Chronic disease can severely impact an individual’s quality of life, influencing both physical and mental health. Major depressive disorder is one of the most common diagnoses among patients with physical conditions. Cognitive-behavioral therapy is a prominent evidence-based psychological treatment for depression. The objective of the present review is to summarize current research on the efficacy of this intervention in medically ill patients with comorbid depression. First, the relation between chronic disease and depression will be briefly described. Following this introduction, studies examining the efficacy of cognitive and behavioral techniques for reducing depressive symptoms in patients with frequent chronic diseases will be outlined. Subsequently, the effects of the psychological treatment for different patient populations will be analyzed. Finally, a few recommendations for adapting the intervention protocols to various target groups of people with specific characteristics will be provided in order to improve the mental health of patients with chronic medical conditions.
To function more efficiently amid oscillating environmental conditions related to alternating day and night cycles, the circadian clock system developed as an adaptative strategy, serving temporal regulation of internal processes, by anticipating daily recurring changes. At the basis of the circadian clock is a 24-hour oscillation of the expression of clock genes, organized into interconnected self-regulatory transcriptional-translational feedback loops, present throughout the cells of the body, organized into a hierarchical system. Complex combinatorial mechanisms of gene expression regulation at pre-transcriptional, transcriptional, post-transcriptional and post-translational level offer stability and flexibility to the system, responsive to the actual conditions. The core clock genes CLOCK/NPAS2, ARNTL1/ARNTL2, PER1/PER2/PER3 and CRY1/CRY2 encode transcription factors responsible for generating the circadian rhythm in the molecular oscillator machinery, but beyond internal timekeeping, additional functions through gene expression regulation and protein interactions provide them key roles in basic mechanisms like cell cycle control or metabolism, and orchestration of complex physiological or behavioral processes. Elucidation of these intricate regulatory processes, the role of genetic variations as well as clock desynchronization associated with modern lifestyle, promise important medical implications, from a deeper understanding of etiopathology in rare inherited or common adult disorders, to a better management by the application of chronotherapy.
Objective: Pharmaceutical serialization is a process in the pharmaceutical industry that offers a secure solution to track and authenticate drugs in the distribution chain. The unique recognition number for every drug unit helps to identify and combat counterfeit products. This paper aims to highlight the advantages of serialization implementation as an innovative tool to combat globally the counterfeiting drugs phenomenon.
Methods: Worldwide a considerable effort was focused on enhancing medicines identification. Analytical methods, development of the new lab equipment, digital solutions, and blockchain technology are the new directions for the future. Also, legislation needs to be correlated at the international level between the pharmaceutical industry, distribution, and pharmacies.
Results: A good collaboration between responsible entities should be implemented to protect public health and to promote patients’ access to safe medicines. A directive implemented on European Union focused on fake drugs, Global Monitoring and Surveillance System launched by the World Health Organization, or the international campaign “Fight the Fakes” are remarkable examples.
Conclusions: An efficient joint effort between the pharmaceutical industry and law enforcement is required. Counterfeit medicines are a worldwide threat to public health and demand a unitary pharmaceutical serialization system to be implemented as an ideal solution.
Caffeine is a widely consumed substance, as its main intake reasons are its memory and concentration enhancing properties. Beside these well-known effects, there has been put forward a hypothesis that caffeine consumption along with antinociceptive medication can potentiate the analgesic effect of this class of drugs. Our aim was to point out the importance of this particular potentiator effect by selecting and analyzing all papers on this topic written in English from the Medline database, published until the present moment. We observed that caffeine can represent a significant aid for certain patients in matters of pain management, by both reducing the pain killer doses and by increasing life quality.
From its discovery in the 1980s, Polymerase chain reaction was further developed and is nowadays used as the foundation for the various PCR-based techniques used in molecular diagnosis across different species, and numerous types of samples. Real-Time PCR enables the user to monitor the amplification of a deoxyribonucleic acid (DNA) or complementary DNA (cDNA) target during the PCR run, in real-time, and not at the end, as it is the case in conventional PCR. The most frequent types of applications include gene expression analysis, gene silencing, variant analysis, and fusion temperature analysis. Given its vast field of application, a key question remains, and it is related to the controls (negative controls, positive controls, internal exogenous and endogenous controls) and their purpose in a Real-Time PCR experiment. In this paper, we set out to find how and when to use them, and which type of controls are suitable for certain experiment types, since the use of appropriate controls during Real-Time PCR experiments will reduce the effects of variables aside from the independent variable within the sample, therefore yielding accurate results, be it in research or diagnostic purposes.
Ventricular septal defects (VSDs) are the most common type of heart malformation and may occur like a part of a syndrome or as an isolated form. Clinical manifestations are related to the interventricular flow, which is determined by the size of the defect. Aiming at the identification of genetic causes is important in both syndromic and non-syndromic forms of VSD, to estimate the prognosis and choose the optimal management. Other reasons of the identification of genetic factors in the etiopathogenesis include the assessment of the neurodevelopmental delay risk, recurrence in the offspring, and association with extracardiac malformations. The diagnostic process has been improved, and currently, the use of the most suitable and accessible technique in the clinical practice represents a challenge. Additional advantages in genetic testing were brought by next-generation sequencing technique, various testing panels being available in many laboratories.
Chemical peel is a dermato-cosmetic procedure used to destroy and remove, in a controlled manner and under the supervision of the specialists, the degraded parts of the skin, in order to allow acceleration of the skin regeneration process. Based on their depth of skin penetration chemical peels are classified into superficial, medium and deep peels. The substances used in the chemical peels differ from each other depending on the effective action depth. Different peel agents with an appropriate peel depth should be selected based on the problem to be treated, considering also the nature of skin pathology. To achieve the best results other factors, such as skin type and characteristics, region to be treated, safety issues, healing time, and patient adherence, should also be considered. The present review focuses on the particularities of the substances used in various peel types, highlighting recent advances in chemical peel technology and explaining suggested application of certain substances in different peel types.
Patient positioning is a crucial step in neurosurgical interventions This is the responsibility of both the neurosurgeon and the anesthesiologist.
Patient safety, surgeon’s comfort, choosing an optimal trajectory to the lesion, reducing brain tension by facilitating venous drainage, using gravitation to maintain the lesion exposed and dynamic retraction represent general rules for correct positioning. All bony prominences must be protected by silicone padding. The head can be positioned using a horseshoe headrest or three pin skull clamp, following the general principles: avoiding elevating the head above heart more than 30 degrees, avoiding turning the head to one side more than 30 degrees and maintaining 2 to 3 finger breaths between chin and sternum. Serious complications can occur if the patient is not properly positioned so this is why great care must be paid during this step of the surgical act.
Cardiovascular autonomic neuropathy is the most frequent clinical form of autonomous diabetic neuropathy and appears secondary to cardiac autonomous fibre involvement, actively involved in cardiac rhythm impairment. Type 2 diabetes mellitus patients can present cardiac autonomic neuropathy early in the disease. Autonomous nerve function in DM patients should be assessed as early as the diagnosis is set in order to establish the optimal therapeutic strategy. The most frequent cardio-vagal test used is heart rate variability. An abnormal heart rate variability in the presence of orthostatic arterial hypotension indicates a severe cardiac autonomic neuropathy diagnosis. The development of cardiac autonomic neuropathy is subjected to glycaemic control, duration of the disease and associated risk factors. The glycaemic control is extremely important, especially early in the disease. Therefore, a poor glycaemic control carries unfavourable long-term effects, despite an ulterior optimal control, a phenomenon named “hyperglycaemic memory”. In type 2 diabetes mellitus patients, the association of cardiac autonomic neuropathy with intensive glycaemic control increases the mortality rate, due to the fact, that, secondary to autonomous impairment, the patients do not present the typical symptoms associated with hypoglycaemia. Stratifying the cardiac autonomic neuropathy aids the clinician in assessing the morbidity and mortality risk of diabetes mellitus patients, because it is an independent risk factor for mortality, associated with silent myocardial infarctions and the risk of sudden death.
Spleen-derived immune cells are considered to play central role in the progression of ischemic brain damage contributing to both the local and systemic inflammatory response initiated by an ischemic insult in the brain tissue. Brain-spleen communication in acute ischemic brain injury has been studied especially in rodent models of stroke, which mimic the acute focal brain ischemia in humans. Rodent spleens decrease in size after experimentally induced stroke, due mainly by the release of spleen`s immune-cells into the circulation. Splenectomy prior to middle cerebral artery occlusion is protective to the ischemic brain resulting in decreased infarct volume and reduced neuroinflammation. Various therapeutic strategies in clinical use aiming to protect the neural tissue after stroke were found to involve the modulation of splenic activity, altogether indicating that the spleen might be a potential target for therapy in ischemic brain injury. Importantly, the most clinical studies demonstrated that the splenic response in stroke patients is similar to the changes seen in rodent models. Thus, despite the limitations to extrapolate the results of animal experiments to humans, rodent models of stroke represent an important tool for the study and understanding of brain-spleen communication in the pathogenesis of acute brain ischemia.