The role of medical registries, potential applications and limitations.

Medical registries provide highly reliable data, challenged hierarchically only by randomized controlled trials. Although registries have been used in several fields of medicine for more than a century and a half, their key role is frequently overlooked and poorly recognized. Medical registries have evolved from calculating basic epidemiological data (incidence, prevalence, mortality) to diverse applications in disease prevention, early diagnosis and screening programs, treatment response, health care planning, decision making and disease control programs. Implementing, maintaining and running a medical registry requires substantial effort. Developing the registry represents a complex task and is one of the major barriers in widespread use of registries. Medical registries have potential to evolve to a next generation by taking benefit from recent semantic web technology developments. This paper is aimed at providing a summary of the basic information available on medical registries and to highlight the progress and potential applications in this field.

Expression of Nestin and CD133 in serous ovarian carcinoma.

Pupose: Nestin and CD133 are regarded as putative markers of cancer stem cells (CSCs) and related to poor prognosis in various cancer sites. Since few studies have focused on their role in ovarian cancer, we aimed to investigate their predictive value and association with neoangiogenesis. METHODS: Immunohistochemical analysis for nestin and CD133 was performed on 85 serous ovarian carcinoma tumor samples using tissue microarray technique. Nestin immunoreactivity was detected in both tumor and endothelial cells, whilst CD133 was only identified in tumor cells. CD34 endothelial expression was used to assess intratumor microvessel density (MVD). RESULTS: Of the tissue samples 49.4% were nestin-positive and 24.7% were positive for CD133. In both univariate and multivariate analysis nestin or CD133 expressions in tumor cells were not significantly associated with clinicopathological parameters (age, serum CA125, peritoneal carcinomatosis, malignant ascites, tumor grade). However, in multivariate analysis nestin expression in tumor cells proved to be an independent prognostic factor, associated with poorer survival and time to progression (p=0.025 and p=0.05, respectively). This has not been achieved for CD133. Furthermore, a significant concordance between nestin endothelial expression (nestin-determined MVD) and CD34-determined MVD was achieved. CONCLUSION: In addition to the well-known clinicopathological characteristics, tumor expression of nestin might be a valuable prognostic factor for survival in patients with advanced ovarian cancer. With regard to its endothelial expression, nestin might be as reliable as CD34 for quantifying tumor angiogenesis. Further investigation is justified in order to better clarify the role of these biomarkers.

The development of scientific reasoning in medical education: a psychological perspective.

Scientific reasoning has been studied from a variety of theoretical perspectives, which have tried to identify the underlying mechanisms responsible for the development of this particular cognitive process. Scientific reasoning has been defined as a problem-solving process that involves critical thinking in relation to content, procedural, and epistemic knowledge. The development of scientific reasoning in medical education was influenced by current paradigmatic trends, it could be traced along educational curriculum and followed cognitive processes. The purpose of the present review is to discuss the role of scientific reasoning in medical education and outline educational methods for its development. Current evidence suggests that medical education should foster a new ways of development of scientific reasoning, which include exploration of the complexity of scientific inquiry, and also take into consideration the heterogeneity of clinical cases found in practice.

Paraoxonase 1 genotype-phenotype correlation in patients with metabolic syndrome.

The aim of the study was to investigate the influence of three single nucleotide polymorphisms (SNPs) (-108C>T, -162A>G and -909G>C) from the promoter region of paraoxonase 1 (PON1) gene on the enzyme activity, in patients with metabolic syndrome (MS). The study group consisted of 61 individuals with MS and the control group of 73 individuals without MS, matched for age and gender. For each individual, clinical and genetic parameters with possible influence on PON1 activities (paraoxonase, arylesterase and lactonase) were measured. PON1 genotyping was performed with PCR-RFLP, using specific primers and restriction enzymes. We found no differences for distribution of PON1 -108C>T, -162A>G and -909G>C polymorphisms, between the two groups (p-NS). The -108C>T and -909G>C polymorphisms were associated with paraoxonase (p=0.03, p=0.006, respectively), arylesterase (p<0.001, p<0.001, respectively) and lactonase (p<0.001, p<0.001, respectively) activities. The -162A>G polymorphism was not associated with paraoxonase (p-NS) or lactonase (p-NS) activities, but influenced the arylesterase activity (p=0.03). PON1 activities were influenced by all three polymorphisms, regardless of the presence of MS.

Current insights into the association of Nestin with tumor angiogenesis.

Tumor angiogenesis is regarded as a hallmark of cancer and provides an important target for therapy. Nestin is an intermediate filament protein (IF) originally recognized as a neural stem cell marker. Development and progression of cancer requires sustained angiogenesis, dependent on the proliferation and migration of endothelial cells which seem to be better portrayed by nestin expression in various malignancies such as central nervous system, gastro-intestinal cancers, malignant melanoma, lung, prostate or breast cancer. The purpose of the present review was to emphasize the insights into nestin expression in relation to tumor angiogenesis in different types of cancer. Current evidence suggests that nestin positivity in tumor cells reflects stem-like properties of those cells. Whether or not expressed in both tumor and endothelial cells, nestin overexpression might reflect the extent of angiogenesis and function as a molecular anti-angiogenic target for cancer.

How many potential drug-drug interactions cause adverse drug reactions in hospitalized patients?

BACKGROUND: Potential drug-drug interactions (DDIs) are frequent in drug prescription but clinically significant are the ones which can result in changes of therapeutic effect of one of the two drugs or in adverse drug reactions (ADRs). The aim of this study was to assess the potential DDIs as well as the DDIs which cause adverse drug reactions (ADRs) in an internal medicine department hospitalized patients. METHODS: The prospective study included all patients admitted between November 2010 and January 2011 in an internal medicine ward. Information on patients' demographics and their medication use history was obtained from each patient by interview. In addition, medical history, medication use during hospitalization, and relevant laboratory and clinical data were obtained from medical records. Potential DDIs were identified using the Thomson Micromedex program. Each patient was monitored during the hospitalization period in order to detect the ADRs resulting from DDI's if present. RESULTS: Three hundred and five patients were enrolled in this study during 3 months. Of 1279 potential DDIs, Fourteen led to 13 ADRs out of which 8 were serious and caused hospital admission or prolongation of hospitalization. There was a statistically significant association between ADRs related to DDIs and the presence of ATC (Anatomical Therapeutic Chemical) C medication during hospitalization and the length of hospital stay, in the multivariate analysis. CONCLUSION: Awareness of the most commonly occurring DDIs should be raised by the utilization of drug-drug interaction guides in the Romanian clinical practice which can help prescribers and pharmacists prevent DDI related ADRs.

The Surveillance of the People with Chronicle Diseases Making the Personal Electronic Folder in Pharmacies for these Patients.

The aim of the project is to create a database in pharmacy, which will include all the medications and treatment schedules of the supervised patients for increase the quality of the health services, identify the possible drug interaction of the chronicle diseases therapy with treatment for acute disease, the possible reaction which could appear during the therapy and avoid the self medication, which could harm results of the therapy instituted by the specialists.