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Rezumatele Conferinei naionale Maladii bronhoobstructive la copii, consacrat profesorului universitar, doctor habilitat Victor Gheeul

27 aprilie, Chiinu, Republica Moldova

national Conference Abstracts Bronchial Disorders in Children Dedicated to Professor, M. D., Ph. D., Victor Gheteul

April 27, Chisinau, Republic of Moldova

Association between gastroesophageal reflux and spirometric finding in children with bronchial asthma

I. Adam

Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University93, Burebista Street, Chisinau, Republic of Moldova

Corresponding author: +37379514096. E-mail: ianos.adam@gmail.com

Gastroesophageal reflux disease (GERD) is one of the most common diseases that affects the upper gastrointestinal tract. GERD includes endoscopically positive, endoscopically negative, and extraesophageal reflux disease. In the past few years attention and discussion of the extraesophageal symptoms of GERD has been growing. One of the most discussed topics is the relation of GERD to bronchial asthma.

The aim of this study was to assess lung function disorders using spirometric measurements in a group of children with as-thma, with and without gastroesophageal reflux disease.

The study included 114 children with moderate to severe asthma, aged from 5 to 16 years. The main group entered 58 chil-dren with association of asthma with GERD; controls included 56 GERD-free asthmatic children. Asthma diagnosis was established according to GINA criteria (2010) and GERD was diagnosed on the basis of ESPGHAN (2009) recommendations.

Analysis of the mean forced expiratory volume (FVC) values showed restrictive characteristics of changes in lung functio-ning. Thus, FVC values in the first group were reduced down to 64,032,42% in children with moderate asthma and 64,63,42% in those with severe progression of the disease, compared with the same subgroups with GERD (69,122,49% and 71,932,56%, respectively, p>0,05). According to the European Respiratory Societys standards, obstructive type changes include following spirometric criteria: a decrease in dynamic lung function variables that characterize the airflow-volume relationship (FVC, FEV1, PEF and MEF25-75). Our study results showed lower levels of

FEV1 in children with asthma and GERD (61,742,58% in mo-derate asthma and 61,053,84% in severe asthma), compared with GERD-free cases (72,352,13% and 73,82,53%, respecti-vely; p

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Hygienic estimation of training conditions of pupils with chronic respiratory diseases

*A. Cazacu-Stratu, Gr. Friptuleac

Hygiene Department, Nicolae Testemitanu State Medical and Pharmaceutical University26/2, Testemitanu Street, Chisinau, Republic of Moldova

*Corresponding author: +37322729857. E-mail: angelacs@rambler.ru

Among the chronic respiratory diseases, children frequently suffer of recurrent bronchitis and chronic asthma. Statistics show that recurrent and persistent chronic bronchitis represents 26-42% of all bronchopulmonary diseases. Some of the most common diseases recorded in medical practice, both in children and adults, are diseases of the respiratory system. Respiratory diseases in the Republic of Moldova have little tendency to increase, and the ave-rage prevalence consists of 37,4% of general morbidity. However, chronic bronchitis and asthma morbidity have a high tendency to increase. The prevalence of chronic bronchitis in Republic of Moldova is 3,210,12, and 1,340,08 for asthma.

A decisive role in the pathogenesis of these diseases is evalu-ating risk factors such as ecological harmful factors, food, passive smoking, intra and extra domicile environment (habitual exhaust, household chemicals, dust, pollen and damp), weather conditions, additives and alimentary dyes, pharmaceutical remedies used without a medical prescription, and the lifestyle of the family.

The training conditions of children in the schools were inves-tigated from 6 rural locations. We evaluated 2000 microclimatic indices, 2000 of concentration of CO2 and CO, and 70 probes

for determination of fungals poluation. During the study in the winter, air temperatures were very low. In the school Gordineti, district Edine, temperatures were registered at 15oC. At the be-ginning of the lessons the average temperature was 12,8 oC 0,4, and 13,6 oC 0,1 at the end of the day. Temperatures were recorded as lower than the hygienic norm temperature levels (18-20 oC) in the following schools: Feteti, the district of Edine, Mihai Eminescu, and Mihai Sadoveanu from the district of Cahul. Relative air humidity in the classrooms varied during the lessons, but exceeded the hygienic normative levels (the hygienic norm being 30-60%) in all investigated schools. The concentration of carbon dioxide exceeded admissible limits at the end of the lschool day in all schools, the biggest values being registered in Feteti, Ion Incule and Mihai Eminescu, which exceeded the hygienic normative (MAC - 0,1%) 3 times during the day. Air pollution in the buildings from fungus (Penicillium, Mucor) and high relative air humidity presented the main factors in the development of chronic respiratory diseases amongst children.

Key words: chronic bronchitis, bronchial asthma, children, risk factors.

Frequency and impact of glutathione-S-transferase gene polymorphisms on lung function and bronchial asthma susceptibility in Moldovan children

*O. Cirstea, l. Vasilos, A. Cojocaru, A. Horoditeanu-Banuh, M. Aram, D. Savoschin

Scientific Department of Pediatrics, Research Institute for Maternal and Child Health Care93, Burebista Street, Chisinau, Republic of Moldova

*Corresponding author: +37369038523. E-mail: olga.cirstea@gmail.com

Asthma is a highly prevalent chronic inflammatory disease of the respiratory tract with genetic predisposition. However, the complex mechanisms of its inheritance, from the genetic pre-disposition of atopy to allergic diseases, are still not completely understood. Recent data suggest that the pathogenesis of atopic diseases is complex and might be caused by gene-gene and/or gene-environmental interactions. Polymorphisms of the gluta-thione-S-transferase (GST) genes are known risk factors for some environmentally related diseases.

The aim of the present study was to investigate the frequency of polymorphisms in the GSTT1, GSTM1, GSTP1 and NAT2 genes in the population groups of healthy Moldovans and children with asthma, and to analyze their role on lung function.

The studied population included 180 subjects 90 children with asthma, aged 5 to 17 years (mean VEM age of 10,9 0,4

years) and 90 healthy controls who showed no signs or history of allergic diseases (mean age 13,5 0,2 years). The asthma group in-cluded 51 males and 39 females, who were randomly selected from asthmatic children referred by the Allergy Clinic of the Research Institute for Maternal and Child Healthcare, Chisinau, Moldova, during 2009-2010. Asthma was defined according to the criteria of the Global Initiative for Asthma (GINA). A complete clinical history, physical examination, and pulmonary function test (PFT) were performed for all the subjects in accordance with standards. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured using a portable spirometer (Spirobank G, Mir, Italy). Genes coding for the xenobiotic-metabolizing enzymes (GSTT1, GSTM1, GSTP1 and NAT2) were evaluated by polyme-rase chain reaction (PCR).

Analysis of the xenobiotic-metabolizing enzyme genes

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frequency in the studied population showed an equally distributed prevalence of GST genes genotypes in the patient group in com-parison with the controls. However, the heterozygous genotype of the GSTP1 341 C>T Ala114Val polymorphism was found signifi-cantly more frequent in healthy subjects (14,49,7% in patients vs 26,79,0% in controls; 2 = 3,4, gl = 1, p=0,06). The GSTM1 null genotype was overrepresented in asthmatic males in comparison with controls (54,99,4% vs 35,311,3%; 2= 3,21, gl=1, p=0,07). The GSTT1 null genotype was associated with a significant de-crease in the FEV1/FVC% ratio when compared with the GSTT1 wild genotype (89,33,4 vs 95,81,3, respectively, p

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the clinical and immunological features of obstructive bronchitis in children under five years of age

A. Donos

Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University93, Burebista Street, Chisinau, Republic of Moldova

Corresponding author: +37369266225. E-mail: aladonos@rambler.ru

WHO statistics show that more than 10% of world population suffers from symptoms of allergies, or have atopic backgrounds. Acute respiratory infections constitute for more than of the cau-ses of death in children under 5 years old, and 30-40% are preschool or school children. Bronchial obstruction is found in 20-25% of cases and 1-2% of them needed hospitalization. Obstructive bron-chitis represents a medical and social problem considering that other risk factors in childhood may increase the risk of persistency of bronchial problems and asthmatic development.

Eighty-nine children under the age of 5 entered the study, 57,7% boys and 42,3% girls. Study participants were divided into three subgroups: the 1st group children with wheezing, the 2nd group children with asthma, and the 3rd group children with pneumonia and wheezing. Every subgroup included children of the following ages: 1-12 months, 1-3 years, and 3-5 years. A struc-tured questionnaire was applied to collect the data. Laboratory examination included: complete blood count, chest radiology, determination of sanguine gases, spirometry, immune status, skin prick tests, total immunoglobulin E (IgE), serum levels of the immunoglobulin A, immunoglobulin G, immunoglobulin M, and circulating immune complexes (CIC).

The first study group mostly consisted of children 1 to 3 years old, and the second group, chidlren 3 to 6 years old. In the first group there was an insignificant prevalence of urban residents compared with rural (56,7%, vs. 43,3%; p>0,001) and a significant prevalence in the 3rd group (80,0% vs. 20,0%; p

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Bronchiolitis: aetiology, pathophysiology and therapeutic managementJ. legg

Paediatric Respiratory Services, Southampton University Hospitals, United KingdomCorresponding author: +02380794829. E-mail: julianplegg@googlemail.com

Acute viral bronchiolitis in young infants remains a cause of substantial morbidity and health care costs. It is the most common lower respiratory tract condition and the most common reason for the hospitalization of infants. A number of respiratory viruses have been associated with acute viral bronchiolitis although respiratory syncytial virus (RSV) remains the most frequently identified virus. The majority of affected infants have a mild self-limiting disease, while others have more severe illness and require hospitalization and,sometimes,ventilatory support. Bronchiolitis has an overall mortality rate of 0.2-0.5%, with 99% of deaths occurring in de-veloping countries.

Bronchiolitis is a clinical diagnosis based on a typical pattern of rhinorrhoea, cough, poor feeding, tachypnoea, subcostal recession and auscultatory findings of wheezing and fine inspiratory crack-les. There is a distinct seasonal pattern with a peak in incidences in autumn and winter.

Evidence-based reviews have suggested a limited role for diagnostic laboratory or radiographic tests in typical cases of

bronchiolitis. A nasopharyngeal aspirate has been identified as the most sensitive methodfor virus detection. Pulse oximetry also provides valuable information about the severity of the disease and guides subsequent management.

Supportive therapy remains the major treatment option, as no other specific treatments to date haveshown to provide clinically significantbenefits. Minimal handling, oxygen supplementation, and appropriate fluid management (including nasogastric feeds if necessary) are the mainstay of therapy. Nasal suctioning can be helpful as well. Very young infants may require cardiopulmonary monitoring for apnoea. There is a wide variation in treatment for bronchiolitis, which has led to the development of evidence-based clinical practice guidelines for treatment. Bronchodilators are in-consistently used and have been advocated for certain subgroups of infants. Several large, recent trials have revealed a lack of ef-ficacy for routine use of either bronchodilators or corticosteroids for the treatment of bronchiolitis. Preliminary evidence suggests a potential future role nebulized hypertonic saline.

Key words: bronchiolitis, infants, respiratorycondition.

the role of Mycoplasma Pneumonia infection in child wheezing disorders

l. neamtu1, *S. Sciuca1, V. Magalu2

1Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University2Laboratory of Immunology, Scientific Research Institute for Maternal and Child Health Care

93, Burebista Street, Chisinau, Republic of Moldova*Corresponding author: +37379471374. E-mail: ssciuca@rambler.ru

The study was aimed to evaluate the role of the specific serolo-gic diagnosis of Mycoplasma infection and clinical peculiarities of bronchopulmonary diseases with recurrent episodes of wheezing in children.

Seventy-six children (ages 6 months to 7 years) with wheezing disorders (bronchial asthma and obstructive bronchitis) were included in our study. The diagnosis, classification of asthma, and asthma severity levels were based on GINA guidelines. The determination of M. pneumonia and M. hominis IgG, IgA, IgM antibodies were performed by using an enzyme-linked immuno-sorbent assay (Human, Germania).

Analysis of the serologic examination results showed that 56 patients had the Mycoplasma infection and 20 exhibited no signs of Mycoplasma infection. In I group (the Mycoplasma-positive group) 4 patients had bronchial asthma, and 6 patients with obstructi-ve bronchitis had specific antibodies in diagnostic titers (IgM 0,350,01 (cut-off 0,25), IgG 0,330,13 (cut-off 0,300,03) and IgA 1,470,01 (cut-off 0,801), IgG 1,180,46 (cut-off 0,330,02) accordingly). In the remainder of the first group (47 children), 10 children had b\ronchial asthma and 36 children had obstructive

bronchitis associated with acute pneumonia. Levels of specific antibodies consisted of: M. pneumonia (4 children) IgM 0,290,02 (cut-off 0,25), IgG 0,470,02 (cut-off 0,32) and M. hominis (4 children) IgA 0,250,15 (cut-off 0,24), IgG 1,030,25; cut-off 0,30,01 and in 2 children a mix infection (M. hominis and M. pneumonia IgG 0,800,2 (cut-off 0,28) and IgG 0,500,07 (cut-off 0,33) accordingly) (in the group with pneumonia and bronchial asthma) and M. pneumonia 0,450,06 (cut-off 0,34), IgG 0,440,02 (cut-off 0,35) and M. hominis IgM 0,340,09 (cut-off 0,30), IgG 0,970,17 (cut-off 0,29) (in the group with pneumonia and ob-structive bronchitis).

In II group (the Mycoplasma-negative group) 4 patients had obstructive bronchitis and 16 children had pneumonia, including 6 children with associated bronchial asthma and 10 patients had pneumonia with obstructive bronchitis. The levels of specific antibodies was below the cut-off: M. pneumonia IgM 0,180,09 (cut-off 0,520,15), IgG 0,170,02 (cut-off 0,330,03), M. pneu-moniae IgM 0,10,02 (cut-off 0,25), IgG 0,140,02 (cut-off 0,27) and in last group IgM 0,10,04 (cut-off 0,25) and IgG 0,170,04 (cut-off 0,29) accordingly.

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The Evolution of pneumonia in children with Mycoplasma infection was complicated in 11 cases: in 6 cases with pleural effusion and in 5 cases with atelectasia (patients from the Myco-plasma-negative group had pleural effusion only in 2 cases).

Mycoplasma infection in children with obstructive bronchitis

Cystic fibrosis (mucoviscidosis) in childrenS. ciuca

Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University 93, Burebista Street, Chisinau, Republic of Moldova

Corresponding author: +37379471374. E-mail: ssciuca@rambler.ru

Cystic fibrosis (CF) is a monogenic autosomal recessive dis-order with a chronic progressive evolution, which determines an abnormal production of viscous secretions from the glands of exogenous excretion, and characterized by chronic obstructive pneumopathy, chronic diarrhea, malnutrition and malabsorption syndromes.

Respiratory symptoms onset in CF patients usually starts early 80% in the first year of life with recurrent bronchitis, mostly with severe obstructive syndrome, latent persistent pneumonias, pulmonary and non-respiratory complications development. CF is also characterized by the installation of chronic obstructive pulmonary disease, which manifests itself by wheezing, prolonged expiration, persistent cough during respiratory infectious episodes which has latent evolution, nocturnal exacerbations, paroxys-mal and exhausting evolution. Bronhoobstructive syndrome is develops al the level of the small bronchi and is conditioned by the viscous, sticky secretions and infective bacterial component. Expectorated secretions are abundant, purulent, in cases with progressive evolution haemoptysis may develop. In long-term evolution children develop progressive respiratory failure. The progressive evolution of the disease is conditioned also by resistant bacterial agents (S.aureus, Ps aerugenosae, H. influenzae), which

accelerates destructive processes of the lung parenchyma and contribute to the expansion of the pulmonary fibrosis phenomena, and development of complications in the lungs (pneumothorax, atelectasis, bronchiectasis, bullous-distrophy, lung abscess, hae-moptysis, asphyxia, calcinates in lungs, pulmonary hypertension and pulmonary heart disease).

Chest deformity is a clinical expression of the severe pulmo-nary pathological process: thoracic cage expansion, dorsal kyp-hosis, hypertrophic pulmonary osteoarthropathy (in schoolage children) which causes chest pain, bone brittleness (fragility), swelling, and hydrarthrosis. Chronic persistent severe hypoxia determines the presence in CF children of fingers hippocratism.

ENT disorders at children with CF are presented by the nasal polyposis, sinusitis and chronic rhinitis, transmission deafness.

The prognosis is reserved, with high risks of death in cases with severe neonatal onset. Currently the disease may have a stable evolution, if favorable circumstances are present: early diagnosis, efficient treatment with digestive enzymes, control of pulmonary infections, respiratory kinesiotherapy.

Key words: cystic fibrosis, children, etiology, clinical features, complications, management.

and bronchial asthma is a significant risk factor, thus the identifi-cation of this infectious agent is important for the development of efficient programs of treatments in pediatric pneumology.

Key words: Mycoplasma pneumonia, wheezing disorders, children.

Pathogenic mechanisms of bronchial asthma phenotype in schoolchildren*S. ciuca, R. Selevestru

Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University93, Burebista Street, Chisinau, Republic of Moldova

*Corresponding author: +37379471374. E-mail: ssciuca@rambler.ru

The aim of the study was the assessment of total immunoglo-bulin E (IgE) in children with different phenotype of bronchial asthma.

This study included 122 schoolchildren (aged 6-12 years) with bronchial asthma, including 37 schoolchildren (30.3%) with intermittent asthma, 39 children (32%) with persistent mild asthma, 33 children (27%) with moderate persistent asthma, and 13 children (10.7%) with severe persistent asthma. The values of total IgE were evaluated by the immunoenzymatic method. The results were statistically processed in Epi Info 3.5 program.

The definition of the severity of bronchial asthma pheno-

type in 122 schoolchildren revealed allergen-induced bronchial asthma in 70.5% (86 schoolchildren); virus-induced bronchial asthma in 7.4% (9 schoolchildren); bronchial asthma induced by physical effort in 6.6% (8 schoolchildren) and unresolved asthma in 15.6% (19 schoolchildren). The total IgE concentration was higher in schoolchildren with allergen-induced bronchial asthma (400,342,4 ME/ml) in comparison with IgE values in virus-induced bronchial asthma (45,93,9 ME/ml, p

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Chest imaging findings in children with cystic fibrosis

*S. Sciuca1, O.turcu1, M. Efros2

1Department of Pediatrics, NicolaeTestemitanu State Medical and Pharmaceutical University 2Department of Imagistic,Research Institute for Maternal and Child Health Care

93, Burebista Street, Chisinau, Republic of Moldova*Corresponding author: +37379471374. E-mail: ssciuca@rambler.ru

Cystic fibrosis (CF) is an inherited chronic life-threatening disease that most critically affects the lungs. It causes the produc-tion ofsticky mucus that clogs the lungs and leads to inflammation. The severity of lung damage determines the evolution of the disease and requires instrumental confirmation.

Research was performed to determinate the structural changes of the lung tissue in children with CF by the conventional chest X-ray and thorax spiral computed tomography (CT).

In this study we evaluated the chest X-raysof 55 patients (32 girls and 23 boys) and the CT scans of 36 patients with CF (21 girls and 15 boys), from 2 to 18 years. Four patients had a mild evolution of CF, 10 children had moderate, and 21 suffered from the severe form of the disease.

The most common chest radiographic findings in CF patients were hyperinflation (87.3%), bronchial thickening (94.5%) and dilatation (41.8%), an increase in interstitial markings (76.3%), and pneumofibrosis (85.4%).

Abnormal findings were detected in 94.4% patients examined by CT. Bronchiectasis developed in 77.7% CF patients, including 28.6% cases in the upper or mid lobes and 71.4% children with gen-eralized bronchiectasis. Cysticbronchus deformations withliquid levels were identified in 2 of the patients with severe evolution of CF. Sectors of fibrosis were revealed in 6 spiral CT images. In two of the CF children CT findings of chronic obstructive bronchitis were detected, and in other two patients no structural bronchial changes were founded.

The method of spiral tomography offeredmore complete and detailed information about the anatomo-morphological substrate of pulmonary modifications in children with cystic fibrosis.

In children with CF structural bronchopulmonaryspiral CTsreveals modificationssuch as focal fibrosis, and sometimes widespread bronchial deformations with saccate bronchiectasis.

Key words: cystic fibrosis, lungs, children.

levels and bronchial asthma phenotype in schoolchildren (2=22,2, p 12 months) with asthma risk factors (parental history of asthma, in utero exposure to parental smoking, and repeated wheezing before age 1) and any history of wheezing. It

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is recommended that a single trial inhalation using epinephrine or albuterol is to be considered on an individual basis.

Nebulized racemic epinephrine demonstrates better short-term improvement in pulmonary physiology. Combined treatment of systemic glucocorticoids (dexamethasone) and bronchodilators (epinephrine) may significantly reduce hospital admissions.

It is recommended the infant be suctioned, when clinically in-dicated before feedings, as needed, prior to each inhalation therapy and normal saline nose drops may be used prior to suctioning. Current guidelines do not recommend routine chest physiotherapy in the management of bronchiolitis.

Infants with this severe disease may need supportive care for respiratory failure and dehydration, such as mechanical ventilation and supplemental fluid therapy. Treatment for severe bronchiolitis may include: humidified oxygen therapy, chest physical therapy, bronchodilator medications: Ventolin, Salbutamol, Epinephrine (Adrenalin), anti-viral medication from bronchiolitis: ribavirin, palivizumab, antibiotics for associated otitis media, suspected bacterial pneumonia, and mechanical ventilation.

It is recommended that the family be educated on the following

the role of pulmonary infection in progression of cystic fibrosis lung diseaseI. Stan

Department of Pediatrics, Maternal and Child Healthcare Institute, Bucharest, RomaniaCorresponding author e-mail: iustinas@yahoo.com

Cystic fibrosis (CF) is a life-shortening genetic disease cha-racterized by variability in the age of death. This is largely due to variability in the rate of progression of lung disease, the primary cause of mortality. In most patients with cystic fibrosis (CF) life expectancy is limited due to a progressive loss of functional lung tissue. 80% of premature deaths continue to result directly or indirectly from loss of lung function.

The factors associated with an increased risk of lung disease progression are: young age, high lung function, being of the fe-male sex, certain CFTR genotypes, pancreatic insufficiency, poor nutritional status, lower socioeconomic status, respiratory viral infections, and infection of Pseudomonas aeruginosa or Burkhol-deria cepacia.

Virtually all patients with CF are chronically infected with one or more bacterial species, and the inflammatory response to infec-tion appears to be more intense in patients with CF. Early infection of CF in the airways is mostly caused by Staphylococcus aureus and Haemophilus influenza, than from P. aeruginosa or other gram negative stains. Recent studies, especially those following patients diagnosed by neonatal screening, have shown that infection of P. aeruginosa usually occurs at very young age. Positive antibody response to P. aeruginosa was found in children, with the mean age of 15 months, about 12 months before first cultures were positive. Also in young, non-sputum producing children it was found that throat swabs frequently showed positive cultures for P. aeruginosa. Chronic infection is prevalent in about 80% of all patients with CF. In patients with chronic infection and alginate-coated mucous strains of Ps. aeruginosa, eradication is nearly impossible. CF and Ps. aeruginosa, an unfavorable relationship, can be explained by the

possibility of CFTR acting as a specific receptor for Ps. aeruginosa. CFTR may influence bacterial adherence to epithelial cells. The overproduction of pro-inflammatory cytokines and significantly lower levels of the anti-inflammatory cytokine IL-10, which in-hibits the production of pro-inflammatory cytokines, results in excessive and persistent inflammation in the CF airways. As a result, lung functioning deteriorates more rapidly in Ps. aerugi-nosa-positive CF patients compared with Ps. aeruginosa-negative CF patients. Patients with cystic fibrosis are often colonized with bacteria other than PA, causing bronco-pulmonary infections that lead to the deterioration of lung functioning such as: Burkholderia cepacia complex, Achromobacter xylosoxidans and Stenotrophomo-nas maltophilia. Patients chronically infected with S. maltophilia are cable of rising a specific antibody response against this bacteria associated with worsening lung function. Chronic infection of S. maltophilia is correlated with a decline in lung functioning, but this decline was already present prior to the chronic infection, where the high prevalence of Aspergillus and ABPA and NTM may have contributed a role in this result.

Staphylococcus aureus (S. aureus) is one of the earliest bacteria detected in infants. Treatment with anti-staphylococcal agents reduces the infection rate of MSSA but may lead to a higher rate of infection of Ps. aeruginosa. S. aureus which isolates harbor to a multitude of virulence factors, overlapping to a large degree in MSSA and MRSA. To date there are no conclusive studies demon-strating that the early aggressive treatment of MRSA respiratory infection can prevent chronic infection or if this approach ulti-mately improves outcomes.

Key words: cystic fibrosis, pulmonary infection, lung disease.

topics regarding the care of a child with bronchiolitis: to call their primary care provider if the following signs of worsening clinical status are observed: increasing respiratory rate and/or work of breathing as indicated by use of the accessory muscle, inability to maintain adequate hydration, or worsening general appearance.

Therapies NOT Routinely Recommended:It is recommended that scheduled or serial inhalation thera-

pies not be used routinely nor repeated if there is no measured improvement in the clinical outcome after a trial inhalation. Hypertonic saline inhalations are not to be given for the routine treatment of bronchiolitis due to inconsistent evidence regarding its effectiveness. It is recommended at this time that the following drugs not be used in the treatment of bronchiolitis: antibodies (immunoglobulins), Montelukast, Recombinant human deoxy-ribonuclease (rhDNase), antihistamines, oral decongestants, and nasal vasoconstrictors. Antibiotics are not recommended unless bacterial infection is suggested (e.g., toxic appearance, hyperpy-rexia, consolidation or focal lobar infiltrates on chest radiograph, leukocytosis, positive bacterial cultures).

Key words: bronchiolitis, treatment, child.

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Efficacy of controller therapies in childhood asthma

E. Stasii

Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University 93, Burebista Street, Chisinau, Republic of Moldova

Corresponding author: +37369403168. E-mail: ecaterina_stasii@yahoo.com

Asthma is a serious global health problem. People of all ages in countries throughout the world are affected by this chronic airway disorder that when uncontrolled can place severe limits on daily life and can be fatal. The prevalence of asthma is increasing in most countries, especially amongst children. It is now estimated that as many as 300 million people of all ages and all ethnic backgrounds suffer from asthma. The burden of this disease on the government, health care systems, families, and patients is increasing worldwide. The increase in the prevalence of asthma has been associated with an increase in atopic sensitization, and is paralleled by similar increases in other allergic disorders such as eczema and rhinitis.

Effective management of asthma in children requires the development of a partnership between the parents/caregivers of the patient with asthma, and his or her health care professionals. Simple educational interventions (designated to teach self-ma-nagement skills) amongst children admitted to the hospital have shown to significantly reduce readmission and morbidity rates. The goals for successful management of asthma are to achieve and maintain control of the symptoms, maintain normal activity levels (including exercise), maintain pulmonary function as close to normal as possible, prevent asthma exacerbation, avoid adverse effects from asthma medications, and prevent asthma mortality. These goals for therapy reflect an understanding of asthma as a chronic inflammatory disorder of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness and coughing. Clinical studies have shown that asthma can be effectively controlled by intervention to suppress and reverse

inflammation, as well as treating the bronchoconstriction related symptoms.

Although pharmacologic intervention to treat established asthma is highly effective in controlling symptoms and improving quality of life, measures to prevent the development of asthma by avoiding or reducing exposure to risk factors should be imple-mented wherever possible. Asthma exacerbations may be caused by a variety of factors sometimes referred to as triggers, including allergens, viral infections, pollutants and drugs. Because many asthma patients react to multiple factors that are ubiquitous in the environment, avoiding these factors completely is usually im-practical and very limited to the patient. Therefore, medications to maintain asthma control play an important role in maintaining health. Each patient is assigned to one of five treatment steps depending on their current level of control, and treatment is adjusted in a continuous cycle driven by changes in their asthma control status. This presentation reflects the peculiarities of treat-ment steps for achieving control in children with asthma. Is also describes the prescriptions in long-term treatment with inhalation of low, medium, and high doses of glucocorticosteroids, leuco-triene modifiers, therapies with sustained-release theophylline, cromones, long-acting 2 agonists, and anti-IgE treatment in patients of different ages. The presentation includes the peculiarity of long-term supervision, as well as assessment and monitoring of patients with asthma.

Key words: bronchial asthma, children, control, treatment.

An evaluation was conducted of herpetic infections and clinical and immunological features in wheezy children. The study group included 54 children with recurrent wheezing, who were admitted to the Public Medical and Sanitary Institution Childrens Muni-cipal Clinical Hospital No. 1 in 2008-2009. Patients were divided into 3 groups according to the age: group 1 children aged 0-12 months (18.8%), group 2 12-24 months of age (62.9%), and group 3 24-36 months (18.3%). The herpetic infection diagnosis was confirmed by the following examination methods: PCR (po-lymerase chain reaction) and the immunoenzymatic technique. Humoral immunity was assessed using the Mancini method and cell-mediated immunity was assessed using sheep erythrocytes. All patients included in the study had positive family epidemiological

Wheezing in children with persistent herpetic infectiont. urcanu

Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University93, Burebista Street, Chisinau, Republic of Moldova

Corresponding author: +37322243556. E-mail: tamara-turcanu@rambler.ru

anamnesis of herpetic infections. Analysis of the results was carried out by means of the medical statistical method.

Children with herpetic infections are at a major risk of recur-rent wheezing. All examined children had mixed forms of herpetic infections (Herpes simplex virus+Cytomegalovirus). Association of the acute renal failure with Herpes simplex virus+Cytomegalovirus infections has facilitated the apparition of secondary humoral and cell-mediated immunological disorders (decrease of CD3, CD-4, CD8, and CD-20 levels and also immunoglobulin A and G fractions).

Key words: wheezing, acute respiratory infections, herpetic infections.

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ClInICAl RESEARCH StuDIES

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*Corresponding author e-mail: office@worldmedicine.md Manuscript received March 23, 2012; revised April 30, 2012

Articol naintat spre publicare de ctre reprezentana companiei farmaceutice World Medicine n Republica Moldova

(Chiinu, MD-2060, str. Decebal, 139. Tel.: 022287858)

l. n. Azbukina, M. G. Rudenko, V. V. Kubasov, E. V. Goltei

Modern methods for correction of iron-deficiency anemia during pregnancyIron-deficiency anemia is an urgent problem during pregnancy. It may be favorable background for the development of various complications in the

mother and fetus. The goal was to determine the effectiveness of the drug for the treatment of iron-deficiency anemia Fersinol-Z in pregnant women. The study involved 100 women who were divided into two groups. The study found that the drug Fersinol-Z significantly improves hemoglobin level of 11.2% during the month.

Key words: Fersinol-Z, iron-deficiency anemia, pregnancy.

- () ,

. . 2 . 57 , ( ), 43 , ( ). , , 11,2% .

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(7-10%), (12%), , (38%), - [3, 5, 8, 16].

, , , , , - , , - - [9, 13].

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a .

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. 57 ,

Nr. 3 (327), 2012

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- . . . . . 2003;LII(4):1722.

2. , , , . : . . 2006;14(7):1-3.

3. , . () . . 2011;8-9.

4. . . , 2002.5. , .

. . . 1991;2:40-3.

6. . . , 1994;99:5-8.

7. , . - . . -. 1999;1:110-111.

8. . . . -. 1993;1:15-7.

9. , , , . - . . . . 2000;2:88-91.

10. . . - . 2003;11(1):18-20

11. , . . . 2010;8(8):20-24.

( ), 43 , - ( ).

, - 110 / I III 105 / II [4].

- , 16-20 , 28-30 . - , . . 16 20- , 28-30 . .

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110/105 / ( ), 3,51012, ( 0,85). ( 110-90 /) . - ( 89-70 /) 9% (5 ), 9,3% (4 ).

102,7 /, 103,4 /, 114,8 /, 106,5 /. , 8,3%. , , - 11,2%, , 2,9%. , (9 ) , , -, 2 , ( 9 ), , ( , ).

,

305

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12. . . SonoAce-International. 2007.13. , , .

. . 1991;99-101.

14. , , . -, . .: 2003;447.

15. . . .1999;8-15.

16. , , . - . . . 1985;1:46-8.

17. Breymann C, Major A, Richter C, et al. Recombinant human erythro-poietin and parentrral iron in the treatment of pregnancy anemia: a pilot study. J Perinat Med. 1995;23:89-98.

IntroducereHipotensiunile arteriale acute se dezvolt n urma diferitor

maladii, stri patologice, intervenii chirurgicale, anestezie i intoxicri [1]. Unele substane medicamentoase, prin erori de trata-ment, n urma administrrii criminale sau cu scop de suicid, la fel pot fi cauz a hipotensiunilor medicamentoase acute, ce necesit o abordare deosebit, ajustat la particularitile aciunii substanei (ganglioblocante, adrenoblocante, deprimante ale sistemului ner-vos central, inhibitoare ale enzimei de conversie etc.) [2]. Aceste substane pot afecta activitatea normal a organismului n diferite moduri modificarea funciilor celulare i/sau a organelor, ct i dereglarea proceselor de captare i transport a substanelor, inclu-siv a oxigenului. Pe de alt parte, medicamentele antihipotensive (adrenomimeticele fenilefrin, norepinefrin, efedrin; peptidele vasoactive angiotensinamid etc.), utilizate n tratamentul acestor hipotensiuni, se caracterizeaz prin particulariti i dezavantaje proprii (durat scurt de aciune, necesitatea administrrii n perfuzie sau repetate, dezvoltarea dereglrilor metabolice, aci-

Influena profeturului asupra regimului de oxigenare a organismului

I. CorechiDepartment of Pharmacology and Clinical Pharmacology

Nicolae Testemitanu State Medical and Pharmaceutical University27, N. Testemianu Street, Chisinau, Republic of Moldova

Corresponding author: +37369097202. E-mail yanosh.k@mail.ruManuscript received January 07, 2012; revised April 02, 2012

the action of the Profetur on the body oxygen regimenProfetur or isopropylphosphite-S-isopropylisothiurea, administered at a dose of 20 mg/kg in rats, reduces the consumption of oxygen by the body under

normal circumstances and during hexamethonium-induced hypotension. The substance also removes the increase in oxygen consumption by the body, observed after administration of ganglion blocking agent. After a single intravenous injection of 5 mg/kg in cats, isothiourea derivative causes prolonged elevation of blood pressure in normal conditions and on the background hexamethonium-induced hypotension. It also increases the arteriovenous difference in blood oxygen saturation and oxygen consumption index, more pronounced in the combined use of profetur and hexamethonium.

Key words: Profetur, oxygen consumption index, antihypotensive.

-S-, 20 /,

, . , . 5 /, . - - , .

: , , .

do-bazice i electrolitice etc.) [2, 3], iar n unele cazuri nu sunt eficiente (de exemplu utilizarea remediilor medicamentoase cu aciune -adrenoblocante fentolamin, clorpromazin etc.) [3].

Derivaii izotioureici (izoturon, difetur, raviten) reprezint un grup nou de remedii hipertensive i antihipotensive [4] lipsite de aceste dezavantaje posed durat lung de aciune dup adminis-trare unimomentan, nu produc dereglri metabolice, majoreaz presiunea arterial pe fundal de blocare a -adrenoreceptorilor etc [5]. Anterior a fost cercetat utilizarea derivatului izotioureic izo-turon n blocada ganglionar fr tensiune, cu cercetarea influenei substanei asupra efectelor hexametoniului [5], n care s-a stabilit c izoturonul nltur aciunea stimulant a ganglioblocantului asupra respiraiei tisulare, diminueaz consumul oxigenului de ctre organism, majoreaz diferena artero-venoas i indicele de utilizare a oxigenului, toate pe fundalul restabilirii i stabilizrii valorilor presiunii arteriale.

Profeturul sau izopropilfosfit-S-izopropilizotiuroniul, repre-zint un derivat nou alchilizotioureic cu aciune vasoconstrictoare,

Nr. 3 (327), 2012

306

care, n cercetrile anterioare, a demonstrat aciune antihipotensiv exprimat. Considernd aceast aciune a derivatului alchilizotio-ureic, ct i labilitatea exprimat a reaciilor schimbului gazos i posibilitatea determinrii cantitative a indicelor lui (ceea ce face posibil utilizarea sa n cercetarea aciunii diferitor substane asupra regimului de oxigenare a organismului), acest studiu are ca scop determinarea aciunii profeturului asupra altor efecte ale hexametoniului, n particular consumului oxigenului de ctre organism i oxigenrii sngelui arterial i venos.

Material i metode

Cercetarea aciunii profeturului (izopropilfosfit-S-izopropi-lizotiuroniu) asupra consumului oxigenului de ctre organism a fost efectuat cu utilizarea aparatului lui S. V. Miropolskii [5], care permite cercetarea unimomentan sau n dinamic a acestui parametru la animalele mici de laborator (oareci, obolani, cobai etc.). Studiul s-a efectuat pe 40 de obolani divizai n 4 loturi, la care li s-au administrat intraperitoneal: lotul I (control) 3 ml sol. fiziologic NaCl; lotul II sol profetur 20 mg/kg; lotul III sol. hexametoniu 20 mg/kg; lotul IV sol. profetur 20 mg/kg n com-binaie cu sol. hexametoniu 20 mg/kg. Determinarea consumului de oxigen s-a efectuat pn i la diferite intervale de timp dup administrarea substanelor.

Aciunea profeturului, hexametoniului i asocierii lor asupra oxigenrii sngelui arterial i venos a fost studiat la 21 pisici cu masa corporal 1,5-3 kg, anesteziate prin administrarea intraperi-toneal a sol. uretan n doza de 1-1,2 g/kg, n condiii de respiraie cu aer atmosferic. Animalele au fost repartizate n trei loturi (cte 7 n fiecare). Primul lot a servit la determinarea modificrii con-centraiei oxihemoglobinei sngelui arterial i venos sub influena hexametoniului, care a fost administrat intravenos n doza de 10 mg/kg. La animalele din lotul II s-a studiat aciunea profeturului, administrat n doz de 5 mg/kg, administrat la fel intravenos. Aciunea asocierii preparatelor (n aceleai doze) asupra concen-traiei oxihemoglobinei sngelui arterial i venos a fost cercetat la animalele din lotul III. Oxihemoglobina a fost determinat prin metoda oxihemometriei metod fotometric de determinare a saturrii sngelui cu oxigen, bazat pe particularitile spectrale ale oxihemoglobinei [5].

Probele sngelui (n volum de 0,5 ml) arterial i venos au fost colectate din aort i, respectiv, vena cav posterioar. n toate experienele au fost supuse determinrii probele sanguine colectate pn i la diferite intervale de timp dup administrarea substanelor cercetate.

n baza datelor obinute s-a calculat diferena artero-venoas a oxigenului i coeficientul de utilizare a oxigenului pe poriunea aorta vena cav posterioar:

HbO2A HbO2VHbO2A

kO2 = , unde:

kO2 coeficientul de utilizare a oxigenului;HbO2A gradul de oxigenare a sngelui arterial;HbO2V gradul de oxigenare a sngelui venos.Datele obinute au fost prelucrate statistic conform metodei

parametrice de cercetare, cu aprecierea veridicitii prin interme-diul criteriului t-Student [6].

Rezultate obinuten urma experienelor efectuate, s-a determinat, c hexame-

toniul exercit aciune bifazic asupra consumului de oxigen al organismului iniial l mrete (min 10-20), ulterior l mico-reaz (fig. 1).

8

13

18

23

28

33

38

Iniial 10 30 60 90 120

Timpul (minute)

Co

nsu

mu

l oxi

gen

ulu

i de

ctr

e o

rgan

ism

(ml/k

g/m

in) Control

Profetur 20 /kgHexametoniu 20 mg/kgHexametoniu+Profetur

C

Fig. 1. Aciunea profeturului, hexametoniului i asocierii lor asupra consumului oxigenului de ctre organism.

Profeturul determin micorarea consumului oxigenului (fig. 1). Utilizarea combinat a ambelor substane a dus la excluderea primei faze de majorarea a consumului de oxigen de ctre hexa-metoniu i a diminuat ulterior i mai mult acest indice (fig. 1).

Nivelul iniial al oxihemoglobinei sngelui arterial la animalele din primul lot a constituit 89%, cu variaii n experiene concrete n limite de la 83 la 95% (fig. 2). Gradul iniial de oxigenare a sngelui venos a fost de 65%.

Administrarea intravenoas a hexametoniului a fost nsoit de micorarea presiunii arteriale cu 41% i majorarea oxigenrii sngelui arterial cu 3%, atingnd nivelul maxim de 93% la a 30-a minut dup administrarea preparatului (fig. 2). Dup o or de la administrare, nivelul oxihemoglobinei sngelui aortal s-a mic-orat cu 3% comparativ cu valoarea maximal, nregistrat la 30 min., dar fr a atinge valorile iniiale (fig. 2). Dup administrarea hexametoniului s-a determinat i diminuarea semnificativ a cantitii oxihemoglobinei sngelui venos, nivelul minim fiind atins dup 30-60 minute. Diferena artero-venoas a oxigenului s-a majorat cu 11% imediat dup administrarea ganglioblocantu-lui ca urmare a majorrii coninutului oxihemoglobinei sngelui arterial, ct i micorrii celui venos, nivelul maxim fiind atins la a 30-a minut (154% fa de valoarea iniial). Coeficientul de utilizare a oxigenului la fel s-a majorat cu 50%, atingnd valoarea maxim la 30 minute.

Administrarea intravenoas a profeturului n doza de 5 mg/kg a fost nsoit de majorarea pronunat i ndelungat (45-60 min) a presiunii arteriale (fig. 2). Oxigenarea iniial arterial i venoas n aceste experiene a constituit 92% i, respectiv, 63%.

Dup administrarea profeturului, cantitatea oxihemoglobinei sngelui arterial s-a micorat cu 4%, dar deja la a 15-a minut dup administrare, a atins valoarea iniial. Concomitent s-a determinat micorarea semnificativ a valorilor oxihemoglobinei sngelui venos, valoarea minim fiind atins la a 60-a minut (-24%). Corespunztor s-a modificat i diferena artero-venoas a oxigenului dac la a 2-a minut ea era 4%, la a 60-a minut a atins 16%. Coeficientul de utilizare a oxigenului s-a majorat de la 0,32 (valoare iniial) la 0,48 la a 60-a minut. Datele obinute la cercetarea influenei asocierii profeturului cu hexametoniul asupra oxigenrii arteriale i venoase sunt prezentate n fig. 2. Administra-rea intravenoas a hexametoniului n doza de 10 mg/kg a produs micorarea rapid a presiunii arteriale cu 44% i mrirea moderat

307

ClInICAl RESEARCH StuDIES

a frecvenei micrilor respiratorii. Concomitent s-au determinat modificrile caracteristice ale nivelului oxihemoglobinei crete-rea celei arteriale cu 1% i diminuarea celei venoase cu 7%.

20

30

40

50

60

70

80

90

100

Oxi

hem

oglo

bina

(%)

HbO2A HHbO2V HDAVO2 HHbO2A PHbO2V PDAVO2 PHbO2A H+PHbO2V H+PDAVO2 H+P

0,2

0,3

0,4

0,5

0,6

0,7

Coe

ficie

ntul

de

utili

zare

a O

2

Hexametoniu

Profetur

H+P

60

80

100

120

140

160

180

Iniial H 2 (Iiial) 2 15 30 60 90Tim pul (n m inute)

Pres

iune

a ar

teria

l (m

mH

g) Hexametoniu

Profetur

H+P

Fig. 2. Influena hexametoniului n doza de 10 mg/kg (n = 7), profeturului n doza de 5 mg/kg (n = 7), i asocierii lor (n = 7) asupra valorilor presiunii arteriale i oxigenrii

sngelui aortei i venei cave posterioare:

HbO2A gradul de oxigenare a sngelui arterial,HbO2V gradul de oxigenare a sngelui venos,

DAV diferena artero-venoas a oxigenului,H hexametoniu, P profetur.

Diferena artero-venoas i coeficientul de utilizare a oxige-nului nu au suferit modificri semnificative. Administrarea pro-feturului n doza de 5 mg/kg pe fundalul aciunii hexametoniului s-a soldat cu restabilirea nivelului presiunii arteriale i o micorare moderat a frecvenei micrilor respiratorii, majorat dup ad-ministrarea primei substane. Nivelul oxihemoglobinei sngelui arterial s-a redus cu 3%, dar mai puin comparativ cu diminuarea nregistrat la utilizarea izolat a profeturului. n cteva minute, nivelul oxihemoglobinei sngelui arterial a atins valoarea iniial, iar la a 60-a minut s-a mrit semnificativ (cu 2%). Saturarea cu oxigen a sngelui venos s-a micorat la a 2-a minut pn la 81% din valoarea iniial. Diminuarea produs a fost mai mic dect cea indus de administrarea separat a profeturului 87% din valoarea iniial. Treptat, diminuarea oxigenrii sngelui venos a progresat, atingnd 2/3 din valoarea iniial la a 30-a minut. Se remarc, c administrarea izolat a profeturului s-a soldat cu diminuarea maxim a oxihemoglobinei sngelui venos la a 60-a minut (fig. 2).

DiscuiiMajorarea iniial a consumului de oxigen sub aciunea gangli-

oblocantului, poate fi explicat prin dezvoltarea dispneei ca reacie compensatoare la hipotensiunea provocat de el [5]. Profeturul a prentmpinat hipotensiunea arterial i astfel a exclus stimularea reflex a respiraiei.

Gradul nalt de oxigenare a sngelui arterial pe parcursul desfurrii experienelor de cercetare a aciunii hexametoniu-lui asupra oxigenrii sanguine denot sporirea oxigenrii ei n pulmoni, probabil ca urmare a creterii amplitudinii i frecvenei micrilor respiratorii. Un rol important probabil l au i modifi-crile circulaiei pulmonare ce se dezvolt n urma administrrii ganglioblocantului: micorarea tonusului vaselor pulmonare, presiunii arteriale pulmonare i vitezei circulaiei sngelui n circulaia pulmonar [3]. Diminuarea cantitii oxihemoglobinei sngelui venos, ca urmare a administrrii hexametoniului, indic majorarea consumului oxigenului pe unitate de volum sanguin [5]. Hexametoniul produce hipoxie de tip hipocirculator datorit micorrii rezistenei vasculare periferice, debitului cardiac, pre-siunii arteriale, i a vitezei liniare de circulaie [5].

Profeturul determin diminuarea consumului oxigenului de ctre organism, cu mrirea moderat a diferenei artero-venoase i indicelui de utilizare a oxigenului, ceea ce poate fi explicat prin abilitatea derivailor izotioureici de a diminua respiraia tisular a organelor vital importante ca urmare a modificrilor n activitatea aparatului cardio-vascular i respirator, ct i a metabolismului [5, 7].

Modificarea diferenei artero-venoase a oxigenului i coeficien-tului de utilizare a oxigenului sub aciunea profeturului pe fundalul blocadei ganglionare a fost mai mare dect cele nregistrate la uti-lizarea separat a profeturului. Dar, comparativ cu administrarea separat a hexametoniului, valorile acelorai indici au fost mai mici la 2-15 min, ceea ce poate fi explicat att prin modificrile indicilor hemodinamici creterea rezistenei vasculare periferice, minut-volumului circulator, debitului cardiac, ct i prin majorarea mai puin pronunat a respiraiei tisulare (comparativ cu utilizarea izolat a hexametoniului) [5].

Concluzii1. Profeturul micoreaz consumul oxigenului de ctre orga-

nism.2. Hexametoniul exercit aciune bifazic asupra consumului

oxigenului de ctre organism.3. Profeturul nltur faza de cretere a consumului oxigenului

indus de ganglioblocant.4. Profeturul crete diferena artero-venoas i coeficientul de

utilizare a oxigenului pe poriunea aort ven cav posteri-oar, mai pronunat n asociere cu hexametoniul.

Bibliografie1. , . .

. 1. : -, 2009.2. Tintinalli Judith E, Stapczynski J. Stephan, David M. Cline, et al. Tin-

tinallis Emergency Medicine: A Comprehensive Study Guide. New York: McGraw-Hill Medical, 2010.

3. Brunton Laurence, Chabner Bruce, Knollman Bjorn. Goodman and Gilmans The Pharmacological Basis of Therapeutics, Twelfth Edition, 2011.

4. Stratu Ecaterina, Victor Ghicavi, Mihai Todira. Aciunea Ravitenului asupra tonusului inelelor de aort pe fundal de blocare a canalelor ionice n perfuzat. Materiale ale Conferinei anuale a USMF. Vol. 1. Probleme medico-biologice i fundamentale. 2009;272.

5. , , . . : , 1983.

6. Stanton Glantz. Primer of Biostatistics: Sixth Edition, 2005.7. , . .

: , 1972;23-26.

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Efectul antimicrobian al compuilor coordinativi ai cuprului, zincului, cobaltului i nichelului cu n-piridin-2-iltiosemicarbazon 2

piridincarboxi-aldehid i derivaii ei

C. lozan-tru

Department of Microbiology, Virusology and ImmunologyNicolae Testemitanu State Medical and Pharmaceutical University

26/1, Testemitanu Street, Chisinau, Republic of MoldovaCorresponding author: +37322205587. E-mail: karo_lina_ro@yahoo.com

Manuscript received January 07, 2012; revised April 02, 2012

the antimicrobial effect of the coordination of compounds copper, zinc, cobalt, and nikel with n-pyrididine-2-iltyosemicarbazone 2 pyrididinecarboxyaldehyde derivatives

In human pathology infections determined by different resistance microorganisms are characterized by a higher incidence and more sever consequences requiring a prolonged high dose of active antibiotic treatment. The bacteria can have a natural or acquired resistant to these antibiotics. This study involved a new group of coordinations of compounds which showed high antibacterial activity to grampositive and gramnegative bacteria and presents new directions in the elaborations of antibacterial preparations.

Key words: gram-negative, gram-positive bacteria, coordinations compounds, antibacterial activity, antibiotic resistance.

, , n-pyrididine-2-iltyosemicarbazone 2 pyrididinecarboxyaldehyde

, , , . . , , .

: e, e , e , , .

ntroducereEra antimicrobian a nceput circa 75 de ani n urm. Departe

de a fi pe sfrite, este tot mai mult contestat de apariia micro-organismelor rezistente. Rezistena microbian a fost accelerat de utilizarea excesiv a antibioticelor n colaborare cu plasticitatea deosebit a geneticii microorganismelor.

Infeciile provocate de microorganisme cu rezisten antimi-crobian constituie o problem major n toat lumea, datorit impactului lor imens asupra vieii omeneti i costului lor econo-mico-social nalt, din acest motiv, n lumea contemporan, infec-iile sunt considerate o ameninare la adresa securitii naionale.

n septembrie 2001, Organizaia Mondial a Sntii a lansat prima strategie global pentru combaterea problemelor grave, cauzate de apariia i rspndirea rezistenei antimicrobiene, constituind o problem de sntate, care se agraveaz la nivel european i global i care sporete rata morbiditii i mortalitii, asociat bolilor transmisibile.

Obiectivele actuale ale celor implicai n programele anti-microbiene pentru blocarea rezistenei microbiene, transmiterii infeciilor, constau n elaborarea unei tactici mai bune pentru combaterea rezistenei i a unor noi medicamente i vaccinuri. Prin urmare, studiile destinate elaborrii de preparate noi anti-microbiene rmn prioritare n continuare.

Astfel, scopul prezentei lucrri a fost studierea proprieti-lor antimicrobiene ale compuilor coordinativi ai cuprului (II), nichelului (II), cobaltului (II) i zincului (II) cu N-piridin-2-ilti-

osemicarbazona-2-piridincarboxialdehidei (HLI), N-piridintiose-micarbazonei 2-acetilpiridinei i N-piridin-2-iltiosemicarbazonei 2-benzoiipiridinei.

Material i metodeStudiul a fost realizat n cadrul catedrei Microbiologie Viruso-

logie i Imunologie a Universitii de Stat de Medicin i Farmacie Nicolae Testemianu, laboratorul microbiologic al Centrului de epidemiologie a bolilor extrem de periculoase i combatere a bioterorismului al Centrului Naional tiinifico-Practic de Medicin Preventiv.

n calitate de obiecte de studiu, n acest experiment in vitro au fost incluse tulpinile de referin: Staphylococcus aureus ATCC 25923, Bacillus cereus 8035, Escherichia coli ATCC 25922, Shigella sonnei S-form i Salmonella abony 03/03y.

Compuii coordinativi au fost sintetizai la catedra Chimie anorganic, Universitatea de Stat din Moldova.

Determinarea activitii antimicrobiene a compuilor a fost efectuat n mediu nutritiv lichid prin metoda diluiilor succesive. Substanele au fost dizolvate n dimetilformamid, cultivarea mi-croorganismelor, obinerea suspensiei, determinarea concentraiei minime de inhibare (CMI) i concentraiei minimale bactericide (CMB) au fost efectuate conform metodei standard [1].

Rezultate i discuiiDezvoltarea chimiei compuilor coordinativi n ultimii ani

se caracterizeaz printr-o alegere crescnd n calitate de obiect

309

ClInICAl RESEARCH StuDIES

magnetic, la temperatura de 50-60C, timp de 30 de min. Dup rcire precipitatul format se filtreaz pe filtru de sticl, se spal cu o cantitate minim de etanol i se usuc la aer. Pentru compuii cobaltului raportul molar de combinare este de 2:1.MX2 nH2O + HL-

3 M(L)X + 2HX + nH2O; n = 2-6, M = Cu, Zn, Ni, X = Cl, NO3CoCl2 6H20 + 2HL

2-3 Co(L)2 nH2O + (6-n)H2O + 2HCl, n = 2-3Compoziia i structura compuilor sintetizai a fost stabilit

prin analiza datelor elementare i cercetrilor fizico-chimice (mag-netochimie, spectroscopie RMN (IH, 13C, IR, termogravimetrice i de analiz X-ray).

Rezultatele studiului activitii antimicrobiene in vitro a com-puilor coordinativi sunt prezentate n tabelul 1.

Datele experimentale demonstreaz c att tiosemicarbazonele HL-3, ct i compuii coordinativi n baza lor manifest activitate bacteriostatic i bactericid n limitele concentraiilor 0,004-20 mg/ml. Prezint interes complexul CuL2NO3 fa de Escherichia coli. Activitatea lui antimicrobian fa de acest microorganism gram negativ este comparabil cu activitatea unor preparate chimi-ce, utilizate n medicin i veterinrie pentru profilaxia i tratarea bolilor provocate de aceast tulpin de microorganisme.

de studiu al compuilor coordinativi ai metalelor de tranziie cu liganzi organici polidentai polifuncionali. Compuilor compleci ai metalelor de tranziie li s-a acordat o atenie deosebit din cauza intereselor biologice, pe care le prezint.

Sinteza liganzilor se realizeaz conform metodei: la suspensia alcoolic care conine 0,03 moli de tiosemicarbazid se adaug 20-25 ml alcool etilic, nclzit la 80-90C pe baia de ap, adugn-du-se o cantitate echimolar de aldehid sau ceton. Balonul, n care se efectueaz sinteza, este ajustat cu un refrigerent ascendent. n astfel de condiii se ine timp de 1-2 ore, apoi substana solid obinut se filtreaz i se spal cu o cantitate minim de etanol. Sinteza se efectueaz conform schemei urmtoare:

unde R = H (HL), CH3 (HL2), C6H5 (HL

3), compuii coordinativi CuL-3NO3, CuL

2-3Cl, CoL2-32Cl2, NiL2-3Cl i ZnL2-3Cl au fost sin-

tetizai la fel conform metodei: la suspensia care conine 2 mmol de sare de metal n 20 ml etanol se adaug 2 mmol de ligand. Amestecul reactant se agit continuu, cu ajutorul unui agitator

tabelul 1Concentraia minim de inhibiie (CMI) i concentraia minim bactericid (CMB) a compuilor coordinativi sintetizai

fa de microorganismele gram-pozitive i gram- negative (mg/ml)

CompusulMicroorganisme gram pozitive Microorganisme gram negative

Staphylococcusaureus ATCC 25923

Bacillus cereus CK 8035

Escherichia coli ATCC 25922

Shigella sonnei S-form

Salmonellaabony CK 03/03

CMI CMB CMI CMB CMI CMB CMI CMB CMI CMB

HL 0,25 - 0,004 0,008 0,12 - 0,01 0,12 0,25 0,008

HL2 - - 0,004 0,008 0,12 - 0,06 0,25 0,25 0,008

HL3 - - - - - - 0,5 0,5 - -

CuLNO3 0,06 0,25 0,008 0,06 0,03 0,12 0,01 0,06 0,12 0,06

CuL2NO3 0,06 0,25 0,03 0,03 0,004 0,06 0,5 0,5 0,06 0,03

CoL2 2Cl2 - - 0,25 - - - 0,12 - - -

ZnL2Cl 0,25 - 0,25 - 0,12 - 0,25 - 0,25 -

NiL2Cl - - - - - - - - - -

CuL3Cl - - - - - - - - - -

CuL3NO3 0,5 - 0,25 0,5 0,25 0,5 0,5 - 0,5 0,5

NiL3Cl - - - - - - - - - -

CoL32Cl2 - - - - - - - - - -

ZnL3Cl - - - - - - - - - -

Concluzie1. Screening-ul compuilor noi sintetizai, de origine chimic a

permis selecia noilor compui chimici cu obinerea dozelor optime de aciune, i s-a demonstrat c manifest activitate bacteriostatic i bactericid nalt fa de un spectru larg de microorganisme, att gram pozitive ct i gram negative.

2. Cercetrile efectuate demonstreaz posibilitatea utilizrii compuilor noi sintetizai de origine chimic pentru combate-rea tulpinilor de microorganisme patogene i servesc, totodat, drept baz tiinific n elaborarea de noi remedii antibacterie-ne i n stabilirea perspectivei de utilizare clinic a lor.

3. Compuii noi sintetizai, de origine chimic, pot fi de mare ajutor n gestionarea maladiilor infecioase, dar ei, bineneles, pot avea i efecte secundare negative, provocate de toxicitatea nalt a compuilor.

Bibliografie1. Buiuc D. Microbiologia clinic. Bucureti, 1998;435-448.2. Buiuc D, Negu M. Tratatat de microbiologie clinic. Bucureti, 1999.3. Chumakov IM, Tsapkov VI, Jeanneau E, et al. Crystal structures of

copper(II) chloride, copper(II) bromide and copper(II) nitrat com-plexes with piridin-2-carbaldehide thiosemicarbazone. Cryst. Report. 2008;53(5):786-792.

4. Jehl F, Chomorat M,Weber M, et al. De la antibiogram la prescripie. Ed. III. Bucureti, 2010.

5. Galechi P, Buiuc D, Plugaru . Ghid practic de microbiologie medical. Chiinu: tiina, 1997;86-101.

6. . . : , 2008;1206.

7. , . . , 2000.

8. , , . o. . 2006;32(10):77.9. . K -

. .: M, 1991;257.

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310

Actualitatea problemeiBoala Inflamatorie Pelvin (BIP) acut ocup un loc de frunte

n structura patologiilor ginecologice, constituind 33-78% dintre acestea. BIP reprezint patologia femeilor tinere, fiind demonstrat c 75% din cazurile de BIP se ntlnesc la femeile cu vrsta mai mic de 25 de ani. nainte de era antibioticelor, mortalitatea n BIP acut constituia aproximativ 1%.

n prezent aceast rat a diminuat semnificativ, ns patologia rmne a fi o problem medical i social foarte serioas din cauza c cel puin 25% dintre femeile cu BIP acut vor dezvolta sechele grave, precum este infertilitatea, sarcina ectopic i durerea pelvin cronic. n procesul terapiei antibacteriene neraionale i masive a avut loc evoluia microorganismelor i selecia acestora cu apariia formelor antibiotico-rezistente. Dac se ia n conside-raie faptul c flora condiionat patogen deine o pondere foarte mare i, pe lng aceasta deine o rezisten natural crescut fa de antibiotice, atunci poate fi explicat numrul mare de procese cronice cu formarea abceselor tuboovariene, limitate de o capsul groas, care mpiedic ptrunderea medicamentelor n focarul inflamator. Astfel, se formeaz un cerc vicios, care complic sem-nificativ tratamentul BIP, iar problema local capt un caracter universal, duce la dezvoltarea insuficienei poliorganice i necesit nu tratarea bolii, ci a bolnavei. n complexul terapeutic sunt incluse 23 antibiotice cu spectru diferit, remedii antibacteriene, antimi-cotice i preparate antihistaminice. Neajunsul acestui tratament este aciunea imunosupresiv asupra organismului. Frecvena afectrii virale n inflamaie duce la diminuarea rspunsului imun

Aciunea preparatelor alopatice i antihomotoxice asupra verigilor patogenice ale bolii inflamatorii pelvine acute

A. Reajeva

Department of Obstetrics and GynecologyNicolae Testemitanu State Medical and Pharmaceutical University

20, Melestiu Street, Chisinau, Republic of MoldovaCorresponding author: +37369149291. E-mail: reajeva@mail.ru

Manuscript received March 20, 2012; revised April 30, 2012

the action of allopathic and antihomotoxic preparations on pathogenic links of pelvic inflammatory diseaseThis article reflects the experience of use of antihomotoxic preparations Traumeel S, Viburcol and Lymfomyosot. In the study were included 220

sick women with a mean age of 27, 56, who were divided into two groups: study group (n = 110) and control group (n = 110). The patients from the first group received traditional treatment and preparations of the antihomotoxic group; the second group (of control) received traditional treatment with the addition of an antioxidant preparation. It was agreed that the administration of antihomotoxic preparations in complex therapy scheme of the pelvic inflammatory disease increases the therapeutic efficiency.

Key words: Traumeel S, Lymfomyosot, allopathic and antihomotoxic preparations.

Traumeel S, Viburcol i Lymfomyosot. 220 , 27,56 , : (n = 110) (n = 110). , () . , .

: Traumeel S, Lymfomyosot, .

natural. Polipragmazia necesar (indicarea a pn la 16 preparate, ce includ dezagregante, polivitamine, spasmolitice, biostimulante, adaptogene, dezintoxicante etc.) induce o aciune agresiv asupra organismului, acesta fiind pus n situaia de a se lupta att cu ma-ladia, ct i cu medicamentele. Un minus al terapiei tradiionale este i existena unei game largi de efecte adverse, care apar din interaciunea preparatelor medicamentoase. Alergizarea crescut a populaiei impune deseori ntreruperea terapiei medicamen-toase masive, trecerea la monoterapie, fapt ce mrete perioada de tratament i scade eficacitatea acestuia. Necesitatea unui tratament spitalicesc de durat i a unui tratament consecutiv de ambulatoriu, de reabilitare pn la restabilirea funciilor organe-lor afectate (normalizarea indicilor de laborator, a temperaturii, a funciei menstruale i regenerative) necesit cheltuieli mari i se ridic la nivel de problem social, argumentat i de frecvena nalt a recidivelor, care pot fi determinate de suprarcire, stres, reinfectare, intervenii intrauterine. Toate cele enumerate anterior determin medicii s caute n permanen ci mai eficiente, sigure i ieftine de tratament al Bolii Inflamatorii Pelvine. Utilizarea noilor metode de tratament n practica clinic reprezint una dintre problemele fundamentale ale ginecologiei. Tratamentul tradiional al patologiilor ginecologice include preparate efecti-ve, ns cu numeroase efecte adverse, astfel existnd necesitatea combinrii lor cu preparatele antihomotoxice, care conin doze mici de ierburi, substane minerale i alte componente, ce nu au o aciune nociv asupra organismului uman, mresc potenialul preparatelor tradiionale, reduc efectele adverse ale acestora i grbesc procesul de nsntoire.

311

ClInICAl RESEARCH StuDIES

Scopul studiuluiOptimizarea tratamentului proceselor inflamatorii ale anexelor

uterine prin administrarea preparatelor homeopatice - terapie bazat pe principiul de similitudine, individualizare i potenare.

Material i metodeScopul studiului a fost de a prezenta avantajele asocierii trata-

mentului antihomotoxic cu tratamentul tradiional. Am comparat rezultatele tratamentului alopatic (antibiotice, AINS, detoxicante, desensibilizante), aplicat la 110 paciente i cele ale tratamentului alopatic asociat cu preparate antihomotoxice, cu vrsta medie de 27,56 de ani. S-a stabilit diagnosticul fiecrei paciente cu ajutorul criteriilor clinice, bacterioscopiei, bacteriologiei, analizelor genera-le i biochimice ale sngelui, USG organelor bazinului mic, unora li s-a efectuat biopsia endometriului i laparoscopia (tab. 1, 2).

Rezultate i discuiiSe observ c durerea n hipogastru a diminuat dup 14 zile

la majoritatea pacientelor din ambele grupuri (72,7% din grupul

tratat tradiional i 38,1% grupul tratat cu preparate tradiionale i antihomotoxice), totui la mai multe femei din grupul celor tratate cu antihomotoxice (41-37,2%) comparativ cu cele din grupul tra-tate tradiional (12-10,9%), durerile au diminuat la sfritul celei de-a doua sptmni, adic de aproximativ trei ori mai eficient. Durerea la examenul ginecologic (palparea abdominal, palparea anexelor i deplasarea colului uterin la examinarea bimanual) relev faptul c durerea a diminuat dup 14 zile la majoritatea femeilor tratate tradiional (48,1% la palparea abdominal, 52,7% la palparea anexelor i 50% la deplasarea colului uterin), iar la majoritatea celor, la care s-au asociat preparatele antihomotoxice n tratament, durerea a diminuat n zilele 4-8 (55,4% la palparea abdominal, 50,9% la palparea anexelor i 46,3% la deplasarea colului uterin), ceea ce demonstreaz eficacitatea de dou ori mai mare a asocierii preparatelor antihomotoxice n tratament. Prepa-ratul Traumeel mbuntete circulaia sanguin la nivelul uterului i anexelor, reduce sensibilitatea fibrelor nervoase la mediatorii durerii, diminund astfel algia abdominal n BIP. Viburcolul, de asemenea, prezint efect antialgic i spasmolitic, totodat avnd i

tabelul 1Pacientele din grupul de studiu au administrat tratament alopatic + preparate antihomotoxice

Antibiotice*

Doxiciclin + Clindamicin - 4 zile, apoiClindamicin 10 14 zile

Doxiciclin + Ceftriaxon Metronidazol 14 zile

Traumeel S: 2-3 fiole IM zilnic, apoi de 2 ori pe sptmn nc 5 fiole, 4 5 sptmni.Lymphomyosot: 1,1 ml IM de 2 3 ori pe sptmn, 4 5 sptmni.

Viburcol: cte un supozitor la fiecare 30 de minute per rectum pn la dispariia durerii.

Selectarea schemei de preparate antibacteriene a fost realizat conform antibiogramei i sensibilitii agenilor patogeni (Doxiciclina activ contra chlamydiilor i mycoplasmelor; Clindamicina activ contra gardnerelelor; Ceftriaxonul activ contra bacteriilor gram pozitive i gram negative).

tabelul 2Pacientele din grupul de control au administrat tratament alopatic

Antibiotice*

Doxiciclin + Clindamicin - 4 zile, apoiClindamicin 10 14 zile

Doxiciclin + Ceftriaxon Metronidazol - 14 zile

Antiinflamatoare

Dezintoxicante

Desensibilizante

Vitaminoterapie

Vitamina E (tocoferol), o lun(cu scop de reducere a potenialul prooxidant i

profilaxie a recurenelor)

efect sedativ, astfel micornd excitabilitatea formaiunilor SNC, care controleaz durerea (talamusul, hipotalamusul, locus ceruleus) i care sunt excitate de ctre influxurile dureroase aferente din zona lombar, fiind cauzate de inflamaia organelor bazinului mic, par-ticipnd la meninerea unui cerc vicios de generare a impulsurilor nociceptive i alternd calitatea vieii la pacientele cu PIB (tab. 3).

Secreia vaginal patologic a diminuat n zilele 9-14 la jumtate dintre pacientele tratate tradiional, iar la majoritatea femeilor din grupul, la care s-a asociat medicaia antihomotoxic (5852,7%), secreia vaginal anormal s-a redus chiar la sfritul primei sptmni de tratament, fapt explicat de efectele Lymp-homyosot-ului, care intensific drenarea limfatic i amelioreaz circulaia sanguin la nivelul bazinului mic, totodat, potennd

mpreun cu Traumeel-ul efectele antibacteriene ale antibioticelor, micornd astfel secreia vaginal patologic.

Febra a disprut la sfrtitul celei de-a doua sptmni la 52 (47,2%) dintre pacientele tratate tradiional, iar la majoritatea pacientelor tratate cu preparate antihomotoxice (5953,6%) n zilele 48, efect datorat Viburcolului, care echilibreaz sinteza In-terleukinelor, Interferonului, anticorpilor, fagocitoza i eliminarea toxinelor bacteriene, micornd treptat temperatura corporal pn la valori normale i meninnd tonusul sistemului imun. Deci, inflamaia i semnele ei au diminuat de dou ori mai rapid n grupul de paciente tratate cu preparate antihomotoxice.

Simptomele urinare (arsuri, durere la miciune) au disprut mai trziu (zilele 914) la majoritatea femeilor tratate tradiional

Nr. 3 (327), 2012

312

(6962,7%), comparativ cu cele, la care a fost asociat medicaia antihomotoxic, la mai mult de jumtate dintre ele acestea dis-prnd la sfritul primei sptmni de tratament (5751,8%). Acest fapt poate fi explicat de potenarea efectului antimicrobian al antibioticelor i intensificarea eliminrii toxinelor bacteriene de ctre preparatele antihomotoxice, oferind un rezultat net

superior dup tratamentul complex, comparativ cu tratamentul tradiional (tab. 4).

Semnele ultrasonografice de inflamaie a uterului i anexelor au diminuat la majoritatea femeilor din ambele grupuri (60% dintre cele tratate tradiional i 70,9% dintre cele, la care s-au asociat preparatele antihomotoxice) n zilele 10-14 de tratament.

tabelul 3Dinamica pozitiv a semnelor clinice

SimptomulTratamentul tradiional

Tratamentul tradiional asociat cu preparate anthi-homotoxice (grupul de studiu)

2-3 zile 4-8 zile 9-14 zile > 14 zile 2-3 zile 4-8 zile 9-14 zile > 14 zile

Durere n hipogastru 8 (7,2%) 10 (9%) 12 (10,9%) 80 (72,7%) 12 (10,9%) 15 (13,6%) 41 (37,2%) 42 (38,1%)

Secreie vaginal patologic 3 (2,7%) 38 (34,5%) 55 (50%) 14 (12,7%) 6 (5,45%) 58 (52,7%) 43 (39%) 3 (2,72%)

Febr 14 (12,7%) 42 (38,1%) 52 (47,2%) 2 (1,8%) 32 (29%) 59 (53,6%) 19 (17,2%) 0

Simptome urinare (durere, arsuri la miciune)

4 (3,6%) 35 (31,%) 69 (62,7%) 2 (1,8%) 7 (6,3%) 57 (51,8%) 45 (40,9%) 1 (0,9%)

Manifestri dispeptice (inapeten-, grea, meteorism)

5 (4,5%) 7 (6,3%) 10 (9%) 88 (80%) 5 (4,5%) 9 (8,1%) 32 (29%) 64 (58,1%)

Durere la palparea hipogastrului 2 (1,8%) 9 (8,1%) 46 (41,8%) 53 (48,1%) 4 (3,6%) 12 (10,9%) 61 (55,4%) 33 (30%)

Durere n regiunea anexelor la examinarea bimanual

1 (0,9%) 6 (5,4%) 45 (40,9%) 58 (52,7%) 2 (1,8%) 10 (9%) 56 (50,9%) 42 (38,1%)

Durere la deplasarea colului ute-rin n examinarea bimanual

0 4 (3,6%) 51 (46,3%) 55 (50%) 0 7 (6,3%) 51 (46,3%) 52 (47,2%)

De asemenea, nu se observ o diferen semnificativ n dinamica valorilor leucocitozei, VSH-ului i proteinei C-reactive ntre gru-purile incluse n studiu, la majoritatea femeilor observndu-se o diminuare a valorilor acestor parametri la sfritul celei de-a doua sptmni de tratament (tab. 5).

tabelul 5Rata sechelelor BIP

ComplicaiiTratament

alopatic

Tratament alopatic asociat cu preparate

antihomotoxice

Algodismenoreea persis-tent

39 (35,4%) 24 (21,8%)

Dereglri menstruale 36 (32,7%) 25 (22,7%)

Dispareunie, micorarea libidoului

51 (46,3%) 33 (30%)

Semne de modificri infla-matorii persistente, determi-nate la USG

38 (34,5%) 21 (19%)

S-a remarcat c algodismenoreea este prezent la 35,4% dintre pacientele care au administrat tratament alopatic i la doar 21,8% dintre femeile, la care s-au asociat n tratament preparatele anti-homotoxice, ceea ce argumenteaz c acestea din urm previn cronicizarea procesului inflamator pelvian, diminueaz cu timpul sindromul dolor. Dereglrile menstruale, de asemenea, sunt pre-zente ntr-un procent mai mic la femeile tratate cu antihomotoxice (22,7%), aceste preparate echilibrnd funcia endocrin, sinteza de hormoni steroizi i prevenind afectarea cronic a ovarelor.

Ponderea dispareuniei este de 1,5 ori mai mic la femeile tratate cu antihomotoxice, fapt explicat de aciunea sedativ, antialgic i antiinflamatorie a acestor preparate.

Concluzii1. Realiznd acest studiu i analiznd literatura de specialitate,

putem afirma c terapia antihomotoxic are numeroase avan-taje n raport cu terapia tradiional, pe care nu o substituie, ns i poteneaz efectele i i diminueaz efectele adverse.

2. Preparatele antihomotoxice, comparativ cu cele alopatice, au

tabelul 4Dinamica pozitiv a semnelor paraclinice

ExamenulTratament tradiional

Tratament tradiional asociat cu antiho-mostatice

5-9 zile 10-14 zile > 14 zile 5-9 zile 10-14 zile > 14 zile

USG (semne de inflamaie) 5 (4,5%) 66 (60%) 39 (35,4%) 10 (9%) 78 (70,9%) 22 (20%)

Analiza general a sngelui (leucocitoz, VSH crescut) 7 (6,3%) 81 (73,6%) 22 (20%) 12 (10,9%) 87 (79%) 11 (10%)

Proteina C-reactiv 13 (11,8%) 93 (84,5%) 4 (3,6%) 19 (17,2%) 90 (81,8%) 1 (0,9%)

313

ClInICAl RESEARCH StuDIES

un pronunat efect dezintoxicant, desensibilizant, antiedema-tos, antibacterian indirect (prin tonizarea sistemului imun) i previn dezvoltarea esutului conjunctiv.

3. Utilizarea preparatelor antihomotoxice a dus la diminuarea sindromului dolor de 3 ori, comparativ cu tratamentul tradii-onal, de 2 ori mai rapid - micorarea sindromului febril.

4. Simptomele urinare au diminuat de dou ori mai rapid n gru-pul cu preparate antihomotoxice, paralel cu dinamica pozitiv net superioar a semnelor paraclinice.

5. Rata sechelelor tip algodismenoree, dereglri menstruale, dis-pareunie s-a redus de 1,5 ori mai eficient n grupul de studiu. Utilizarea preparatelor antihomotoxice a pus n eviden o influen pozitiv asupra funciei reproductive, iar reducerea numrului de preparate medicamentoase n schemele de tra-tament a constituit un avantaj incontestabil a terapiei alterna-tive n tactica ginecologic, reducnd efectele adverse de dou ori vizavi de terapia tradiional.

Bibliografie1. Beigi RH, Austin MN, Meyn LA, et al. Antimicrobial resistance associ-

ated with the treatment of bacterial vaginosis. Am J Obstet Gynecol. 2004;191:1124-9.

2. Haggerty CL, Ness RB. Newest approaches to treatment of pelvic inflam-matory disease: a review of recent randomized clinical trials. Clinical Infectious Diseases. 2007;44(7).

3. CDC.Sexually Transmitted Disease Surveillance. 2008. US Department of Health and Human Services, CDC. Atlanta: GA, 2009.

4. Soper DE. Pelvic inflammatory disease. Obstetrics and Gynecology. 2010;116(2).

5. Paavonen J, Westrom L, Escenbah D. Pelvic inflammatory disease.In:Sexually Transmitted Diseases, K. K. Holmes, P. F. Sparling, W. E. Stamm, et al. New York Eds.: McGrawHill, NY, USA, 2008.

6. Heffner LJ, Schust DJ. Sexually transmitted diseases of bacterial origin. InThe Reproductive System at a Glance. Oxford: Wiley-Blackwell, UK, 2010.

7. Derasse Mireille, Klein Peter, Weiser Michael. The effects of a complex homeopathic medicine compared with acetaminophen in the sympto-matic treatment of acute febrile infections in children: An observational study. The Journal of Science and Healing. 2005;1(1). DOI: 10.1016/j.explore.2004.10.006.

8. Sweet RL, Gibbs RS. Pelvic inflammatory disease. In:Infectious Diseases of the Female Genital Tract. Philadelphia: Lippincott Williams & Wilkins, USA, 2009;220-244.

9. . . 2002;2.10. , . . 2002;2.11. .

, . . 1999;2.

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. , 192, MD-2004 ,

: (+37322) 222715

: (+37322) 295384www.usmf.md

e-mail: curiermed@usmf.md

Bd. tefan cel Mare, 192 MD-2004, Chiinu, Republica Moldova

telefon: (+37322) 222715 Fax: (+37322) 295384

www.usmf.mde-mail: curiermed@usmf.md

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