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CNAA / Theses / 2017 / May /

The optimization of medical and surgical management in acute pelvic inflammatory disease


Author: Cauș Cătălin
Degree:doctor of medicine
Speciality: 14.00.01 - Obstetrics and Gynecology
Year:2017
Scientific adviser: Olga Cerneţchi
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 3 May, 2017
Approved by NCAA on the 31 May, 2017

Abstract

Adobe PDF document – 0.68 Mb / in romanian

Thesis

CZU 618.13-002.1-089

Adobe PDF document 16.00 Mb / in romanian
191 pages

Keywords

acute pelvic inflammatory disease (APID), MIL score (clinical manifestations, imaging and laboratory data), APID severity, APID patient profile

Summary

Thesis structure: the work is displayed on 129 pages of typed text and comprises an introduction, 5 chapters, general conclusions, practical recommendations; including 22 tables, 48 figures, 2 formulas and the and a bibliographic index containing 237 references. The results obtained in the thesis were published in 13 scientific papers.

Field of study: 321.15 Obstetrics and Gynecology.

Purpose of the study: Identifying the patient with acute pelvic inflammatory disease and optimizing the process of diagnostics and the surgical management of this disease.

Objectives: Identifying the medical and social determinants that favor the development of APID, and assessing the modern profile of the APID patient. Assessing the severity of the acute pelvic inflammatory disease and the usefulness of rapid tests for the diagnosis and medical management of APID. Studying the immediate and remote (12 months after) clinical outcomes after an APID episode, in order to establish the efficacy of the medical management, the repercussions on fertility and to identify the disease sequelae that occurred. Developing an algorithm for APID diagnostics and its medical management.

Novelty and scientific originality: The identification of the medical and social determinants that are conditioning the development of APID in the women of reproductive age. Establishing the contemporary profile of women with acute pelvic inflammatory disease. The elucidation of the influence of proinflammatory markers on the severity of the APID evolution. The demonstration of the efficacy of surgical management of APID based on the analysis of immediate and remote (after 12 months) results, in peculiar of the repercussions upon fertility and the occurred sequelae.

The scientific problem solved in the thesis: consists in assessing the medical and social determinants that are conditioning the development of APID, creating a severity score for APID by using the proinflammatory markers to maintain the reproductive function of females and optimizing the surgical management of the disease at various levels of health care.

Theoretical significance and practical value of the work: The study allowed us to create a severity score for the acute pelvine inflammatory disease (MIL) that allowed us to optimize the medical and surgical management of patients diagnosed with the disease. Based on the conducted research, there were proposed for practical implementation several rapid tests for the diagnosis of the infectious etiological factors of APID. The conducted research has proved a high sensibility and diagnostic accuracy of procalcitonin as a proinflammatory marker to monitor the evolution of the acute bacterial disease. Our results have proven the importance and efficiency of the proposed algorithms of medical and surgical management of patients with acute pelvic inflammatory disease. The results of the study have served as a basis for developing clinical protocols on the matter of diagnosis and treatment of the APID, based on its form and severity degree.

Implementation of scientific results: The main research results were implemented in the didactic process at the Department of Obstetrics and Gynecology no. 2, as well in the clinical activity of the Septic Gynecology section, at the MSPI MCH No. 1 and at MSPI Institute of Mother and Child.