initiated in increasing

doses reaching the therapeutic dose – 200 mg/24 hours. Epileptic seizures have not recurred.

Free period of seizures - 3 years with antiepileptic treatment. EEG and cerebral MRI monitoring

were performed regularly, once a year over the last 3 years. Cerebral MRI did not reveal adjacent

lesions. EEG showed the disappearance of sharp waves and the persistence of slow F – C right

waves.

Conclusions. According to the literature data, the seizures could repeat at any time, i.e. over 5

years or 10 after the stroke. In the 3-year period without seizures probably there was no

transformation of a structurally damaged brain into an epileptic one. The last definition of

epilepsy by R. Fisher confirmed that one epileptic seizure cannot be epilepsy. The severity and

location of the infarction advocates a vascular epilepsy, not epileptogenic foci.

Key words: stroke, seizures, antiepileptic drugs

19. TREATMENT OF CHRONIC LYMPHOCYTIC LEUKEMIA – A DIFFICULT CHOICE FOR SEVERE COMPLICATIONS: A CASE REPORT

Authors: Razvan-Gabriel Budeanu, Anamaria-Romina Jugariu, Timea Katona, Alexandru-

Emil Baetu, Gratiana-Andreea Lates

Scientific adviser: Ioan Macarie, MD, PhD, Associate professor


Background. Chronic lymphocytic leukemia (CLL) is the most common form of adult leukemia

in the western European countries and is characterized by the relentless accumulation of

monoclonal B cells with the appearance of small mature lymphocytes and with a characteristic

immunophenotype. Even with the right treatment, this disease is known to have a variable

course: some patients die within one year after diagnosis while others live for longer than ten

years.

Case report. A 59-year-old female with a past medical history of ischemic cardiopathy and

hypothyroidism was admitted to the Haematology Unit of Mures County Emergency Hospital

with severe anemia, chronic fatigue and leukocytosis. After the anemia was corrected, the

diagnosis of chronic lymphocytic leukemia was confirmed by complete blood count and

immunophenotyping for which the patients was only observed for 2 years. Due to the secondary

severe anemia the treatment with Fludarabine is started as monochemotherapy first line

treatment. After one month the patient is hospitalized with severe anemia with Coombs’ test

positive for which methylprednisolone is administered for one week and COP chemotherapy is

induced. Because of the gastrointestinal side effects, the COP chemotherapy is ceased and

Fludarabine treatment is reintroduced. The treatment is continued for one year but the multiple

side effects (hemolytic anemia, herpes zoster, Listeria meningitis) determined cessation of

Fludarabine and Chlorambucil treatment was introduced. The treatment with Chlorambucil was

continued for 3 years. Even though the patient supported well the treatment, the splenomegaly

has progressively increased (from 3 cm to 8 cm) and the infectious diseases appeared

(Acinetobacter pneumonia and pharyngeal candidiasis).

Conclusions. Even though the treatment is accordingly to the actual international guides, the

individual responsibility to the drugs and the unpredictable evolution of this disease may be a

challenge in treating chronic lymphocytic leukemia.

Key words: chronic lymphocytic leukemia, treatment, drug selection, side effects

20. FORENSIC ASPECTS OF NON-TRAUMATIC INTRACEREBRAL HEMORRHAGE: A CASE REPORT


28

Authors: Tabian Daniel1, Diac Madalina1, Damian Simona Irina1,2, Riscanu Laura

Adriana1,2, Knieling A.1,2, Enea M.2 Scientific adviser: Bulgaru Iliescu Diana, MD, PhD, Associate professor 1Iasi Forensic Institute, Romania 2Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania

Background. Cases when unexpected death occurs, when the patient is in apparent health or the

event comes during presumably normal activity, especially when it is unwitnessed or when the

victim is found without apparent signs of foul play, may pose a significant challenge to the

coroner in reaching a proper determination of the cause and the manner of death. Spontaneous

intracerebral hemorrhage (ICH) is a bleeding into the parenchyma of the brain and accounts for

approximately 10 % to 20 % of all strokes. ICH is a multi-factorial disease caused by several

interacting and overlapping risk factors and etiologies. When massive ICH, not connected with

head trauma, has occurred, and it is multifocal or not located in one of the typical sites for

hypertensive hemorrhage, one of a multitude of other causes must be suspected. High alcohol

intake increases the risk of all stroke subtypes and of the development of liver diseases and may

induce hypertension, by affecting brain function and producing a series of alcohol-related or

alcohol caused diseases and is associated with changes in the coagulation system. Liver cirrhosis

is a well-known risk factor for ICH, due to impaired coagulation, despite the relatively rare

occurrence of ICH in cirrhotic patients.

Case report. The authors report a case of a 48 years old man, who was admitted in the

Neurosurgery Department, being found in the street, with a present state of consciousness,

presenting aphasia, right hemiplegia. The first computer tomography revealed left side temporal-

parietal-occipital intracerebral hematoma of 52/20/45 mm, postcentral intergyral subarachnoid

hemorrhage, and cerebral atrophy. On the second computer tomography, the lesions underwent

moderate resorption, and a conservative treatment for ICH was chosen. After 28 days from the

admission in the hospital, the patient died, due to a cardio-respiratory arrest. The release

diagnosis was: Left Side parietal-occipital itracerebral haematoma. Right hemiparesis. Hepatic

encephalopaty. Mixed decompensated alcoholic liver cirrhosis. Scleral and tegumentary

jaundice. Ascites. Hypersplenism. Severe thrombocytopenia. Hypoalbuminemia.

Bronchopneumonia. Schizophrenia. The body was brought for autopsy at the Iasi Forensic

Institute. The necropsic examinatiation revealed: right side occipital epicranial hemorrhagic

infiltration, a left side parietal-occipital lobe blood collection, cerebral oedema, pachypleuritis,

bronchopneumonia, ascites (5 liters), cirrhosis, and splenomegaly.

Conclusions. Proper documentation of injuries, along with history of the case, has a huge

importance in reaching a conclusion on both the cause and the manner of death. In this case, the

absence of external head injuries, the absence of underlying brain lesions that would be

suggestive for a head trauma, the presence of risk factors for primary non-traumatic ICH, make a

context in which the case may be properly interpreted.

Key words: Head injuries, intracerebral hemorrhage, case report.

21. FOSTER KENNEDY SYNDROME AS AN INITIAL PRESENTATION OF NEUROFIBROMATOSIS TYPE 2: A CASE REPORT

Authors: Alexandru Sumleanschi, Serghei Borodin

Scientific adviser: Aureliu Bodiu, MD, PhD, Professor, Department of Neurosurgery, Republican

Clinical Hospital



29

Background. Foster Kennedy syndrome (FKS) is described as ipsilateral optic atrophy and

contralateral papilledema from an intracranial mass. FKS is uncommon manifestation of

Neurofibromatosis type 2 (NF2), which is generally presented with hearing loss and tinnitus.

Case report. In this report we present a 26-year-old female with the atypical presentation of

NF2. First symptoms were progressive vision loss and cognitive dysfunction. Ophthalmological

examination revealed right-sided papilledema and left-sided optic atrophy. Magnetic resonance

imaging (MRI) of the brain revealed bilateral vestibulocochlear schwannoma and three

intracranial meningiomas, involving the parafalcine region and the olfactory groove. Whole

spine MRI showed one intramedullary tumor at C1-C2 level, multiple spinal canal nodules in

cervico-dorsal regions and one Th12-L2 extramedullary tumor. Based on clinical and imaging

findings the diagnosis of neurofibromatosis type 2 was established. The patient underwent

surgical resection of giant parasagittal meningioma, subtotal resection of the olfactory groove

meningioma and total resection of Th12-L2 meningioma. Six months after brain surgery, she

underwent Gamma knife radiosurgery for remnant frontobasal meningioma and for both

vestibulocochlear schwannomas. Despite the combined treatment of intracranial lesions, only an

insignificant vision improvement was achieved.

Conclusions. FKS can be the presenting symptom of NF2. Early detection and treatment of

ophthalmologic manifestations of NF2 may prevent amblyopia development.

Key words: Foster Kennedy syndrome, neurofibromatosis type 2, intracranial meningioma,

intramedullary tumor, extramedullary tumor

DEPARTMENT OF NEUROLOGY no.1

22. INTRACEREBRAL HEMORRHAGE IN A PATIENT WITH MOYAMOYA SYNDROME: CASE REPORT

Authors: Pavel Gavriliuc1, 2, Elena Costru-Tașnic1, Tatiana Pleșcan1, Dacin Ianuș2

Scientific adviser: Gavriliuc Mihail1, MD, PhD, Professor, Department of Neurology and

Neurosurgery 1Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova 2Institute of Neurology and Neurosurgery of the Republic of Moldova

Background. Moyamoya disease is a cerebrovascular disease that is characterized by bilateral

chronic and progressive stenosis or occlusion of the arteries around the circle of Willis with

development of collateral circulation, of unknown etiology. It has a high incidence in Japan and

Asian population, with fewer cases described in Europe. Similar angiographic findings can be

seen in patients with other medical conditions that are described as Moyamoya syndrome. Main

clinical features include transient ischemic attacks, ischemic strokes, and hemorrhagic strokes.

Case report. We describe a 38-year-old female patient that presented with an intracerebral

hemorrhage with a typical location for hypertensive bleeds. She had no vascular risk factors, but

a high normal blood pressure (140/90 mmHg), and elevated ESR. A magnetic resonance

angiography showed occlusion of internal carotid artery with development of collateral cerebral

circulation on the side of the bleeding. Unilateral affection and elevated ESR were more

characteristic for a moyamoya syndrome within a systemic disease.

Conclusions. Despite a typical hypertensive location of the bleeding, vascular imaging is

warranted in all patients with intracerebral bleedings to evaluate for atypical etiologies. Our case

represents a patient that might benefit from revascularization surgery in the context of

multifactorial risk factor control.

Key words: Moyamoya syndrome, stroke, hemorrhage, intracerebral, collateral flow.

23. POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME MIMICKING


30

STROKE IN A YOUNG WOMAN

Authors: Elena Costru-Tasnic1, Pavel Gavriliuc1,2, Tatiana Plescan2, Olesea Odainic2

Scientific adviser: Mihail Gavriliuc1, MD, PhD, Professor, Department of Neurology and

Neurosurgery 1Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova 2Institute of Neurology and Neurosurgery of the Republic of Moldova

Background. Stroke in young patients (


31

min and 5 minutes respectively. The patient developed respiratory distress syndrome in the first

few hours. He had inter- and subcostal retractions, grunting, tachypnea (80 breaths per minute),

nasal flaring and the pulse was 127 beats per minute with a SpO2 under 90% in room air and

higher than 95% with oxygen supplementation. The treatment with Dexamethasone showed no

improvement and an urgent Chest X ray was ordered which revealed a left pneumothorax with

mediastinal shift to the opposite site. ABG revealed severe acidosis. (pH – 7.13, PCO2 – 70, PO2

– 46 mmHg). In view of impending respiratory failure and shock baby was intubated, the

pneumothorax was drained. Hemoculture was positive with GBS. The antibiotic therapy

(Ampicillin/Sulbactam and Amikacin) was started and the patient was carefully monitored.

Conclusions. In conclusion, although respiratory distress syndrome is rare in near term or term

newborn, is usually secondary to a parenchimal pathology, being a common case of spontaneous

pneumothorax in these infants. Early recognition and treatment is life saving. Usual

manifestation is progressive respiratory difficulty starting soon after birth.

Key words: GBS infection, respiratory distress, near term infant, spontaneous pneumothorax

DEPARTMENT OF MOLECULAR BIOLOGY AND HUMAN GENETICS

25. DUCHENNE MUSCULAR DYSTROPHY AND LIMB-GIRDLE MUSCULAR DYSTROPHY: CLINICAL CASES

Author: Nadejda Bejan

Scientific adviser: Sprincean Mariana, MD, PhD, Associate professor, Department of Molecular

Biology and Human Genetics


Background : Muscular dystrophies (MD) represent a large group of genetic disorders that are

manifested by progressive increase of muscle weakness. Duchenne muscular dystrophy (DMD)

is an X-linked disorder and limb-girdle muscular dystrophies (LGMDs) include over thirty

subtypes, that are classified in autosomal dominant (1A-1H) and recessive (2A-2W). Our aims

was to highlight the clinical and genetic aspects in MD by reporting two clinical cases with the

aim of improving the early diagnosis.

Case report. The study was performed on the basis of the literature review and presentation of

two clinical cases: a 6-year-old boy with DMD and another 17 years old boy with LGMD.

Patient G.V. was diagnosed with DMD at the age of 3 years. Electroneuromyography (ENMG)

and genetic test (deletion of exons 45-52 in the dystrophin gene) confirmed the diagnosis. He has

the following clinical signs: calf pseudohypertrophy, waddling gait, lordosis, elevated serum

creatine kinase (CK) - 14 740 U/l, MB fraction – 833 U/l, lactate dehydrogenase (LDH) – 1934

U/l. Patient M.A. was diagnosed with LGMD at the age of 7 years through ENMG. He presents

severe motor deficit, waddling gait, hypoplasia of the thigh muscles, permanent asthenia, total

CK - 486 U/l, MB fraction - 36 U/l, LDH - 358 U/l. He has first-degree disability and

cardiomyopathy.

Conclusions. The first signs of MD (DMD and LGMD) occur at early stages, but often are not

recognized. Genetic counseling and prenatal diagnosis will significantly reduce morbidity and

mortality, will contribute to the improving of the quality of life.

Key words: Muscular dystrophies (MD), Duchenne muscular dystrophy (DMD), limb-girdle

muscular dystrophies (LGMDs).

26. THE CLINICAL-GENETIC PARTICULARITIES IN APERT SYNDROME

Authors: Olga Nadjmacova, Tatiana Țurcanu


32

Scientific adviser: Sprincean Mariana, MD, PhD, associate professor, Department of Molecular

Biology and Human Genetics


Background. Apert syndrome (AS) is a dominant autosomal genetic disorder caused by

heterogeneous mutation in FGFR2 genes on chromosome 10q26 and belongs to a group of

disorders known as craniofacial congenital malformations. AS can promote the premature fusion

of bones in the skull, hands, and feet. The incidence of infants born with Apert syndrome is

approximately 1 in 50000 to 80000. In this study is emphasized the importance of clinical and

genetic approaches in the research on the specific diagnosis in patients with Apert syndrome.

Case report. The clinical particularities of Apert syndrome are determined by craniosynostosis

result from the premature fusion of the skull bones. The child present following clinical features:

short anterioposterior diameter with high forehead and flat occiput, flat facies, shallow orbits,

proptosis, hypertelorism, small nose, maxillary hypoplasia, a cleft palate, low set ears, and

cutaneous syndactyly of the fingers and toes. The neuroimaging of the head revealed

craniosynostosis of the skull bones. The diagnosis of Apert syndrome was confirmed by clinical

manifestations and paraclinical investigations. The treatment of Apert syndrome is directed

toward the specific symptoms that are apparent in each individual.

C

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