Economic efficiency of primary care for CVD prevention and treatment in Eastern European countries.

BACKGROUND: Cardiovascular disease (CVD) is the main cause of morbidity and mortality worldwide, but it also is highly preventable. The prevention rate mainly depends on the patients' readiness to follow recommendations and the state's capacity to support patients. Our study aims to show that proper primary care can decrease the CVD-related morbidity rate and increase the economic efficiency of the healthcare system. Since their admission to the European Union (EU), the Eastern European countries have been in a quest to achieve the Western European standards of living. As a representative Eastern European country, Romania implemented the same strategies as the rest of Eastern Europe, reflected in the health status and lifestyle of its inhabitants. Thus, a valid health policy implemented in Romania should be valid for the rest of the Eastern European countries. METHODS: Based on the data collected during the EUROASPIRE III Romania Follow Up study, the potential costs of healthcare were estimated for various cases over a 10-year time period. The total costs were split into patient-supported costs and state-supported costs. The state-supported costs were used to deduce the rate of patients with severe CVD that can be treated yearly. A statistical model for the evolution of this rate was computed based on the readiness of the patients to comply with proper primary care treatment. RESULTS: We demonstrate that for patients ignoring the risks, a severe CVD has disadvantageous economic consequences, leading to increased healthcare expenses and even poverty. In contrast, performing appropriate prevention activities result in a decrease of the expenses allocated to a (eventual) CVD. In the long-term, the number of patients with severe CVD that can be treated increases as the number of patients receiving proper primary care increases. CONCLUSIONS: Proper primary care can not only decrease the risk of major CVD but also decrease the healthcare costs and increase the number of patients that can be treated. Most importantly, the health standards of the EU can be achieved more rapidly when primary care is delivered appropriately. JEL: I18, H51.

Immunohistochemical markers in the study of gallbladder premalignant lesions and cancer.

AIM: The aim of the study was to perform a comparative analysis of proliferative and apoptotic activity as well as of microvascular density (MVD) in metaplasia, dysplasia and gallbladder carcinoma. MATERIAL AND METHOD: There were investigated 10 cases of chronic cholecystitis associating premalignant lesions and 5 cases of gallbladder carcinoma developed on a chronic cholecystitis background. The immunohistochemical (IHC) staining was made using Ki-67, p53 and CD34 antibodies, and the streptavidin-biotin method. The semiquantitative analysis focused on the intensity of the IHC reaction for Ki-67 and p53 (on a scale from 0 to 4), the Ki-67 index and the percentage of p53 positive cell nuclei. The MVD was established on 5 representative fields as mean of the number of CD34 positive vessels. RESULTS: Ki-67 was positive in all 10 chronic cholecystitis cases (100%) and in all 5 carcinoma cases (100%), which is explainable by the selection manner of chronic cholecystitis associating premalignant lesions and by the invasive pattern of the carcinomas. Ki-67 index rose from 10% in simple dysplastic lesions associated with chronic cholecystitis to 20% in severe dysplastic lesions associated with chronic cholecystitis up until 90% in carcinoma. In all chronic cholecystitis, p53 was negative for normal gallbladder epithelium, in metaplastic territories and in those with mild dysplasia. In the dysplastic areas present in chronic cholecystitis, the positive reaction of p53 rose from 20% (in moderate dysplasia) to 80% (in severe dysplasia). All carcinoma cases were p53 positive (100%), its expression varying from 30% in papillary areas and 30-50% in undifferentiated adenocarcinoma to 80-100% in well differentiated type. In chronic cholecystitis MVD was of 5-9 vessels / field in areas adjacent to pyloric metaplasia and 10-20 vessels / field in severe dysplastic areas. Gallbladder carcinoma cases presented a MVD of 15-30 vessels / field. CONCLUSIONS: The investigation of Ki-67, p53 and MVD brings important data regarding the carcinogenesis process in the gallbladder, initiated on the background of a chronic cholecystitis. The dynamics in the values for Ki-67, p53 and MDV followed from premalignant lesions to carcinoma sustains the hypothesis of the metaplasia-dysplasia-carcinoma sequence.

[The detection of dysplastic lesions of the gallbladder mucosa in polypoid cholelithiasis]. / Evidentierea leziunilor displazice din mucoasa veziculei biliare în colecistitele calculoase polipoide.

AIM: To investigate the hyperplastic and/or dysplastic lesions in the gallbladder mucosa. METHODS: We used the immunohistochemical Ardeleanu-Hsu-Bussolati and Gugliotta methods, with avidin and peroxide biotin, adapted in the laboratory of University Hospital "St. Spiridon" Iasi. There were studied ten cases of polypoid cholelithiasis, with the following markers: Ki67, PCNA, and p53. RESULTS: The immunohistochemical methods using Ki67, PCNA and p53 protein allowed the evaluation of the abnormal proliferation abilities characteristic for some hyperplastic or dysplastic lesions, found in our cases of cholelithiasis. CONCLUSIONS: The utilization of these markers permitted us to establish a good correlation between the high activity of Ki67 and the morphological aggression indicators in hyperplastic and dysplastic gallbladder epithelium. There is also a correlation between the percentage of the cells marked with anti-PCNA antibody and the existence of p53 protein in these lesions.