[PPARs: physiological functions and pharmacological roles of agonists in human diseases. Note II]. / PPARs: functii fiziologice si roluri farmacologice ale agonistilor în bolile umane (Nota II).

Increasing attention paid to the main family of peroxisome proliferator activated receptors--PPARs is generated, on one hand by the multiple functions of its members in numerous metabolically active tissues, and on the other hand by the therapeutic benefits expresed by some specific ligands that are used in certain metabolic diseases treatment plan. PPARalpha stimulates the beta-oxidative degradation of fatty acids and controls plasma lipid transport through the mediated action upon the triglycerides and fatty acids metabolism and by modulation of biosynthesis and catabolism of bile acids in the liver. PPARgamma promotes adipocytes differentiation and fat storage. PPARbeta/delta is involved in control and management of adipogenesis. While PPARalpha mediates the hypolipemiant actions of fibrates, PPARgamma is the receptor for thiazolidinediones (glitazones) reccomended in type 2 diabetes treatment; by binding to PPARgamma, glitazones modulates transcription of genes involved in lipid and carbohydrate metabolism.

[PPARs: structure, mechanisms of action and control. Note I]. / PPARS: structura, mecanisme de actiune si de reglare.

PPARs (peroxisome proliferator activated receptors) are proteine receptors that act as transcription factors activated by ligands. There are three known isoforms of PPARs (alpha, beta/delta, gamma) with similar modulated structure, consisting of distinct regions with specific functions. PPARs activate transcription of their target genes by forming cytoplasmatic heterodimers (PPARs:RXR) with his partner RXR (retinoid X receptor), and once translocated into the nucleus bind to specific DNA sequence called PPRE (peroxisome proliferator response elements) and modulate the expression of genes. Each PPAR is differently expressed in various tissues. Modulatory function of PPARs is induced by natural or synthetic ligand binding. Additional activator proteins are recruited to form a complex that coordinates and regulates the expression of many genes. Moreover, nuclear receptors' activity is also regulated by posttranslational changes.

[Causes of functional digestive disorders and therapeutic approach in primary care medicine]. / Cauzele tulburarilor digestive functionale si abordarea terapeutica în practica medicinii primare.

UNLABELLED: Functional diseases of digestive tract are an ubiquitary problem of diagnosis and treatment for ambulatory care services. Its evolution is chronicle but there are no organic lesions for the beginning. Nevertheless, it impairs quality of life and creates many days of incapacity of work. MATERIAL AND METHOD: We studied 1118 cases with digestive malfunctions, selected from the patients consulted on Ambulatory Care Unit--Internal Medicine, 2007-2008. RESULTS: Basal clinical and laboratory explorations classified the type of digestive malfunctions according to international criteria. So we found these types of anomalies: gastro-oesofagial reflux--788 cases; peptic-like syndrome--752 cases; pyloric functional spasm--385 cases; helicobacter pyloridi positive--632 cases; gallblader dysfunction--767 cases; irritable bowel syndrome--872 cases. The treatment was applied pursued the pathological status. Most of cases had un diagnosticated diseases as peptic ulcer, gastritis, gallbladder diseases. CONCLUSIONS: Our conclusions are that the whole tract has continuity and the site of dysfunction is difficult to diagnose from the beginning. Pro-kinetic drugs and inhibitory of gastric secretion have very good results. The same time we must treat the "background"--extra digestive factors (i.e., Helicobacter pylori infection).

[Obesity prevention--is there any limits for primary care medicine]. / Preventia obezitatii--posibilitati si limite in medicina primara.

What does obesity mean? One of the people's health markers is the nutritional steady-state, the mean ponderal equilibrium. The normal weight means the longest life expectancy assuring body weight, from all points of view. The body weight increasing means adipose tissue accumulation and the onset of obesity. Obesity quantification could be made by BMI (body mass index)--normal range 22-24 kg/m2- waist to hip ratio--normal range 0.8-0.9--and abdominal perimeter--normal range up to 80 cm. Why should we do obesity prevention? Because obesity means a high risk factor for cardio-vascular disease, cancer, bone diseases, general mortality. By 10 kg weight loss, real benefits are achieved: left ventricle hypertrophy reduction, decreasing of cardio-vascular risk, pulmonary function improve, reducing of atherosclerotic symptoms by 91%, of arterial pressure by 10-20 mmHg, of diabetes mortality by 30%, cancer by 40% and general mortality by 20%. In our country, 53% of population is overweight and obese, predominantly urban population. Obesity costs are high: about 4-8% of health budget are spent for screening, diagnosis and obesity management, including economical losses. When should we do obesity prevention? Primary care physicians must control all health indexes. If the patient passes over normal ranges of body weight, we should take account and intervene efficiently, by specific and non-specific therapeutic methods. How could we do obesity prevention? General care physicians and specialists could prevent efficiently this disease by taking apart obesity causes and risk factors: genetics, life-style, drug intake, smoking, professional and endocrine factors. Primary and secondary care physicians have to screen high risk persons, to analyze professional, familial and social conditions, to appreciate educational and economical status. All these realize an integral obesity management, together with the psychologist and the sociologist. Secondary prevention means obesity treatment, in order to prevent complications and, in the same time, to maintain normal body weight after ponderal excess loss. Obesity prevention is an important and complex social problem to debate. We have to mobilize political and economical factors, food industry, education. Obesity control means protection against one of the most aggressive health risk factors.