Overview of the Side-Effects of FDA- and/or EMA-Approved Targeted Therapies for the Treatment of Hematological Malignancies.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadIn the last decade there has been tremendous effort in offering better therapeutic management strategies to patients with hematologic malignancies. These efforts have ranged from biological to clinical approaches and resulted in the rapid development of new approaches. The main "problem" that comes with the high influx of newly approved drugs, which not only influences hematologists that frequently work with these drugs but also affects other healthcare professionals that work with hematologists in patient management, including intensive care unit (ICU) physicians, is they have to keep up within their specialty and, in addition, with the side-effects that can occur when encountering hematology-specific therapies. Nonetheless, there are few people that have an in-depth understanding of a specialty outside theirs. Thus, this manuscript offers an overview of the most common side-effects caused by therapies used in hematology nowadays, or that are currently being investigated in clinical trials, with the purpose to serve as an aid to other specialties. Nevertheless, because of the high amount of information on this subject, each chapter will offer an overview of the side-effects of a drug class with each reference of the section being intended as further reading. Keywords: hematological malignancies; life-threatening side-effects; novel therapies.MDPI A

A narrative review of central nervous system involvement in acute leukemias.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadAcute leukemias (both myeloid and lymphoblastic) are a group of diseases for which each year more successful therapies are implemented. However, in a subset of cases the overall survival (OS) is still exceptionally low due to the infiltration of leukemic cells in the central nervous system (CNS) and the subsequent formation of brain tumors. The CNS involvement is more common in acute lymphocytic leukemia (ALL), than in adult acute myeloid leukemia (AML), although the rates for the second case might be underestimated. The main reasons for CNS invasion are related to the expression of specific adhesion molecules (VLA-4, ICAM-1, VCAM, L-selectin, PECAM-1, CD18, LFA-1, CD58, CD44, CXCL12) by a subpopulation of leukemic cells, called "sticky cells" which have the ability to interact and adhere to endothelial cells. Moreover, the microenvironment becomes hypoxic and together with secretion of VEGF-A by ALL or AML cells the permeability of vasculature in the bone marrow increases, coupled with the disruption of blood brain barrier. There is a single subpopulation of leukemia cells, called leukemia stem cells (LSCs) that is able to resist in the new microenvironment due to its high adaptability. The LCSs enter into the arachnoid, migrate, and intensively proliferate in cerebrospinal fluid (CSF) and consequently infiltrate perivascular spaces and brain parenchyma. Moreover, the CNS is an immune privileged site that also protects leukemic cells from chemotherapy. CD56/NCAM is the most important surface molecule often overexpressed by leukemic stem cells that offers them the ability to infiltrate in the CNS. Although asymptomatic or with unspecific symptoms, CNS leukemia should be assessed in both AML/ALL patients, through a combination of flow cytometry and cytological analysis of CSF. Intrathecal therapy (ITT) is a preventive measure for CNS involvement in AML and ALL, still much research is needed in finding the appropriate target that would dramatically lower CNS involvement in acute leukemia. Keywords: Acute leukemias; central nervous system involvement (CNS involvement); clinical management; pathophysiology.Iuliu Hatieganu University-School of Doctoral Studies (PCD 2019-2021) Romanian Government Ion Chiricuta Oncology Institute Cluj Napoca European Economic Spac

A Brief Insight into the Study of Informal Health Care Payments in Romania

<p>Informal health care payments are a frequently studied topic in Eastern European health care systems, given their impact on the financing of the health care sector. The Romanian health care system is facing the issue of informal payments for a long period. However, little evidence exists regarding the dimension of these payments, or the stakeholders’ attitudes towards them. This article aims at identifying people’s sources of informal payments, as well as their perceptions about the settings where informal payments are offered. Data were collected by means of a telephonic interview. 1,500 individuals who were part of a nationally representative sample were interviewed, out of which, for the present article, a subsample of 647 respondents was extracted. To serve this purpose, a 5-part questionnaire was developed by the research team. The amount of money offered as informal payments varied between 2 and 3,000 Euros. Out of the total sample population, 44.2% believe that in the inpatient surgery care services gifts are offered most frequently, while 55.31% of respondents place inpatient surgery care as being the place where highest amounts of money are given. This may represent a threat for people’s access to this type of services, as well as for the equity of care across different socio-economic categories. As such, policies aimed at addressing informal payments should take into account these particularities.</p

Quit Together: A Smoking Cessation Intervention Using Pregnancy as a Window of Opportunity

Introduction Maternal smoking is one of the most modifiable factors with clear adverse effects for the fetus and the entire family. This study culturally adapted, enhanced, and is currently testing in a randomized controlled trial (RCT) the efficacy of an evidence-based pregnancy and postnatal couple intervention for smoking cessation. Methods Quit Together is an ongoing partnership between US and Romanian research institutions, obstetrics and gynecology clinics in Cluj-Napoca, Romania, and SAMAS, a non-profit organization providing information and support to parents and parents-to-be in Romania. The study builds on the Motivation and Problem Solving (MAPS) approach, a novel strategy successful in preventing smoking relapse postpartum in the US, enhanced by targeting the couples’ smoking behavior and focusing on dyadic efficacy for smoking cessation. The smoking prevention randomized controlled trial intervention begins during pregnancy, includes a postpartum component, and targets pregnant smokers and their partners. The primary outcome is maternal smoking cessation. Results During the intervention formative phase, 15 interviews were conducted with pregnant smokers and ex-smokers and revealed a wide range of partner involvement and support with quitting, ranging from not at all involved to extremely supporting partner. In addition, 155 pregnant smokers (74) and ex-smokers (81) completed a questionnaire detailing their pregnancy history, social support, tobacco smoking, motivation, importance, and confidence related to quitting, emotional health, details about the relationship with the partner, partner smoking status, and partner and couple behaviors related to the pregnancy smoking. The RCT is actively enrolling participants since 2017. Conclusions Quit Together has a large potential for dissemination and adoption into smoking cessation programs that include a quitline. We anticipate strong potential for the future adoption of proactive counseling for couples referred by prenatal health providers, as an extension of the existing quitline in the Romanian universal public health system. Funding Research reported in this publication was supported by the Fogarty International Center and the NIH under Award Number K01 TW009654. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health

State of the European Territory: ESPON contribution to the debate on Cohesion Policy post 2020

Urban DesignSpatial Planning and Strateg