Medical Safety.

At present, the concept of national security has also acquired a medical dimension, because the political and economic security of a country can be threatened also by the rapidity with which infectious diseases spread in the present global world or by the impact of climatic changes. The present paper intends to illustrate the main threats to/for population health, international organizations and their regulations in the field of medical security, the impact of epidemics on the population, economy and health systems, methods to prevent pandemics, as well as the situations in which the post-communist Romanian health system impacted politically the country image at national and international level. The improvement of the health infrastructure in Romania, motivating the medical personnel by creating better working and payment conditions, as well as the recent experience of other states in the epidemics that occurred in Asia and Africa can all contribute to the successful management of medical emergencies and infectious outbreaks.

Responsibility and expectations in antiretroviral therapy--patients' versus doctors' perspective.

AIM: This paper aims to uncover what patients really expect form ART, and also what infectious diseases doctors expect from a patient's ART regime, thus exploring an important side of adherence to ART. MATERIAL AND METHODS: From July to November 2014 we have conducted a qualitative study regarding both patients' and doctors' expectations form the ART. We interviewed 30 patients and 4 doctors. We used semi-structured interviews that were conducted in the Psychosocial Compartment of the HIV/AIDS Regional Center in Iasi. RESULTS: The patients we interviewed came from all 6 counties in the Moldova area. Age varied from 16 years to 59 years; 55% were female and 45% male. 30% came from a rural area. The most common expectations that patients have regarding ART are: "to help me live", "not to make me feel sick", "to be easy to take (not to big, not a lot)", "not to show on the outside what I have on the inside". The infectious diseases doctors that we interviewed work in the HIV/AIDS Regional Center in Iasi. Their expectations regarding an ART regimen for patients were: "to reduce HIV viral load", "to increase CD4 cell count" and "to have minimal impact on the proper functioning of other organs". Patients consider themselves the only factors responsible for their own ART adherence in 56.6% of cases; 20% consider the doctor to be responsible for their adherence, 16.6% feel that their family, friends, and spouse are responsible, and 6.6% (2 patients) couldn't answer. Infectious diseases doctors considered that patients are 100% responsible for adhering to the antiretroviral therapy. CONCLUSIONS: In order to assure adherence to the ART it is important to explore both the doctor and the patient's perspective and to find ways to find a common ground in building a healthy relationship.

Long-term biological effects induced by ionizing radiation--implications for dose mediated risk.

Ionizing radiations are considered to be risk agents that are responsible for the effects on interaction with living matter. The occurring biological effects are due to various factors such as: dose, type of radiation, exposure time, type of biological tissue, health condition and the age of the person exposed. The mechanisms involved in the direct modifications of nuclear DNA and mitochondrial DNA are reviewed. Classical target theory of energy deposition in the nucleus that causes DNA damages, in particular DNA double-strand breaks and that explanation of the biological consequences of ionizing radiation exposure is a paradigm in radiobiology. Recent experimental evidences have demonstrated the existence of a molecular mechanism that explains the non-targeted effects of ionizing radiation exposure. Among these novel data, genomic instability and a variety of bystander effects are discussed here. Those bystander effects of ionizing radiation are fulfilled by cellular communication systems that give rise to non-targeted effects in the neighboring non irradiated cells. This paper provides also a commentary on the synergistic effects induced by the co-exposures to ionizing radiation and various physical agents such as electromagnetic fields and the co-exposures to ionizing radiation and chemical environmental contaminants such as metals. The biological effects of multiple stressors on genomic instability and bystander effects are also discussed. Moreover, a brief presentation of the methods used to characterize cyto- and genotoxic damages is offered.

The HIV-positive patient in intensive care--psychological profile.

AIM: This paper aims to outline the profile of HIV-positive patients in intensive care, in terms of psycho-emotional and vital parameters. MATERIAL AND METHODS: We evaluated the HIV-positive patients that required intensive care (IC), from January 2011 to December 2013, in the HIV/AIDS Regional of the "Sf. Parascheva" Infectious Diseases Clinical Hospital Iasi. RESULTS: From January 2011 to December 2013, the HIV/AIDS Regional Centre in Iasi recorded 2649 hospitalizations, of which 0.67% (18 cases) required intensive medical care. Of these 10 were males and 8 females, aged between 24 and 65 years with a median of 24 years. There were 29 deaths (1.09% of all hospitalizations), 11 of which in intensive therapy (38% of all deaths)--7 men and 4 women. CD4 counts in persons requiring IC care were between 1 and 112/mm3, and most naive patients who died were late-presenters. The main diseases diagnosed were pulmonary tuberculosis and pneumocystosis, the main cause of death being multiple organ failure. The duration of hospitalization ranged between 4.5 and 30 days. Treatment success rate was correlated with the CD4 and biological status: liver and renal failure, respiratory failure, meningeal coma, hypoproteinemia, diselectrolitemia. From a psychological perspective, patients that arrived in the intensive care showed a history of non-compliance and non-adherence, a personality structure often marked by a lack of respect for them, indifference or ignorance regarding the factors that generate well-being. CONCLUSIONS: HIV-positive patients in the position of requiring intensive care showed a marked immunological collapse due to abandonment of therapy or late detection.

The psycho-emotional profile of the HIV-positive naïve patient.

AIM: The paper aims to outline the naïve HIV-positive patient's profile, in terms of feelings and emotions post-diagnosis. MATERIAL AND METHODS: The evaluation took place from January 2011 to December 2013 in the Psycho-social Assistance Office of the "Sfânta Parascheva" Infectious Diseases Hospital in Iasi. We evaluated 146 patients newly diagnosed with HIV infection, both in terms of immunological and virusological and from a psychological perspective, using the Hamilton Anxiety Scale (HAMA), Beck Depression Inventory II (BDI) and the clinical interview. RESULTS: In a period of 3 years (January 2011 - December 2013) we registered in the HIV/AIDS Regional Center in Iasi, 146 new cases of HIV infection in adults, with distribution by years as follows: 46 in 2011, 45 in 2012, 55 in 2013; 39 cases were in Iasi, 39 in Suceava, 26 in Botosani, 18 in Neamt 18, 16 in Bacau and 6 in Vaslui. Of these, 51 were women and 95 men, aged between 24 and 46 years. From the immunological point of view, 11% of patients had values of CD4 > 500 (16 patients), 47% between 500 and 100 (69 patients) and 42% < 100 (61 patients). From a psychological perspective, the clinical interview revealed a state of fear in 68.5% of cases (fear of death, fear of complications, fear of other people's reaction to the diagnosis), confusion in 62% of cases (in terms of diagnosis, the mode of infection, the future), anger in 27% of cases (against the source of infection, against themselves, against God or divinity), guilt and self-blame in 7% of cases. Beck Depression Inventory (BDI) revealed moderate depression in 14% of patients; mild depression in 27% of patients and 58% of patients presented no symptoms of depression. Regarding the anxiety scale HAMA, in 54% of cases it showed mild anxiety, average anxiety in 28% of cases, 14% severe anxiety and 3% (4 cases) very severe anxiety. CONCLUSIONS: Patients newly diagnosed with HIV are a vulnerable population with a specific psycho-emotional profile. Multidisciplinary knowledge--in medical, psycho -emotional and social terms--of the patient's characteristics and needs helps to support adherence to the antiretroviral therapy and improve the quality of life.

Is it enough scintigraphy for everyone? A cross-sectional analysis regarding the impact of justice in the distribution of health care resources.

AIMS: The aim of this study was to evaluate the influence of three demographic criteria: gender, age and education level on the patients that perform a scintigraphy. MATERIALS AND METHODS: The cross-sectional study was applied to 220 patients to whom it was prescribed a scintigraphy by their treating physician. Of these, 74 were men and 145 women, 10 children and 210 adults. According to their education, 88 people did not graduate a high school, a total of 56 people graduated a high school, 27 persons graduated a college, 22 people had a university diploma and 26 people a PhD title. The chi-square test was used to analyze the frequencies for the measurable variables on a nominal scale. The significance threshold is considered to be 0.05, so, only the values which are smaller were taken into consideration. We presented and analyzed only the data that fulfill this condition. RESULTS AND DISCUSSION: From our study it has been found that gender criterion played an important role in performing a scintigraphy for the first time. 71.6% of male patients were undergoing a scintigraphy for the first time. The frequency of exploration by scintigraphy is increasing if you are a female patient than if you are a male patient: chi-square calculated value is chi2 (3)=12.398, p=0.006. From our study it has been found that age item plays an important role in the scintigraphy investigations for all the patients. The first scintigraphy was significantly performed in the 40-50 years old gap, whilst for the patients being aged over 60; they were probably not performing a first time scintigraphy. We did not find significant statistical differences in respect of the education level. CONCLUSIONS: So, we can conclude that access to that medical investigation is not depending on the socioeconomic status of the patient, but in some occasions, the number and the frequency distribution of performing a scintigraphy depend on gender and age. We can also conclude that the principle of egalitarianism is fulfilled and so the justice principle in the distribution of health care resources must be reevaluated.

Hyponatremia at autopsy: cause of death or simply a marker of severity of the underlying disease.

AIM: To analyze the possible interpretations of hyponatremia detected at autopsy in vitreous humor in relation to the cause of death and/or associated pathology (cause of death or a simple marker of the severity of associated diseases). MATERIAL AND METHODS: Hyponatremia is the most common electrolytic disorder in hospital practice, considered as a risk factor for hospital mortality. We conducted a 3-year forensic casework analysis in view ofestablishing the relationship of hyponatremia with mortality: hyponatremia as a direct cause of death or hyponatremia caused by the severity of the underlying disease which is the cause of death. RESULTS: The forensic cases are not fully reliable. Although the target question has not been answered, our findings plead for the association of hyponatremia with severe diseases (sick cell syndrome) and not for hyponatremia as a cause of death, but this does not seems to be proven either, the percentage of cases with significant hyponatremia increasing from zero in cases of trauma and sudden violent death to 50% in cases of severe chronic diseases. CONCLUSIONS: The values obtained by us are in agreement with the data in the literature. Our findings plead for the scenario hyponatremia as a marker of the severity of the underlying disease.

[New trends in the scientific anthropo-cultural psychiatric expertise]. / Orientarea antropo-culturala actualna si stiintifica a psihiatriei expertale.

Starting from the "epistemological naturalization of sciences of life", the authors present the complex content of medico-legal psychiatric examination, from which will result its scientific structure. The ontological, epistemological, hermeneutical and axiological content of this type of examination emphasize its methodological structure in the purpose of combining in a creative way its humanistic and scientific features.

[Hypertrophic cardiomyopathy--cause of sudden death]. / Cardiomiopatia hipertrofica--cauza de moarte subita.

Hypertrophic cardiomyopathy (CMH) is defined by the absence of left ventricular dilatation and the presence of myocardial hypertrophy that is not due to another recognised cause of hypertrophy such as systemic hypertension or aortic stenosis. The bizarre histological appearance of the myocardium is the hallmark of CMH. Myocytes and bundles of myocytes are malaligned and fibrosis may be extensive. Disarray is maximal in areas of macroscopic wall thickening. The condition is most easily recognized in a series of transverse, short axis slices across both ventricles. Histological examination of sections taken in this transverse plane at all three levels (high, mid, apical) including septum, anterior, posterior and lateral walls are needed. The authors report a case of cardiac sudden death to a 45 years old white man. The diagnosis was revealed intra vitam and it was confirmed post mortem.

[Arrhythmogenic right ventricular dysplasia]. / Displazia aritmogena a ventriculului drept.

Arrhythmogenic right ventricular dysplasia (ARVD) is a new form of cardiomyopathy probably more frequent than commonly reported. The incidence is unknown. ARVD is a heart muscle disorder of unknown cause that is characterised pathologically by fibro-fatty replacement of the right ventricular myocardium. It is a rare but important cause of sudden cardiac death in young, otherwise healthy persons. The right ventricle should be extensively sampled histologically in all cases of sudden unexpected death, especially those that are exercise related. The disease is often familial (about 30%) with an autosomal dominant inheritance.

[Myocardial bridging and sudden death]. / Puntea miocardica si moartea subita.

Myocardial bridging (MB) has been described more than 200 years ago. However it's implications on the genesis of myocardial ischaemia were not studied until recently. Little is known about the real incidence, survival in people with this entity and pathophysiology. Data found in the literature are prone to bias since all studies published are retrospective and the populations studied are limited and very selectioned. Most authors agree that most MB is rather frequent and seldom generates ischaemia. A significant clinical effect of myocardial bridging implies a thick MB with at least 75% coronary systolic obstruction associated with ventricular hypertrophy and/or rapid tachycardia. In the peculiar case of sudden death, we think that to consider MB as a cause of this sudden death we need more than a simple necroptic finding of a MB. A history of clinical and/or electrocardiographic confirmed ischaemia or the presence of histological abnormalities suggesting myocardial ischaemia can be helpful.

Etio-pathogenic views on transsexualisms (TS).

Starting from the analysis of six cases of transsexualism (TS) the authors performed complex investigations of all sex levels and identified primary T.S. (disturbances of sexual differentiation), secondary TS (sexual perversions, sexopathy). This distinction appears to the authors as unavoidable for ethico-pathological and legal drive in view of the implications of T.S.--implications able to be analysed from standpoint.

Sociopathy: genesis and development.

A complex study of a sample of 1,029 children and young people cared for in orphanages revealed the increased incidence of the disorders of behaviour in these categories (33%) with great difficulties of post-school integration (70%). Factors like: affective frustration, noxious family climate intellectual handicap, socializing defect, school failure, etc. are deeply involved in the genesis of juvenile maladjustment and it further on can be found within the nucleus of the sociopathic personality and in adult's deviance.

[Integrative model of the ontogeny and destruction of human behavior]. / Model integrativ privind ontogeneza si destructurarea comportamentului uman.

In a review of the data in the literature completed with authors own researches (concerned with twins, chromosome abnormalities, incestuous descent, socially assisted children etc.) an integrative model regarding the ontogenesis and destruction of human behaviour is presented. According to this model, behaviour appears as a hierarchical and integrated system expressing the process of its development from automatic and reactive to noologic and reflexive. The integrative, systemic concept promotes, theoretically and methodologically, the understanding and competent investigation of human behaviour in its two fundamental states, integrated and destructive.