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Chronic amygdalitis with joint syndrome (evolutionary, immune-genetic and therapeutic aspects)


Author: Cezara Andronachi
Degree:doctor of medicine
Speciality: 14.00.04 - Otorhinolaryngology
Year:2016
Scientific adviser: Alexandru Sandul
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific consultant: Liliana Groppa
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 16 November, 2016
Approved by NCAA on the 28 December, 2016

Abstract

Adobe PDF document – 0.52 Mb / in romanian

Thesis

CZU 616.322-002.2:616.72

Adobe PDF document 3.55 Mb / in romanian
154 pages

Keywords

chronic decompensated amygdalitis, joint syndrome, poststreptococcal reactive arthritis, rheumatism, human leukocyte antigens

Summary

The structure of the thesis: The work is presented on 126 pages of printed text and consists of the introduction, 3 chapters, general conclusions, practical recommendations, summary in Romanian, Russian, English and bibliography with 217 references. It includes 29 figures and 8 tables, 5 formulas and 1 annexe. The results are published in 8 scientific papers, including 3 single author papers and 6 works published in reviewed editions.

Research area and objectives. Currently, despite of numerous examinations to diagnose forms of chronic amigdalitis (CA), a number of issues remain unresolved regarding pathogenesis, treatment and complications of the disease. The low efficiency of multiple methods of treatment of CA, to a certain extent, is due to the underestimation of the immunogenetic impact on etiopathogenetic appearance. Recently the obvious results in the area of correlation between CA and human leukocyte antigens (HLA) have been received. More than that, unique biochemical characteristics of each human individual are determined by genetic polymorphism, biochemical diversity at the individual level, updating and identification of the new HLA alleles. Therefore, personal HLA genotyping is complicated and remains a distant goal. Scientific papers aimed to study the role of HLA system in the onset and evolution of CA are welcome in order to improve treatment principles and to develop the new diagnostic criteria for assessment of groups of people prone to this disease.

The scientific novelty. The assessment of the correlation between local immune disorders and systemic immune processes, as well as local immune disorders and the immune reaction in a zone of an isolated inflammatory process is up to date and important. These results complete the opinion about pathogenesis of CA, give arguments for the necessity and define pathogenic treatment, contribute to a fair prognosis. During the study treatment criteria of CA as a function of immune-genetic analysis have been established, a comparative analysis of the evolution and prognosis of patients after conservative and surgical treatment of CA has been performed.

The scientific problem that is solved in the research represents the assessment of the influence of antigenic determinants of HLA Class I (A and B) on the clinical features, evolution and treatment strategy in patients with decompensated chronic amygdalitis associated joint syndrome.

Theoretical value of the study. Immune-genetic peculiarities (antigens HLA class IA, IB) and their influence on the evolution of CA and joint syndrome with appreciation of their correlation with clinical and laboratory status were determined. A dynamic study of evolution of joint manifestations after conservative and surgical treatment of CA with the development of indicators of favorable prognosis was performed.

Applied value of the work consists of the estimation of significance of the indications for conservative and surgical treatment based on clinical, laboratory and imune-genetic status (antigens HLA class IA , IB ) in patients with CA and joint syndrome

. Implementation of scientific results. The main results of the research have been applied in the teaching process at the Department of Otorhinolaryngology of PI SMPU "Nicolae Testemitanu" and in the treatment process of Otorhinolaryngology Department of the Republican Clinical Hospital in Chisinau.