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As the population ages, promoting healthy aging through targeted interventions becomes increasingly crucial. Growing evidence suggests that dietary interventions can significantly impact this process by modulating fundamental molecular pathways. This review focuses on the potential of targeted dietary strategies in promoting healthy aging and the mechanisms by which specific nutrients and dietary patterns influence key pathways involved in cellular repair, inflammation, and metabolic regulation. Caloric restriction, intermittent fasting, the Mediterranean diet, as well as the ketogenic diet showed promising effects on promoting healthy aging, possibly by modulating mTORC1 AMPK, an insulin signaling pathway. By understanding the intricate interplay between diet and molecular pathways, we can develop personalized dietary strategies that not only prevent age-related diseases, but also promote overall health and well-being throughout the aging process. [ABSTRACT FROM AUTHOR]

Introduction: Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) share a bidirectional link, and the innovative antidiabetic molecules GLP-1 Ras and SGLT-2is have proven cardiac and renal benefits, respectively. This study aimed to evaluate CV risk categories, along with lipid-lowering and antidiabetic treatments, in patients with T2DM from a real-life setting in Romania. Material and Methods: A cross-sectional evaluation was conducted on 405 consecutively admitted patients with T2DM in an ambulatory setting, assessing them according to the 2019 ESC/EAS guidelines for moderate, high, and very high CV risk categories. Results: The average age of the group was 58 ± 9.96 years, with 38.5% being female. The mean HbA1C level was 7.2 ± 1.7%. Comorbidities included HBP in 88.1% of patients, with a mean SBP and DBP of 133.2 ± 13.7 mm Hg and 79.9 ± 9 mm Hg, respectively, and obesity in 66.41%, with a mean BMI of 33 ± 6.33 kg/m2. The mean LDL-C levels varied by CV risk category: 90.1 ± 34.22 mg/dL in very high risk, 98.63 ± 33.26 mg/dL in high risk, and 105 ± 37.1 mg/dL in moderate risk. Prescribed treatments included metformin (100%), statins (77.5%), GLP-1 Ras (29.4%), and SGLT-2is (29.4%). Conclusions: In Romania, patients with T2DM often achieve glycemic control targets but fail to meet composite targets that include glycemic, BP, and lipid control. Additionally, few patients benefit from innovative glucose-lowering therapies with proven cardio-renal benefits or from statins. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is the most frequently found primary malignancy of the liver, showing an accelerated upward trend over the past few years and exhibiting an increasing relationship with metabolic syndrome, obesity, dyslipidemia and type 2 diabetes mellitus. The connection between these risk factors and the occurrence of HCC is represented by the occurrence of non-alcoholic fatty liver disease (NAFLD) which later, based on genetic predisposition and various triggers (including the presence of chronic inflammation and changes in the intestinal microbiome), may evolve into HCC. HCC in many cases is diagnosed at an advanced stage and can be an incidental finding. We present such a scenario in the case of a 41-year-old male patient who had mild obesity and mixed dyslipidemia, no family or personal records of digestive pathologies and who recently developed a history of progressive fatigue, dyspepsia and mild upper abdominal discomfort initially thought to be linked to post-COVID syndrome, as the patient had COVID-19 pneumonia a month prior. The abdominal ultrasound revealed a mild hepatomegaly with bright liver aspect of the right lobe (diffuse steatosis), a large zone of focal steatosis (segments IV, III and II) and a left lobe tumoral mass, highly suggestive of malignancy. Point shear wave elastography at the right lobe ruled out an end-stage chronic liver disease. Additional laboratory investigations, imaging studies (magnetic resonance imaging) and histopathological examination of liver fragments confirmed a highly aggressive HCC, with poorly differentiation-G3, (T4, N 1M 0) and stage IVA, associated with nonalcoholic steatohepatitis (NASH). A sorafenib course of treatment was attempted, but the patient discontinued it due to severe side effects. The subsequent evolution was extremely unfavorable, with rapid degradation, a few episodes of upper digestive bleeding, hepatic insufficiency and mortality in a couple of months. Conclusions: Diagnosis of NASH-related HCC is either an accidental finding or is diagnosed at an advanced stage. In order to earn time for a proper treatment, it becomes important to diagnose it at an early stage, for which regular check-ups should be performed in groups having the risk factors related to it. Patients suffering from obesity and mixed dyslipidemia should undergo periodic abdominal ultrasound examinations. This should be emphasized even more in the cases showing NASH. Complaints of any kind post-COVID-19 should be dealt with keenly as little is yet known about its virulence and its long-term side effects. [ABSTRACT FROM AUTHOR]

Idiopathic recurrent pericarditis (IRP) can be the hallmark of an autoinflammatory syndrome with recurrent attacks of chest pain and symptom-free intervals following an acute episode. The recurrence rate may be 35% in the pediatric population, frequently with less severe manifestations than at the first episode. Pericarditis can be the sole clinical manifestation or may be part of a systemic autoinflammatory disease (SAID), especially in the case of a recurrence. Familial Mediterranean Fever (FMF), Tumor Necrosis Factor Receptor-Associated Periodic Syndrome (TRAPS), Mevalonate-Kinase Deficiency (MKD), nucleotide-binding oligomerization domain 2 (NOD2)-associated autoinflammatory syndrome, and others are closely related to IRP based on similar clinical manifestations and treatment responses to anti-interleukin 1 (IL-1) agents, such as anakinra, and should therefore be excluded in patients with IRP. A newly described SAID, an autosomal dominant disorder known as NLRP12-AID (nucleotide-binding leucine-rich repeat-containing receptor 12-related autoinflammatory disease) is caused by heterozygous mutations in the NLRP12 gene and most commonly affects children. Fewer than 40 pediatric patients with NLRP12-AID have been described in the medical literature, with none presenting with RP. We report a case of relapsing pericarditis responsive to anti-IL-1 therapy in a male adolescent who carried a missense mutation in the NLRP12 gene potentially causative of the excessive activation of inflammatory pathways. This is a unique case in the medical literature that associates recurrent pericarditis in an adolescent presumed to be related to the missense mutation in the NLRP12 gene. The role of the NLRP12 inflammasome in generating and maintaining recurrent pericardial inflammation should be considered. [ABSTRACT FROM AUTHOR]

Background: Social prescribing initiatives are tailored coaching programs created to assist participants in improving their personal circumstances and might constitute a creative way to enhance public and preventive health as we work toward providing universal financially sustainable healthcare. Methods: We conducted a scoping review with the aim of summarizing the main global trends on social prescribing and to identify the existing resources and potential targets of social prescribing in Romania. Results: One of the main concerns that arose from this review is the lack of defined pathways to access social programs and the lack of link workers, recognized as a valuable form of support in directing people toward the most appropriate intervention, necessary to increase long-term sustainability. We also acknowledge the importance of primary care in social prescribing, especially in prevention. The level of awareness and the capacity of primary care providers to identify the need for social prescription to increase the awareness of resources and encourage teamwork should be increased. Conclusions: By focusing on these areas, we can enhance the health and well-being of the population and fully realize the benefits of social prescribing in Romania. Further research and collaboration on social prescribing are crucial for optimizing its impact in Romania. [ABSTRACT FROM AUTHOR]

Asthma is the most common chronic noncommunicable disease, having a complex determinism. Early exposure to various environmental factors such as caesarean delivery, use of antibiotics during the neonatal period and formula fed in the first months of life are all associated with an increase in the prevalence of asthma. Also, the intestinal and lung microbiota can have an impact on the association with asthma through changes in the immunomodulatory cells, in the composition of microbiota, but also through changes in the metabolites of the intestinal microflora. The gut microbiome also impacts systemic immunity. There is also evidence which suggests that changes in gut microbiota may play a role in obesityrelated asthma. [ABSTRACT FROM AUTHOR]

The incidence of colorectal cancer is increasing. It is currently the third most common cancer, after lung and breast cancer. Despite the increased incidence, recent advances in early detection, performing the screening according to the recommendations and treatment options have reduced colorectal cancer mortality. The role of the family doctor is to advise and to identify non-modifiable risk factors (age, male sex, race, family history, inflammatory bowel disease) as well as modifiable ones (tobacco consumption, low-fiber, high-fat and highcarbohydrate diet, a sedentary lifestyle, obesity), in order to avoid these risk factors by developing a personalized plan for the prevention and early detection of colorectal cancer depending on the individual risk. Genetic testing and a more comprehensive family history documentation by the family doctor can enable those with a hereditary predisposition for the colorectal cancer to take preventive measures. Applying evidence-based prevention strategies reduces the prognosis of colorectal cancer and reduces mortality. Colorectal cancer has an increased survival rate if diagnosed early and treated properly. [ABSTRACT FROM AUTHOR]

Pregnancy and delivery do not generally increase the risk of SARS-CoV-2 infection, but do appear to favor the evolution to severe forms. The family doctor has an important role in identifying the risk factors for a severe evolution and the careful monitoring of these cases. It is recommended that the history of the patient, a clinical examination and specific investigations have a role in a differential diagnosis of severe forms of SARS-CoV-2 infection in pregnant women with preeclampsia/eclampsia. It is recommended to advise the pregnant woman on the potential risk for the newborn to develop a SARS-CoV-2 infection, as well as suggest postnatal monitoring of the mother and the newborn. [ABSTRACT FROM AUTHOR]

One year after the World Health Organization declared the global pandemic of SARS-CoV-2 (March 2020), growing scientific evidence worldwide suggests that a small percentage of people who have developed COVID-19 and healed after the initial infection may experience a series of persistent symptoms over a period of more than 12 weeks, such as marked fatigue, shortness of breath, confusion, diarrhea, or other symptoms that cannot be explained by an alternative diagnosis. This status has been called “long COVID syndrome” or ”post COVID syndrome”. [ABSTRACT FROM AUTHOR]

Coarctation of the aorta is a relatively frequent congenital heart disease. Depending on the severity of the coarctation and the possible existence of other congenital heart defects, the symptoms may vary. In the neonatal period, the patients may have signs of heart failure, hypoperfusion or even shock. Coarctation of the aorta can be diagnosed incidentally in adolescence or adulthood, usually presented with mild symptoms. The patient’s anatomy, size, age, and clinical course are taken into consideration when choosing the appropriate treatment. Although associated morbidity and mortality risks regarding surgical or interventional treatment are relatively low, it is neccesary to estabilsh a long term follow-up, given the possible post-surgical complications that may occur: re-coarctation, aortic aneurysm, aortic dissection and hypertension. Long term prognosis of these patients mostly depends on the presence of systemic hypertension with its consequences leading to premature cardiovascular events. Another factor is the severity of associated defects: aortic stenosis, mitral valve abnormalities. The purpose of this review is to describe the main treatment methods, indications for intervention and possible complications of the surgical and interventional treatment. [ABSTRACT FROM AUTHOR]

During pregnancy, anatomical and functional changes occur in all organs and systems of the body. The family doctor evaluates the morphofunctional changes in the liver and bile ducts throughout the pregnancy. These morphological and functional changes have often no clinical expression. Morphofunctional changes in the liver and bile ducts cause changes in laboratory tests results. The family doctor has an important role in assessing the pregnant woman and in diagnosing liver and bile ducts pathology early. It is necessary to identify and monitor the risk factors for liver damage: acute fatty liver during pregnancy, intrahepatic cholestasis, cholelithiasis, hepatitis A, B, C, E. The active monitoring for the assessment of suspected hepatobiliary disease involves the medical history and a systematic clinical examination, as well as diagnostic testing to exclude other causes. [ABSTRACT FROM AUTHOR]

After the acute period of the infection with SARS-CoV-2, new symptoms may appear. Alternatively, those present might persist. Medium-term symptoms and complications of COVID-19 infection have been reported to persist in several organs such as the heart, lungs, liver, kidneys, and brain. Subsequent monitoring varies from one week to three months, depending on the symptoms and risk factors present. During the initial follow-up assessment, a comprehensive history of the patient's COVID-19 disease, including disease history, duration and severity of symptoms, types and severity of complications has to be obtained. The need for laboratory tests is determined by the severity of the disease, previous results during their illness and current symptoms. [ABSTRACT FROM AUTHOR]

During pregnancy, anatomical and functional changes occur in all organs and systems of the body. The family doctor evaluates the morphofunctional changes in the reno-urinary system throughout the pregnancy. These morphological and functional changes often have no clinical expression. Morphofunctional changes in the reno-urinary system cause changes in laboratory tests results and are the basis for the appearance of urinary tract symptoms. The family doctor has an important role in assessing the pregnant woman, and in diagnosing renal pathology early. Although the pregnant woman has an increased risk of developing various urinary tract diseases, frequently, under active monitoring and conservative treatment, the evolution can be favorable. [ABSTRACT FROM AUTHOR]

Headache is one of the most frequent symptoms for which patients seek medical attention from their family physicians. Typologies are different in children, compared to adults. Ethiologies and clinical features are diverse, accompanied, on occasion, by EEG changes. Against this background, it is the purpose of this article to give a rundown of the most recent research in primary and secondary headache with focus on a recently recognised clinical entity where headache and epilepsy intersect, namely epileptic cephalalgia. The result is meant both as a diagnostic and therapeutic tool for the use of family physicians and as an 'uptodate' on the latest headache research its applications. [ABSTRACT FROM AUTHOR]

Obesity represents a risk factor concerning the severity and frequency of asthma attacks. A number of obesity-related factors contribute to the increased risk and severity of asthma. The relationship between obesity and asthma derives from a complex interaction of biological, physiological and environmental factors. Some of these factors are causes for increased the severity of SARS-CoV-2 infection forms. Encouraging weight loss strategies, through a change in lifestyle, a balanced diet, as well as combating a sedentary lifestyle, is an essential stage of asthma management within the family doctor's field. Further studies are needed to further develop the strategy regarding the comorbidity of obesity – asthm – -SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

High blood pressure (hypertension) can be one of the most important causes of morbidity or mortality, both maternal and fetal. Monitoring the values of blood pressure during pregnancy and the impact on the health of the pregnant woman and the evolution of the pregnancy by the general practitioner is one of the main prophylactic measures. Surveillance of the pregnant woman, even from the first month of pregnancy, and the identification of risk factors for hypertension are the basis of a diagnosis and early therapeutic intervention, in order to prevent complications. The guidelines also address the intervention and postpartum counseling of these pregnant women on the risk of developing other cardiovascular complications over time, as well as the risk that the next pregnancy will have pregnancy-induced hypertension. The general practitioner, through these interventions, is an important link in the multidisciplinary monitoring team of pregnant women at risk for pregnancy-induced hypertension. [ABSTRACT FROM AUTHOR]

Aging is characterized by progressive and broadly predictable changes that are associated with increased susceptibility to many diseases. The process of prescribing medication is complex and includes: deciding whether a drug is indicated, choosing the best drug, determining a dose and an appropriate schedule for the patient's physiologic status, monitoring the effectiveness and toxicity, educating the patient about expected side effects, and indications for seeking consultation. More than half of adults over the age of 65 consulted in primary care use at least 5 medications. The risk of drug interactions and side effects is increased by augmenting the number of drugs used, as well as pharmacokinetic and pharmacodynamic changes. Applying the Beers criteria to elderly patients decreases the risk of drug interactions and side effects. [ABSTRACT FROM AUTHOR]

The first cases of the new coronavirus SARS-CoV-2 were reported for the first time in people in Wuhan, China in December last year. The infection with the SARS-CoV-2 virus spread quickly in China, followed by outspread in other countries. It was declared a pandemic in March 2020. SARS-CoV-2 causes the disease COVID-19, an acute severe respiratory syndrome. Infections were reported in children of all ages, from newborn to adolescence, with a smaller incidence than in adults, and having a better prognostic than in adults. A particular evolutionary feature of the SARS-CoV-2 infection in children is Paediatric Inflammatory Multisystem Syndrome (PIMS), a rare but severe disease which is associated with COVID-19 and which has been reported to have been diagnosed in children from Europe and North America. Paediatric Inflammatory Multisystem Syndrome has similar characteristics to those of the Kawasaki disease and concomitant infection of SARS-CoV-2. A small percentage of children who have been diagnosed with severe acute respiratory syndrome determined by SARS-CoV-2 require hospitalisation and very few require care in the intensive care unit. The prevention of COVID-19 focuses on hand hygiene, wearing face masks in enclosed spaces and social distancing. [ABSTRACT FROM AUTHOR]

Atopic dermatitis is a chronic inflammatory skin disease associated with pruritus that occurs most frecquently in children. A family history of atopy (eczema, asthma, or allergic rhinitis) and skin barrier abnormalities genetically determined are major risk factors for atopic dermatitis. The diagnosis of atopic dermatitis is clinical, based upon the history, onset, and morphology of skin lesions. The goals of treatment are to reduce symptoms, prevent exacerbations, to improve the quality of life and minimize therapeutic risks. The optimal management is based on the severity of the disease and involves the elimination of exacerbating factors, restoration of the skin barrier function, pharmacologic treatment of skin inflammation (topic and systemic agents), and patient education. [ABSTRACT FROM AUTHOR]

COVID-19 has been a continuing challenge for the entire medical world since SARS-CoV-2 spread rapidly around the globe from the Wuhan region of China. One of the multiple reasons for concern was the one related to the pregnant woman, the influence on the pregnancy, the fetal transmission, the possible teratogenic effects, the evolution of the newborn from the infected mother, the presence of the virus in breast milk. The data from the literature are still controversial, being necessary larger study because the final conclusions are still far from over. [ABSTRACT FROM AUTHOR]

Sleep apnea syndrome (SAS) in children is different from that in adult. The evaluation of SAS is initiated by the familiy doctor in primary care and consists in medical history, through clinical examination and SAS questionnaire. Polysomnography is the gold standard for diagnosis and follow-up. The neglected SAS could result in failure to thrive. The treatment consists in tonsillectomy/adenoidectomy or more complex surgery for macroglosia or micrognathia. [ABSTRACT FROM AUTHOR]

Too short or too long sleep duration increases the risk of developing cardiovascular events, hypertension, stroke and cardiovascular mortality. These findings have been confirmed by recent studies and a sleep duration of 7-8 hours a day for adults is now an important component of a healthy lifestyle. Healthy diet, avoiding excess alcohol, tobacco, caffeine or other stimulants, practicing exercise and cognitive-behavioral therapy are essential to ensuring proper sleep and helping to reduce cardiovascular risk together with other non-pharmacological measures outlined in current guides. [ABSTRACT FROM AUTHOR]

Alcoholism is a common condition and frequently clinicians are forced to confront its complications in general hospital settings. There are an estimated 3 million alcohol-dependent people in Romania alone, from which a significant number suffers episodes of withdrawal severe enough to require pharmacologic treatment. Alcohol withdrawal syndrome is a clinical diagnosis, with symptoms that range from minor (anxiety/palpitations) to severe (delirium tremens/hallucinations). Benzodiazepines have the best evidence in treating this disease. A symptom-triggered therapy approach is favored using a validated tool, such as CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised), for shorter periods of hospitalization and for using lower doses of sedatives. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a systemic inflammatory disorder that manifests predominantly in the synovial joint, where it causes a chronic inflammatory process, leading to early osteoarticular destructions. These destructions are progressive and irreversible, generating a significant functional deficiency. During the last years, the diagnostic approach of RA has focused on early arthritis. Early arthritis can develop into established RA or another established arthropathy, like systemic lupus erythematosus or psoriatic arthritis. It can have a spontaneous resolution or may remain undifferentiated for indefinite periods of time. The management of early arthritis has changed considerably in the past few years, under the influence of new concepts of diagnosis and new effective therapies. The treatment goal of early arthritis should now be the clinical remission and prevention of joint destruction. Methotrexate is the first line of therapy, used to treat early arthralgia and to reverse or limit impending exacerbation to RA. Biological treatment is used as a second line therapy in patients with severe disease who do not respond or have a contraindication to disease-modifying antirheumatic drugs (DMARDs). Patients with early arthritis should usually be identified and directed to rheumatologists to confirm the presence of arthritis, and to establish the correct diagnosis plus to initiate the proper treatment strategies. [ABSTRACT FROM AUTHOR]

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Immunization is one of the most effective preventive health measures. The number of cases of most vaccine- preventable illnesses declined by more than 90 percent after routine childhood immunizations were introduced. Vaccination programs directly benefit the immunized child. They also indirectly benefit unimmunized persons through community immunity. Community immunity occurs when the portion of the population that is immune to the infection is large enough to decrease the risk of transmission. Community immunity protects children who are too young for immunization and persons with contraindications to vaccines.Children who are behind on vaccines should be caught up using the minimum age for first dose and the minimum intervals between doses. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease is comprised of two major disorders: ulcerative colitis and Crohn disease. Among intestinal infl ammatory diseases, there must be made a difference between extra intestinal manifestations and the complications of the disease or treatment. Anemia represents one of the most frequent extraintestinal manifestations in inflammatory bowel disease. The etiology of anemia in patients with inflammatory bowel disease can be multifactorial, often involving a combination of iron deficiency , anemia of chronic disease, vitamin B12 deficiency, folic acid deficiency, drugs or hemolysis. Patients with iron deficiency may not always manifest with signs and symptoms; so, hemoglobin levels in patients with inflammatory bowel disease must be regularly monitored for earlier detection of anemia. [ABSTRACT FROM AUTHOR]

Menopause is characterized by many huge changes in the quality of women's life. Hormonal changes, accompanied by numerous symptoms cause changes in body composition and increasing the body mass index (BMI). Decreased estrogen levels cause increased visceral adipose tissue, lean mass loss, bone mineral density loss, decreased protein. In the early postmenopausal years, women who do not take estrogen therapy typically gain fat mass and lose lean mass. All these effects on body composition are major risk factors for hypertension, cardiovascular diseases, diabetes, dyslipidemia, psychiatric disorders (depression, dementia), osteoarthritis, osteoporosis. Abdominal obesity influences blood pressure by increasing insulin resistance, impaired glucose tolerance, increasing insulinemia, which causes increased adrenergic activity, producing vasoconstriction. Increased BMI in postmenopausal women is associated with increased risk of breast, endometrial and ovarian cancer. [ABSTRACT FROM AUTHOR]

Cardiovascular disease in patients with chronic renal disease (CKD) is commonly found in primary care. It is important to recognize chronic kidney disease, defined as abnormalities of kidney function or structure (markers of renal impairment) or eGFR of less than 60 ml / min / 1.73 m2, presented for more than 3 months. Chronic kidney disease has an estimated prevalence of 8-11% worldwide. After the age of 40 years, there may be a physiological progressive reduction in eRFG (glomerular filtration rate) of 1 ml / min / year. Chronic kidney disease is an independent cardiovascular risk factor; low glomerular filtration rate (eGFR) is associated with increased mortality, multiple cardiovascular events and multiple hospitalizations. Cardiovascular risk assessment in patients should take into account the degree of renal function. Evaluation of renal function is based on eRFG and albuminuria or creatinine / albumin ratio. On the other hand, chronic kidney disease increases the risk of fatal and non-fatal cardiovascular events. Trying to identify and to control modifiable risk factors has beneficial effects on maintaining renal function and slowing down progression. The choice of medication and therapy should be made in accordance with the degree of impairment of renal function. General measures (smoking cessation, limitation of salt intake, aerobic exercise), good control of high blood pressure, optimal glycemic control, lipid lowering therapies, antiplatelet agents help to reduce the risk of cardiovascular events and at the same time, delay progression of function kidney˝ [ABSTRACT FROM AUTHOR]

Vitamin D is required to maintain normal blood levels of calcium and phosphate, which are in turn needed for the normal mineralization of bone, also play a role in muscle function, nerve conduction, the immune system and general cellular function in all cells of the body. Populations at risk for vitamin D deficiency are infants, adolescents, eldery, pregnant and lactating women. The actions of the vitamin D hormone 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) are mediated by the vitamin D receptor (VDR), a ligand-activated transcription factor that functions to control gene expression. Epidemiological data underline a strong correlation between vitamin D deficiency and higher risk for chronic inflammatory illnesses or autoimmune diseases. Evidence is not sufficiently to draw conclusions regarding the benefits of vitamin D supplementation for the prevention of cancer. Literature increasingly supports the inverse relationship of vitamin D level and diabetes, metabolic syndrome, cardiovascular disease mortality. [ABSTRACT FROM AUTHOR]