Background: Frailty is a major challenge for the aging population, increasing the risk of falls, disability, hospitalization, and death. It's common with age, and often linked to reduced physical activity and poor diet, especially in those prone to sarcopenia. Gait speed tests are frequently used to assess mobility in older adults. Materials and methods: This six-month study at "Sfântul Luca" Chronic Disease Hospital involved 143 patients over 65 (mean age 72.85 ± 10.07), 113 of whom were women. The Tensiomed Arteriograph measured heart rate, pulse wave velocity, and central aortic blood pressure to assess acute vascular stiffness. Results: As patients aged, their physical circumstances changed: in the age group 75-84 years (“Very elderly”) only 39% of the subjects achieved medium- and good-physical performance, while 56% of them were characterized by low-physical activity (Chi-square test, p <0.001). The mean Mini-Mental State Examination (MMSE) values of individuals with inadequate physical activity were significantly lower (21.02 ± 4.68 points) than those with adequate physical activity (Student t-test, p <0.001). Conclusion: Regular physical activity has been shown to improve hemodynamic factors and potentially slow down arterial aging, thus promoting healthy aging. It is imperative for healthcare professionals to promptly evaluate whether older, frail patients can benefit from rehabilitation, enabling swift recovery through multidisciplinary care.
Preventive medicine plays a crucial role in ensuring the efficiency of healthcare systems, and laboratory investigations represent one of its main pillars. However, achieving an optimal balance between the benefits and costs of testing remains a challenge. Caught between public expectations, appropriate test utilization, and the need for adequate physician training in test ordering, enhancing patients’ understanding and knowledge becomes essential. To explore this aspect, a general online survey was conducted, completed by 321 respondents. The results show that, while respondents generally followed physicians' recommendations, many also sought laboratory testing on their own initiative. Direct access to laboratory services - facilitated by the widespread availability of private laboratories - has become a common practice. This raises concerns about the potential overuse of laboratory testing and underscores the importance of further investigating the factors driving patient self-empowerment. Enhancing shared decision-making between patients and physicians is essential to optimize the benefits of testing, minimize unnecessary costs, and reducing the risk of health-related anxiety.
With recent advances in the understanding of psoriatic disease, it is increasingly considered a systemic inflammatory condition rather than limited to the skin and joints. A variety of biologics are available today for the treatment of psoriasis, but with them, characteristics such as rapidity of onset, long-term efficacy, safety profile, and effects on comorbidities differ. We designed an observational, non-interventional, retrospective study of patients with severe psoriasis receiving biologic treatment with IL-17 inhibitors and aimed to investigate the correlations between etiopathogenic factors and the efficacy and persistence of these therapies in a group of psoriasis patients from Romania. Study results show that patients treated with ixekizumab had better persistence and high adherence compared to those treated with secukinumab. In this study, ixekizumab demonstrated lower risks of non-persistence, discontinuation, and switching and a higher likelihood of high adherence compared with secukinumab. This study contributes to the understanding of the persistence of anti-IL17 biologic therapies in psoriasis and the factors that may influence it.
Psoriasis is a chronic, immune-mediated inflammatory disease that significantly affects a patient’s quality of life. Several systemic complications can influence disease progression and response to treatment. Biological therapy is considered the most effective therapeutic option in treating moderate to severe forms of psoriasis. The success of therapy may depend on its persistence, also known as drug survival. The dermatologist needs to be aware of comorbidities and factors that influence the persistence or discontinuation of biological treatment to make appropriate treatment decisions. We have identified several studies on the persistence of biologic therapy or drug survival in patients with psoriasis and summarized some of the most important issues known to date. In several recently published studies, the survival of ustekinumab is better than TNF‐α inhibitors but lower than ixekizumab. Notably, the studies were performed on a limited number of patients and follow-up time. Moreover, secukinumab appears to have a shorter drug survival than other biological agents, especially in patients with biological experience. A real indicator of therapeutic success could be a high quality of life. Female gender and obesity have been consistently highlighted among the predictors of treatment discontinuation, while psoriatic arthritis could be a predictor of persistence and maintenance of biological therapy. We are currently aiming to improve the therapy for patients treated with biological agents to reduce the pressure on the national public health system.
Psoriasis is a chronic inflammatory disease, with multisystemic implications and genetic predisposition, characterized by the development of erythematous, scaling plaques on the skin. Management of moderate to severe psoriasis vulgaris may involve a biological treatment that suppresses the immune system. Because of this, the patients with psoriasis on an immunosuppressive treatment are theoretically at an increased risk of infections, including SARS-CoV- 2 infection. SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) is responsible for the current pandemic. In Romania, COVID-19 (Coronavirus Disease 19) was first reported on February 26, 2020, by confirming the first patient with SARS-CoV-2 by RT-PCR method. COVID-19 progression was divided into three phases: early infection, pulmonary phase, and hyperinflammatory phase. Although the inhibition of pro-inflammatory cytokines by biologic therapy is detrimental in the viral phase, it seems to be beneficial in the hyperinflammatory phase, by protecting the patients with psoriasis in progressing towards extra-pulmonary manifestations and death. Analyzing the evolution of the 8 cases of patients from our dermatology department – Colentina Clinical Hospital, with generalized psoriasis vulgaris on biologic immunosuppressive treatment and SARS-CoV-2 infection, we observed that they did not develop a more severe form of COVID-19 than the general population. Patients on biologic immunosuppressive treatment are more susceptible to the development of infections, including by SARS-CoV-2, but it was found that the biologic therapy can protect against a more severe type of COVID-19.
Background and aim: Minimally invasive surgery represents the actual tendency in many medical domains including urology. Gaining practical skills for these procedures becomes essential when preparing the future resident physicians in urology. The purpose of this study is to demonstrate that using medical simulation as an education tool improves the practical skills of the urology house officers in laparoscopy by using an accessible tool such as a box trainer. Methods: The study includes the objective and subjective evaluation of the practical skills of 54 students with no experience in laparoscopy. Each participant was evaluated before doing the practical activity on the simulator both in a subjective manner by filling a self-evaluation form and also objectively by timing the duration of doing laparoscopic basic tasks, knot tying and realizing a continuous suture. The participants were divided in two groups (A-28 participants, B-26 participants). Each group executed the same procedures with the same instruments, but with a different teaching technique. Results and conclusions: Medical education with the help of a laparoscopic box trainer simulator is a useful tool for improving practical abilities and the time of execution of general procedures.
