[Heart insufficiency in elderly--new dimensions of the problem]. / Insuficienta cardiaca la vârstnici dimensiunile problemei.

The 21st century's demographic and epidemiologic perspectives suggest an absolute and percentual increment of elderly population. In the same time the prevalence of heart insufficiency increases with advanced age, which transforms heart failure in a true challenge for health insurance system. This new dimension of the problem resides in the increment of heart insufficiency's prevalence and in the high costs of medical care of these patients. Heart failure's medical costs are high not only due to the necessity of compensating the cardiac function but also due to the necessity of treating the etiology, the risk factors and the co-morbidities with cardiac side effects. Elderly patients usually have a low therapeutic compliance and an important number of iatrogenic reactions mainly due to poly-medication, poly-pathology and cognitive and physical deficiencies, which need special measures of therapeutic education for the patient and family and medical survey, probably best in a nursing house; all these elements increase significantly the cost, which is almost double than the cost for cancer. The prophylaxis in heart insufficiency means an extremely efficient management of entire cardiac pathology in order to delay the moment of heart failure. In elderly patients, the treatment in heart insufficiency is difficult not due to hospital treatment of decompensation episodes but due to low therapeutic compliance at home. We need special programs to ensure medical education of the patient and the family/caregiver in order to avoid iatrogenic pathology and to ensure therapeutic efficiency.

[Retroprospective epidemiological study of toxocariasis cases hospitalized between 2005-2008]. / Cercetari epidemiologice, retroprospective, asupra cazurilor de toxocaroza la copiii spitalizati in perioada 2005-2008.

UNLABELLED: The authors presents the results of a retroprospective epidemiological study on toxocariasis cases admitted in the Paediatric Diseases Clinic of Iasi, between January 2005 - June 2008. MATERIAL AND METHOD: The study included a number of 228 children. RESULTS: The age distribution highlighted a predominance of 3-7 years of age group (46.9%); sex distribution, a significant predominance in males (53.5%) and a small advance the rural areas (54.3%) given the urban areas (45.6%). The present study lead to a spring-autumn seasonality. A high risk for infection is the dog (41.2%). The distribution of toxocariasis in children patients in Moldavia, Romania, highlighted a predominance in Iasi county (45.6%).

[Retrospective clinical and laboratory study of the toxocariasis cases hospitalised between 2005 and 2008]. / Studiu clinic si de laborator, retroprospectiv, asupra cazurilor de toxocaroza la copiii spitalizati in perioada 2005-2008.

UNLABELLED: The authors present the results of retroprospective clinical and laboratory diagnosis on toxocariasis cases hospitalized in the Paediatric Diseases Clinic of Iasi, between January 2005-June 2008. MATERIAL AND METHOD: The study included a number of 228 children. RESULTS: The most frequent clinical manifestation was pulmonary symptoms 80.70%: dyspneea, wheesing, asthma, cough, interstitial pneumonitis. The most frequent digestive symptoms were abdominal pain 41.22%, hepatosplenomegaly 29.38%; cutaneous manifestations were pruritus and urticaria. The laboratory diagnosis: hypereosinophilia was present at 94.73% childrens associated with hyperleucocytosis and hyper-gammaglobulinemia. All the patients were serologic confirmed with toxocariasis. The children responded well to treatment with albendazole.

[Clinical, epidemiological and cytogenetic studies on 221 patients with Down syndrome]. / Studii clinice, epidemiologice si citogenetice pe un lot de 221 pacienti cu sindrom Down.

UNLABELLED: Down syndrome, determined by 21 trisomy, represents a major cause of infantile morbidity and mortality. AIM: The analysis of dysmorphic features in Down syndrome, incidence of major congenital abnormalities, of some epidemiological parameters and cytogenetic specifics. MATERIAL AND METHOD: Methods used were clinical, epidemiological and cytogenetical. We analysed 221 patients, from Iasi county, with clinical supposition of Down syndrome, identified in the first year of life, between 1985 and 1999. RESULTS: The majority of patients (67%) have more than 5 from 10 characteristics dysmorphic signs of Down syndrome in neonatal period. Visceral congenital abnormalities--82 cases (37.1%) were isolate (cardiac or digestive) or multiple. The presence of one visceral abnormality determined the death of patient in 30 cases (46.15% of death). Medium incidence of Down syndrome in Iasi county was 1.306 per thousand (1/769 new-born), with median value 1.091per thousand and corrected value related to the maternal age 1.056 per thousand. Cytogenetic analysis was performed at 101 patients, in 95 cases (94.05%) clinical suspicion of Down syndrome was correct, patients presenting 21 trisomy (in the majority of cases a homogenous free trisomy). CONCLUSION: The data obtained by us are concordant with the majority of literature studies, that a test the correctness of clinical trial and validate our results.

[Therapeutic patient education--method of optimizing treatment in chronic diseases]. / Educatia terapeutica a pacientului--metoda de optimizare a tratamentului bolilor cronice.

The technological revolution of the 20th century has changed not only the life style but also the human interrelations, including the physician-patient relationship. The old, primarily patriarchal, system (in which the patient trusted completely the physician and followed religiously his commandments) evolved into the current system in which the patient is an active partner in medical care. Patient education is increasingly recognized as an integral part of the therapy. The objectives of therapeutical education rely essentially in the improvement of the patient knowledge and skills concerning the disease and its treatment in order to harmonize his life style with the restrains of the illness. Therapeutical education must be complex, individualized, repeated, motivating, and controlled. In chronic diseases, both the health provider and the patient are in front of a permanent challenge. The educational process is in continuous movement, liable to permanent improvement.

[Iatrogeny and the elderly]. / Iatrogenia si vârstnicii.

Discussions about the impact of iatrogeny over general health were avoided and neglected for a very long time. It was brought to medical interest due to recent studies concerning therapeutic compliance, patient's medical education and acute awareness of ethical implications of medical activities. Even if iatrogeny was always present in medicine, we realized but recently the dimensions and the necessity of a coherent and systematic approach of this problem. Iatrogenic pathology in elderly population has even a bigger impact due to conjugation of two major demographic phenomena: an absolute and percentage increase of elderly population parallel with an increase of prevalence of iatrogenic pathology with age. That's why iatrogeny in elderly becomes a major health problem, unfortunately often ignored, neglected and even obscured inspite of well-recognized impact over duration and quality of patient's life as well as over the cost of medical assistance.

[Importance of genetic factors in the pathogenesis of gonadal and postgonadal human infertility]. / Importanta factorilor genetici în patogenia sterilitatii umane periferice (gonadica si postgonadica).

The infertility is a important health problem, affecting about 10-15% of couples. The important role of genetic factors in pathogenesis of infertility is now increasingly recognized and our knowledge in this field are improved each day. For these reasons we review the most important genetic causes of infertility. In this paper we analyse the genetic implications in gonadal and postgonadal infertility. Gonadal infertility affects both sexes and are characterised by hypergonadotrophic hypogonadism. Gonadal infertility is produced by chromosomal or monogenic mutations. Chromosomal causes are represented by gonosomal aneuploidy and structural chromosomal abnormalities. The monogenic disorders are consequences of a recessive mutations of hormone, hormonal receptor or enzymes genes. Postgonadal infertility is present in men and is the result of some obstructive disorders.

[ The importance of genetic factors in pathogenesis of central infertility (hypothalamic and pituitary]. / Importanta factorilor genetici în patogenia sterilitatii umane centrale (hipotalamica si hipofizara).

The infertility is a important health problem, affecting about 10-15% of couples. The important role of genetic factors in pathogenesis of infertility is now increasingly recognized and our knowledges in this field are improved each day. For these reasons we review the most important genetic causes of infertility. In this paper we analyse the genetic implications in central infertility (hypothalamic and pituitary). These conditions affect both sexes and are characterised by hypogonadotrophic hypogonadism. In majority of cases central infertility is produced by recessive mutations of hormone or hormonal receptor genes. In some cases the infertility is a component of a specific syndrome.

[Antisense oligonucleotides with pharmacologic action]. / Oligonucleotide antisens cu activitate farmacologica.

The potential therapeutic applications of the antisense strategy are illustrated by numerous examples of the oligonucleotides investigated in preclinical and clinical trials especially for antiviral, antiinflammatory, anticancer and antiatherosclerotic activity. The main advantages of the antisense oligonucleotides therapeutic candidates are comparatively discussed with the classical drugs.

[Basic principles of the antisense strategy]. / Principii fundamentale ale strategiei antisens.

The antisens strategy is based on specific inhibition of the mutant gene expression by oligodeoxynucleotides (OGN), capable of selectively hybridizing with target DNA or RNA. Molecular mechanisms of the antisense oligonucleotide comprise: inhibition of splicing, inhibition of 5'-capping and 3'-polyadenylation, activation of RN-ase H, small interfering RNA, ribozymes. The antisense strategy is applied to: rational design of potent, selective therapeutic agents, target validation and detection of pathologic gene expression in vivo. The main aim of the antisense oligonucleotide design is to improve the affinity for target RNA and the resistance to nucleolytic degradation.

[Drug therapy at the beginning of the genomic era]. / Terapeutica medicamentoasa la începutul erei genomice (I).

The individualisation of drug therapy according to the genetic profile of each patient would allow to avoid the adverse effects and to reach the maximum therapeutic efficiency, therefore an optimum risk/efficiency ratio. This desideratum has become feasible in the genomic era by identifying and mapping a true mononucleotid polymorphism signature DNA (single nucleotide polymorphism fingerprint--SNP) and by using the new technologies. The present day data regarding the polymorphism of the genetic determinants involved in the response to drugs are synthetically shown, as well as the defining of the new fields--pharmacogenetics and pharmacogenomics. Although superposable and interchangeable up to a point, the term of pharmacogenetics rather refers to the study of the variability of response to drugs according to the genetic profile, the term of pharmacogenomics being reserved to the analysis of the genome (DNA and its products, RNA and proteins), in relation with the response to drugs. The differences among the individuals concerning the pharmacokinetics and the pharmacodynamics can be explained through the polymorphism of the substrata (enzymes, carrier proteins, receptors) that explains the genetic stratification of the population. The development strategies of the drug research and of the pharmaceutical industry will certainly be modulated by the new acquisitions in the field of pharmacogenetics and pharmacogenomics, with the inherent bioethical implications. New specific drugs for the patients possessing peculiar genotypes could be synthesized, the starting off of the prealable stratification of the patients according to their genotype.

[DNA repair pathways and their involvement in human diseases]. / Mecanismele de reparare a leziunilor ADN. Implicatii în patologia umana.

Integrity maintenance of the genome is crucial. Human DNA is vulnerable to damage arising from both endogenous and exogenous sources. Different DNA repair pathways counteract these potentially mutagenic accidents: damage reversal by methylguanine methyl transferase (MGMT), base nucleotide repair (BER), nucleotide excision repair (NER), mismatch repair (MMR) and repair of strand breaks. In some cases, DNA damage is not repaired but is instead bypassed by specialized DNA polymerases. The existence of human diseases associated with defects in DNA repair illustrates the importance of this process of quality control. Many of these human diseases have an increased susceptibility to cancer.