Medic.ro 64

Aceste publicatii sunt dedicate exclusiv cadrelor medicale.

Ultimul numar al revistei este disponibil doar pentru abonati. Te poti abona foarte usor aici.

 

 

Title: Ne ramane speranta

Author: Dr. Maximilian Constantinescu

Introduction: Arta medicala, in cel mai pur sens hipocratic, nu poate fi practicata decat ca profesiune liberala. Medicul, singurul responsabil al actelor sale, trebuie sa fie liber de orice constrangeri pentru a se ocupa de pacient, in interesul pacientului. Dar, din pacate, aceasta idee se opreste aici, la nivel teoretic. In zilele noastre, medicul se loveste de extrem de multe bariere - bineinteles, nedeclarate ca atare. Lovit din toate partile, el a ajuns la momentul in care pacientul trece undeva pe un plan secund. Pe primul plan stau raportarile, bilanturile, contractele, actele, semnaturile etc. In mod aberant si suprarealist, cel ce a terminat Facultatea de Medicina a ajuns sa fie contabil, administrator, statistician, fara ca macar sa isi fi dorit sa studieze academic aceste stiinte.

 

Title: Atentie, reducere de personal in DSP-uri!

Author: Alexandra Parvulescu

Introduction: Nemultumit de activitatea serviciilor deconcentrate ale Ministerului Sanatatii, Cseke Attila pregateste pentru perioada urmatoare reducerea functiilor de conducere, dar si de personal, din fiecare directie de sanatate publica.

 

Title: Dreptul de a te imbolnavi, la mila angajatorului?

Author: Ioana Daian

Introduction: Intrebare-intrebatoare: are vreun patron din Romania interes ca angajatii lui sa stea acasa cand sunt bolnavi? Dupa ce ca nu muncesc, sa mai fie si platiti pentru asta? Ca sa reduca cheltuielile CNAS, Ministerul modifica semnificativ modul de acordare si de plata ale concediilor medicale. Totul in numele „grijii statului fata de adevaratii bolnavi”!

 

Title: Medicul roman, o specie pe cale de disparitie?

Author: Ioana Daian

Introduction: La 20 de ani dupa Revolutie asistam la un adevarat exod al medicilor romani. Se golesc spitalele de medici, desi, paradoxal, acum pot prescrie (cel putin teoretic!) cele mai noi tratamente existente pe plan mondial sau pot face aproape orice operatie care se realizeaza in restul lumii. Din pacate insa, medicina la nivel european este practicata doar de restransul grup de medici ce lucreaza in putinele spitale de top ale Romaniei!

 

Title: Stiinta medicala romaneasca, integrata de mult timp in UE

Author: Ioana Daian

Introduction: Medicii nostri, mai ales cei care lucreaza in spitale sau in institute de cercetare, fac fata cu brio nivelului actual al medicinei europene. Ca o recunoastere a valorii cercetarii medicale romanesti, Federatia Europeana a Academiilor de Medicina a ales anul acesta Bucurestiul ca oras academic european in care sa se desfasoare una dintre cele doua conferinte pe care le organizeaza anual.

 

Title: Noul Contract-Cadru - analiza comparativa

Author: Dr. Andrei Nanu, dr. Antoniu David

Afiliation: Medright Experts

Introduction: Incepand cu acest numar al revistei “Medic.ro”, ne propunem sa realizam o analiza comparativa a prevederilor noului Contract-Cadru privind acordarea asistentei medicale de medicii de familie in cadrul sistemului de asigurari sociale de sanatate pentru anul 2010 fata de cele mentionate in contractul aferent anului 2009.

 

Title: Cat de bine respiri?

Author: Ioana Daian

Introduction: Un studiu arata ca aproape 80% din decesele cauzate de astm ar putea fi evitate printr-o mai buna informare a pacientilor si o mai atenta supraveghere a respectarii tratamentului recomandat de medic. Este motivul pentru care Societatea Romana de Pneumologie demareaza campania „Iti poti controla astmul!”, manifestare inscrisa in seria dedicata anului „2010, Anul Plamanului”.

 

Title: Excel in relatie cu practica medicala

Author: Laurentiu Craciunas

Afiliation: www.contraboli.ro

Introduction: Indiferent de inclinatia spre partea de cercetare sau partea clinica, activitatea medicului de familie presupune organizarea unui numar mare de pacienti si accesul rapid la date statistice.

Title: Comunicarea, prioritara pentru noul presedinte al SRP

Author: Dr. Maximilian Constantinescu

Introduction: Societatea Romana de Pediatrie (SRP) are din acest an un nou presedinte, in persoana prof. dr. Marin Burlea, de la Universitatea de Medicina si Farmacie “Gr. T. Popa” din Iasi.

 

Title: Ghid practice pentru diagnosticul si tratamentul carcinoamelor bronhopulmonare

Author: Conf. dr. Tudor Eliade Ciuleanu, dr. Andrei Ungureanu

Afiliation: Institutul Oncologic „Prof. Dr. Ion Chiricuta” Cluj-Napoca

Rezumat: Cancerul bronhopulmonar reprezinta cea mai frecventa localizare oncologica (peste 200.000 de noi cazuri in 2009 numai in SUA). Descoperirile in cercetarea fundamentala s-au tradus in ameliorarea reala, dar relativ modesta a rezultatelor clinice. Supravietuirea la 5 ani in 2009 a fost de 15%, fata de 8% in 1960. La baza tratamentului cancerului pulmonar stau principiile tratamentului multimodal (chirurgie, radioterapie, chimioterapie, terapie biologica). Pe langa precizarea locului chimioterapiei cu dublete ale platinei, ultimii ani au adus inregistrarea unor noi citostatice (pemetrexed) si a unor molecule tintite in tratamentul cancerului pulmonar (bevacizumab, erlotinib, gefitinib). Anul 2009 ne-a permis identificarea unor principii de individualizare a terapiei. Selectarea terapiei in functie de caracteristicile genetice ale tumorii si de profilul unor markeri moleculari permite administrarea cu probabilitatea maxima de raspuns terapeutic. Devine importanta astfel repozitionarea comunitatii medicale fata de cancerul bronhopulmonar, in functie de noile progrese inregistrate.

Cuvine-cheie: cancer bronhopulmonar, chimioterapie, radioterapie, terapie moleculara tintita

Abstract: Lung cancer represents the most common type of cancer worldwide, with more than 200000 new cases in 2009 in US only. Despite the scientific interest of the oncological community and the research in molecular science there was no spectacular progress in survival rate for more than 50 years. The 5 years OS in 2009 was 15% compared with 8% in 1960. The management of lung cancer is based on a multimodal approach (surgery, radiotherapy, chemotherapy, molecular targeted therapy). Last years lead to the clarification of the role of platinum doublets and brought in new cytotoxic agents (pemetrexed) and targeted agents (bevacizumab, erlotinib, gefitinib). The year 2009 enlightened us with respect to tailoring the therapy. Selecting the patients by their molecular marker profile allows us to apply the treatment with highest possibility of response. It is important thus to reconsider our position to lung cancer taking into account the latest discoveries in this field of research.

Keywords: lung cancer, chemotherapy, radiotherapy, monoclonal antibody, targeted molecular therapy

 

Title: Managementul actual al bolii de reflux gastro-esofagian (II)

Author: Dr. Dan Pitigoi¹, dr. Victor Stoica², dr. Adrian Gosav³, prof. dr. Mircea Diculescu⁴

Afiliation: 1. medic primar gastro-enterologie; 2. medic specialist gastroenterologie; 3. medic rezident gastroenterologie, 4. Institutul de Boli Digestive si Transplant Hepatic Fundeni

Rezumat: Articolul aduce informatii valoroase despre managementul bolii de reflux gastro-esofagian (BRGE), date cuprinse in ghidurile internationale, dar si din experienta clinica personala a autorilor. Noile definitii ale bolii de reflux gastro-esofagian si ale conditiilor clinice asociate sunt prezentate conform Acordului de la Montreal. Recomandarile prezentate sunt considerate cele mai bune metode de diagnostic sub raport cost-eficienta, cu accent pe doze, durata si indicatiile de tratament. Terapia de lunga durata cu inhibitorii pompei de protoni este de cele mai multe ori singura solutie, ceea ce atrage atentia asupra efectelor adverse ale acestui tip de medicatie. Netratata, boala de reflux gastro-esofagian duce la complicatii precum stricturile esofagiene, esofag Barrett sau adenocarcinom. De aceea, diagnosticarea si tratarea timpurie si corecta a BRGE pot preveni complicatii importante esofagiene sau extra-esofagiene.

Cuvinte-cheie: boala de reflux gastro-esofagian, diagnostic, tratament, complicatii

Abstract: This article brings a great amount a valuable data regarding the management of GERD; data derived from international guidelines but also from personal clinical experience. New definitions of GERD and associated clinical conditions are made according to the Montreal global consensus. There are recommendations of best cost-efficient diagnosis methods; with emphasis on doses, duration and indication of treatment. Long term therapy with IPP is sometimes the only solution that’s why we must not forget possible important side effects of this medication. Left untreated GERD has a natural evolution towards complications such as esophageal stricture, Barrett esophagus or adenocarcinoma. Therefore early recongnition of GERD, even by the general practitioner, early and correct treatment might prevent important esophageal or extraesophageal complications.

Keywords: gastro-esofagian reflux disease, diagnosis, treatment, complications

 

Title: Starea sistemului opiaceu in dereglarile neurovegetative la copii

Author: Dr. Gheorghe Railean

Afiliation: Institutul de Cercetari Stiintifice in Domeniul Ocrotirii Sanatatii Mamei si Copilului (director - dr. hab. st. med., prof. universitar Ion Ilciuc), Chisinau, Republica Moldova

Rezumat: Au fost examinate statusul neurovegetativ si starea sistemului opiaceu in ser la 196 de copii cu afectiune perinatala, internati in sectiile de reanimare a nou-nascutului si neuropediatrie a ICSOSM si C. Lotul de baza a fost alcatuit din 132 de copii cu sindrom algic, 54 cu dereglari paroxistice si 10 copii cu dereglari motorii. Lotul martor cuprinde 15 copii conventional sanatosi. Starea sistemului opiaceu la acesti copii, in special β-endorfina, leu-encefalina si substanta P au fost examinate in dinamica in raport cu manifestarile clinice neurovegetative. Studiul starii sistemului opiaceu pune in evidenta incordarea procesului de adaptare la copii cu creierul prealabil afectat, mai evident in perioadele de varsta 7 si 10 ani.

Cuvinte-cheie: neuropeptide, enkefaline, metabolism, patologie neurovegetativa

Abstract: 196 children with perinatal diseases, hospitalized in emergency pediatric department of C. ICSOSM, were examined the neurovegetativ status and opioide system in serum. The main group consist of 132 children with algic syndrome, 54 - with a paroxysm disorder and 10 children with motor disturbances. The control group served 15 children conventional healthy. Opioide state system in these children, in particular β-endorphins, leu-encefalina and substance P, were followed up and exam in relation of age and clinical neurovegetative manifestations. The study of the opioide system put in evidence that children in 7 and 10 years period are easily affected by algic syndrome.

Keywords: neuropeptides, enkephalins, metabolism, neurovegetative pathology

 

Title: Actualitati in diagnosticul si tratamentul herpesului genital

Author: Conf. dr. Victoria  Arama¹, dr. Radulescu Mihaela²

Afiliation: 1. Institutul National de Boli Infectioase „Matei Bals”, UMF „Carol Davila”, Bucuresti 2. Medic rezident de boli infectioase, Institutul National de Boli Infectioase „Matei Bals”, Bucuresti

Rezumat: La nivel mondial, herpesul genital (HG) este o problema importanta de sanatate publica, reprezentand cea mai frecventa boala cu transmitere sexuala si prima cauza de ulceratii genitale. In ultimele decenii, incidenta HG se afla intr-o continua crestere. HG este produs predominant de HSV2 (Herpes Simplex Virus 2), dar, in ultima vreme, a crescut semnificativ implicarea HSV1. Se estimeaza ca 80% dintre pacientii infectati sunt paucisimptomatici, ramanand nediagnosticati si netratati. Se apreciaza ca 70% din contaminari au loc in perioada asimptomatica de boala, ca urmare a excretiei virale asimptomatice, care are loc intermitent, in absenta oricaror semne clinice. Leziunile de HG reprezinta veritabile porti de intrare pentru virusul HIV, fapt care conduce la dublarea riscului de achizitie a infectiei HIV. Herpesul genital poate imbraca forme clinice multiple, deseori atipice, fiind uneori greu de diagnosticat clinic. Primoinfectia este intotdeauna mai zgomotoasa clinic decat recurentele. La pacientii imunodeprimati si la nou-nascutul infectat de la mama, boala poate imbraca forme severe, cu leziuni extinse, ulcerohemoragice si cu determinari viscerale. Deseori, HG are un rasunet important la nivel psiho-social, psiho-sexual si psiho-profesional. In ultimii ani s-au inregistrat progrese importante in diagnosticul de laborator al infectiei HSV, existand teste serologice rapide care diferentiaza HSV1 de HSV2. Cu ajutorul acestor teste se poate confirma diagnosticul chiar in timpul consultatiei. Ghidurile terapeutice recente (CDC si IHMF) subliniaza importanta diagnosticarii si tratarii precoce a HG. La ora actuala exista 3 molecule antivirale recomandate in terapia HG: Aciclocir, Valaciclovir (Valtrex) si Famciclovir. Trialurile clinice au demonstrat superioritatea valaciclovirului din punct de vedere al eficientei clinice si sigurantei. Tratamentul antiviral in HG are urmatoarele efecte benefice: reduce intensitatea si severitatea simptomelor, previne complicatiile, reduce rata recurentelor clinice, previne transmiterea bolii la partener si reduce impactul psihosocial al bolii. In ultimul deceniu, s-a introdus o noua strategie terapeutica foarte eficienta, numita terapie antivirala supresiva, care consta in administrarea zilnica si pe termen lung (ani) a unei doze de valaciclovir sau aciclovir, care va reduce frecventa recurentelor pana la disparitia acestora.

Cuvinte-cheie: herpes genital, HSV, valaciclovir, aciclovir

Abstract: Worldwide, genital herpes (GH) is a major public health problem, as it is the most common STD and the most frequent cause of genital ulcers. In the last decades, the incidence of GH is increasing. HSV2 (Herpes Simplex Virus 2) is the main cause for GH, but in recent decades has significantly increased the involvement of HSV1. It is estimated the 80 percent of infected patients are atypical or asymptomatic and remain undiagnosed and untreated. 70 percent of contaminations occur in asymptomatic periods, as a result of asymptomatic viral excretion, which is intermittent, without any clinical signs. GH lesions are true gateways for HIV, which leads to doubling the risk of HIV infection. GH can take multiple clinical forms, often atypical, sometimes difficult to diagnose clinically. In immunocompromised patients and newborns infected from their mother GH can have severe clinical presentation, with extensive ulcerohemoragic lesions, and visceral determinations. Often GH has an important psycho-social, psycho-sexual and psychoprofessional impact. In the last years has been important progress for laboratory testing of HSV, and there are rapid serologic tests to differentiate HSV1 from HSV2. With these tests the diagnostic can be confirmed during consultation. Recent therapeutic guidelines (CDC and IHMF) accentuate the importance of early diagnostic and treatment for GH: Acyclovir, Valacyclovir (Valtrex) and Famciclovir. Clinical trials have proven valacyclovir superiority in terms of clinical efficiency and safety. Antiviral treatment can suppress the simptoms, prevent complications, reduce the rate of reccurence, prevent transmition to sexual partener and improves psychosocial impact. In the last decade has been introduced a new highly efficient therapeutic strategy, the suppressive treatment, which consists of daily and long term (years) dose of valacyclovir or acyclovir, which reduces frequency of reccurences.

Keywords: genital herpes, HSV, valaciclovir, aciclovir

Title: Infectii cutanate bacteriene superficiale

Author: Elena Severin, George-Sorin Tiplica

Afiliation: Clinica Dermatologie 2, Spitalul Clinic Colentina, Bucuresti

Rezumat: Infectiile cutanate superficiale sunt printre cele mai frecvente cauze de prezentare la medic, in special la copii. Piodermitele superficiale sunt infectii localizate in epiderm, sub stratul cornos, si la nivelul foliculilor pilosi. Majoritatea piodermitelor primare si secundare sunt cauzate de Staphylococcus aureus si de Streptococcus β-hemolitic de grup A. Aceste bacterii pot determina un spectru larg de infectii, de la piodermite superficiale pana la infectii invazive de parti moi, in functie de organismul patogen, localizarea anatomica a infectiei si factori care tin de gazda. Impetigo-ul si foliculitele sunt cele mai frecvente piodermite. Optiunile terapiei antibiotice locale includ acidul fusidic si mupirocina, iar de curand a fost introdus retapamulinul - un nou agent antibiotic topic eficient si bine tolerat in tratarea impetigo-ului, a abraziunilor si plagilor suturate (fara abcese ulterioare) cauzate de S. Aureus (excluzand MRSA) si S. pyogenes. Antibioticele pe cale sistemica se utilizeaza in cazul in care administrarea terapiei topice este inadecvata (multiple infectii, lipsa de raspuns la terapia locala) sau in cazul in care sunt prezente simptome ale unei infectii sistemice. Printre antibioticele orale prescrise frecvent se numara cefalexin, amoxicilina/acid clavulanic si dicloxacilina. Recent a aparut o rezistenta de nivel intermediar a MRSA la vancomicina care ar putea genera in viitor probleme in tratament.

Cuvinte-cheie: piodermite, antibiotice topice, retapamulin

Abstract: Uncomplicated superficial skin infections are among the most frequent reasons for visits to the doctor, particularly in children. Pyodermas are infections in the epidermis, just below the stratum corneum or in hair follicles. The majority of the primary and secondary pyodermas are caused by either S. aureus or group A streptococcus. These bacteria cause a broad clinical spectrum of infection ranging from superficial pyodermas to invasive soft-tissue infections depending on the organism, the anatomic location of infections, and on host factors. The most common forms of pyodermas are impetigo and folliculitis. Among the topical antibiotic used are fusidic acid and mupirocin. Retapamulin is a novel topical antibacterial agent well tolerated and effective for the management of impetigo or infected small lacerations, abrasions or sutured wounds (without subsequent abscess) caused by S. aureus (excluding MRSA) and/or S. pyogenes. Systemic antibacterials are recommended where the use of topical agents is inadequate (individuals with multiple sites of infections or those who do not respond to topical treatment) or if symptoms of systemic infection are present. Commonly prescribed oral antibacterials for the treatment of skin infections are cephalexin, amoxicillin/clavulanic acid and dicloxacilin. Recently, intermediate-level resistance of MRSA to vancomycin has emerged and constitutes a potential further problem in treatment.

Keywords: pyodermas, topical antibiotics, retapamulin

Title: Nev epidermic verucos linear inflamator asociat unui psoriazis vulgar

Author: Daniel Nocivin

Afiliation: medic primar dermatolog, doctor in stiinte medicale, Clinica de Dermatologie, Spitalul Militar Constanta

Rezumat: Prezentam cazul unui copil ce sufera de nev epidermic verucos linear inflamator, de la debutul sau nespecific pana la varsta de 7 ani, cand, din cauza a doua episoade de psoriazis eruptiv, a devenit clinic si histopatologic manifest.

Cuvinte-cheie: nev epidermic verucos linear inflamator, psoriazis, debut nespecific

Abstract: We present the evolution of a child with inflammatory linear verrucous epidermal nevus, from its onset with nonpeculiar clinical aspects, until the age of 7 years when, due to two episodes of eruptive psoriasis, it gets the fully clinical and histo-pathological appearance.

Keywords: inflammatory linear verrucous epidermal nevus, psoriasis, non-peculiar clinical aspects

 

Title: Restructurarea functiei de bariera a pielii cu dermocosmetice avansate

Author: Dr. Mihaela Leventer

Afiliation: medic primar dermatolog, Clinica Dermastyle, Bucuresti

Rezumat: Epidermul joaca un rol activ in mentinerea bunei functionari a pielii. Structura complexa, considerata mult timp inactiva datorita dependentei totale de dermul vascularizat si inervat, epidermul sufera o permanenta transformare si diferentiere celulara de la baza spre suprafata. Pierderea integritatii celulare datorita agresiunilor externe sau a celor din mediul intern, reducerea liantului lipidic intercelular duc la aparitia starii de piele uscata. Caracterizat prin aspect descuamat, fisurat, eritematos, aspru la pipait si intens pruriginos, tegumentul uscat creeaza disconfort puternic pacientilor, indifferent de varsta. Intelegerea structurii si functiei epidermice a ajutat la gasirea unor solutii terapeutice imbunatatite. Astfel, emolientii folositi traditional au fost imbunatatiti prin excluderea emulgatorilor din compozitie si prin adaugarea de substante antiradicali liberi, astfel incat refacerea functiei de bariera a pielii sa fie rapida si eficienta.

Cuvinte-cheie: structura epidermului, functie de bariera, piele uscata, emolienti

Abstract: The epidermis has an active role in maintaining the good functioning of the skin. A complex structure, long time considered inactive due to its total dependence on blood and nerve contents of the dermis, the epidermis is prone to continuous change and cell differentiation from base to surface. The aspect of dry skin is caused by loss of cell integrity due to external or internal aggression and reduced intercellular lipidic glue. The dry skin is squamous, fissured, erythematous, rough and intensely itchy, and is the cause of intense discomfort to patients of all ages. Understanding the structure and function of the epidermis has helped finding better therapeutical solutions. For that matter traditional emollients were improved by the exclusion of emulgators from their contents and the addition of free antiradicals, allowing for a faster and more efficient restoration of the skin function as a barrier.

Keywords: epidermis structure, barrier function, dry skin, emollients

 

Title: Acneea - diagnostic si tratament

Author: Asistent univ. dr. Camelia Diaconu

Afiliation: medic primar medicina interna, doctor in medicina (dermatologie), UMF “Carol Davila”, Spitalul Judetean Ilfov, Bucuresti

Rezumat: Acneea este o afectiune a glandelor pilo-sebacee ale pielii frecventa la adolescenti si adulti tineri, cauzata de interactiunea mai multor factori. Prima anomalie este productia excesiva de sebum datorita hiperplaziei glandelor sebacee. Leziunile apar in zonele corpului cu cea mai mare concentratie de glande sebacee, adica fata, toracele, bratele si zona lombara. Tratamentul se face cu medicamente topice sau sistemice. Pentru formele usoare de acnee se folosesc retinoizi topici, benzoilperoxid, acid azelaic. Antibioticele topice si medicamentele cu actiune bacteriostatica si antiinflamatoare sunt eficiente pentru tratamentul formelor usoare si moderate de acnee.

Cuvinte-cheie: acnee, antibiotice, terapii topice

Abstract: Acne is a disease of the pilo-sebaceous glands of the skin common in adolescents and young adults, caused by the interaction of several factors. The first anomaly is excessive production of sebum glands due to hyperplasia. Injuries occur in body areas with the greatest concentration of sebaceous glands, i.e. face, chest, arms and lumbar area. Treatment is done with topical or systemic medications. For mild forms of acne are used topical retinoids, benzoilperoxid, azelaic acid. Topical antibiotics, bacteriostatic and anti-inflammatory drugs are effective for treatment of mild to moderate acne.

Keywords: acne, antibiotics, topical therapies

 

Title: Tratamentul otitelor externe acute si cronice

Author: Dr. Sebastian Cozma

Afiliation: medic primar ORL Spitalul Clinic de Recuperare Iasi - Compartimentul de Audiologie si Vestibulogie; Sef de Lucrari – Disciplina ORL, Universitatea de Medicina si Farmacie „Gr.T. Popa” Iasi

Rezumat: Otitele reprezinta o patologie foarte des intalnita in practica de cabinet a medicului de familie. Diagnosticul si tratamentul otitelor se face deseori cu dificultate, urechea fiind greu abordabila fara instrumente optice maritoare si fara aparatura de evaluare functionala a auzului, mai ales la copil. Tratamentul otitelor externe este de multe ori unul local, dar se poate asocia si cel general, in functie de diagnosticul etiologic si de gravitatea cazului. Stabilirea protocolului terapeutic se face in general dupa diagnosticul pozitiv si diferential clinic, insa uneori necesita si examene microbiologice. Prognosticul este in general favorabil.

Cuvinte-cheie: otita externa, tratament

Abstract: Otitis is a very common disease in the activity of family practice physician. Diagnosis and treatment of otitis is often difficult, the ear being hardly affordable without magnifying optical instruments and without functional hearing assessment equipment, especially in children. Treatment of external otitis is often a local one, but may be associated with a general one based on etiological diagnosis and on the seriousness of the case. Establishing the therapeutic protocol is generally according to the clinically positive and differential diagnosis, but sometimes requires microbiological examinations. The prognosis is generally favorable.

Keywords: external otitis, treatment

archive