THE RE-ENGINEERING OF MANAGERIAL PROCESS IN PUBLIC ADMINISTRATION

The base of this research was a comparative analyse of the international practices in the field, in order to identify the most important tendencies in public services management. Considering the results of this research, there were identified the foundamental principles of an intelligent management model for public management (subsidiarity, public value and deliberative governance). Starting from this point, we proposed a new intelligent management model applicable in romanian public sector, which can be structured into three major components: top management component (executive and deliberative), operational management component (back office) and communication component (front level). As a case study, we focused in particullary on the water supply public service and we developed a methodology for projecting the front-office component starting from the necessity of optimising stakeholder satisfaction.public management, intelligent services, intelligent public organizations, top management, back and front office

Underactive bladder - an underestimated entity

Introduction. The concept of underactive bladder is relatively new. Currently there is no generally accepted definition of this pathology. Diagnosis depends on urodynamic findings, and symptoms are usually rare and intricated with the symptoms of other urinary pathology. Matherials and methods. This review examines the current literature on underactive bladder regarding pathology, definition, diagnosis, current guidelines, and any further potential medical developments. Conclusions. Underactive bladder is a poorly understood pathologic condition. Only since 2002 has there been any consensus regarding the definition. The diagnosis relies only on urodynamics; clinical diagnosis is a challenge even for a consultant; and treatment does not seem to alleviate much of the suffering. This disease remains underrecognized and undertreated. More research is needed to identify less invasive diagnosis tools and treatment for this pathology

Underactive bladder - an underestimated entity

Introduction. The concept of underactive bladder is relatively new. Currently there is no generally accepted definition of this pathology. Diagnosis depends on urodynamic findings, and symptoms are usually rare and intricated with the symptoms of other urinary pathology. Matherials and methods. This review examines the current literature on underactive bladder regarding pathology, definition, diagnosis, current guidelines, and any further potential medical developments. Conclusions. Underactive bladder is a poorly understood pathologic condition. Only since 2002 has there been any consensus regarding the definition. The diagnosis relies only on urodynamics; clinical diagnosis is a challenge even for a consultant; and treatment does not seem to alleviate much of the suffering. This disease remains underrecognized and undertreated. More research is needed to identify less invasive diagnosis tools and treatment for this pathology

Hematologic manifestations in celiac disease : a practical review

Celiac disease (CD) is a systemic autoimmune disease driven by gluten-ingestion in genetically predisposed individuals. Although it primarily affects the small bowel, CD can also involve other organs and manifest as an extraintestinal disease. Among the extraintestinal features of CD, hematologic ones are rather frequent and consist of anemia, thrombocytosis (thrombocytopenia also, but rare), thrombotic or hemorrhagic events, IgA deficiency, hyposplenism, and lymphoma. These hematologic alterations can be the sole manifestation of the disease and should prompt for CD testing in a suggestive clinical scenario. Recognition of these atypical, extraintestinal presentations, including hematologic ones, could represent a great opportunity to increase the diagnostic rate of CD, which is currently one of the most underdiagnosed chronic digestive disorders worldwide. In this review, we summarize recent evidence regarding the hematological manifestations of CD, with focus on practical recommendations for clinicians

Clinical and paraclinical neurological manifestations for perinatal asphyxia

Spitalul Judeţean de Urgenţă Bacău, Secţia NeonatologieIntroducere: Asfixia perinatală este o afecţiune încă des întâlnită în practica curentă. Cele mai greu de evaluat şi de tratat manifestări sunt cele neurologice, impactul suferinţei neurologice pe termen lung fiind unul cu multiple implicaţii atât pentru pacient cât şi pentru cei incluşi în asistenţă la naştere. Material şi metodă: Am efectuat un studiu retrospectiv pe 65 de nou-născuţi în perioada 1.01.2015 - 1.01.2016. Parametrii evaluaţi au fost: vârsta de gestaţie, tipul naşterii, greutatea la naştere, scorul Apgar, pH la naştere şi în dinamică, ecografia transfontanelară, glicemia, probele hepatice şi renale, culturi. Rezultate: În perioada analizată au fost un număr de 65 de nou-născuţi cu diagnosticul de asfixie din care doar 12 cu asfixie severă, care cuprinde toate criteriile pentru această patologie (ph<7, Apgar la 1 min=3 care se menţine şi ulterior, modificări neurologice şi ale altor organe). Restul au fost hipoxii perinatale sau, după vechea nomenclatură, asfixii uşoare şi medii. S-a constatat că şi formele mai uşoare sau hipoxiile s-au însoţit de manifestări neurologice care se menţin pe parcursul internării: tonus 80% modificat, reflexe diminuate (73,8%) însoţite şi de modificări ale ETF (15,38% prezintă hemoragii intraventriculare; 4,65% ulterior leucomalacie; 7,69% edem cerebral, alte manifestări, de tipul dilataţiilor ventriculare: 7,6%). Nou-născuţii cu asfixie severă prezintă semnele de suferinţă cele mai importante cu decerebrare - 2 cazuri (3%), convulsii generalizate tonico-clonice - 4 cazuri (6,1%) şi tulburări de tonus şi reflexe. Concluzii: Asfixia severă dă cel mai adesea complicaţii neurologice severe, dar aceste complicaţii neurologice moderate au fost întâlnite şi în formele de hipoxie perinatală.Introduction: Perinatal asphyxia is a common disorder still occurring in current practice. The neurological manifestations are the most difficult to be assessed and treat; the impact of long-term neurological distress has multiple implications both for the patient and for those involved in the assistance at the birth process. Material and methods: We undertook a retrospective survey on 65 newborn infants during 2015 and January, 1st, 2016. The features assessed during the survey involved: gestational age, type of birth, birth weight, Apgar score, pH at birth and in dynamics, cranial ultrasound, glucose levels, hepatic and renal samples, and cultures. Results: During the analyzed period there were 65 newborn infants diagnosed with asphyxia, but only 12 of them with severe asphyxia and showing all the criteria for severe asphyxia (ph<7, Apgar at 1 minute = 3 that is constant, neurological changes). The rest of them were perinatal hypoxias or according to the old terminology mild and moderate asphyxia. It was found that even the milder forms or the hypoxias were accompanied by neurological manifestations that remained constant over the hospitalization period: the tonus 80% modified, diminished reflexes (73.8%) also accompanied by changes of cranial ultrasound (15.38% showing intraventricular hemorrhages; 4.65% further leukomalacia; 7.69% cerebral edema, other manifestations - ventricular dilatations: 7.6%). Neonates diagnosed with severe asphyxia show the most important disorder signs with decerebration - 2 cases (3%), generalized tonic-clonic convulsions: - 4 cases (6.1%), and tonus and reflex disorders. Conclusions: Severe asphyxia most frequently generates severe neurological complications, but these moderate neurological complications were also encountered in the forms of perinatal hypoxia

Antidepressant Flavonoids and Their Relationship with Oxidative Stress

Depression is a serious disorder that affects hundreds of millions of people around the world and causes poor quality of life, problem behaviors, and limitations in activities of daily living. Therefore, the search for new therapeutic options is of high interest and growth. Research on the relationship between depression and oxidative stress has shown important biochemical aspects in the development of this disease. Flavonoids are a class of natural products that exhibit several pharmacological properties, including antidepressant-like activity, and affects various physiological and biochemical functions in the body. Studies show the clinical potential of antioxidant flavonoids in treating depressive disorders and strongly suggest that these natural products are interesting prototype compounds in the study of new antidepressant drugs. So, this review will summarize the chemical and pharmacological perspectives related to the discovery of flavonoids with antidepressant activity. The mechanisms of action of these compounds are also discussed, including their actions on oxidative stress relating to depression

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Impact of Safety-Related Dose Reductions or Discontinuations on Sustained Virologic Response in HCV-Infected Patients: Results from the GUARD-C Cohort.

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced ≥1 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with ≥1 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not ≥5. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin.This study was sponsored by F. Hoffmann-La Roche Ltd, Basel, Switzerland. Support for third-party writing assistance for this manuscript, furnished by Blair Jarvis MSc, ELS, of Health Interactions, was provided by F. Hoffmann-La Roche Ltd, Basel, Switzerland

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

Background: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. Methods: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. Results: SVR24 rates were 46.1 % (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1,2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. Conclusions: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginter-feron alfa-2a/ribavirin

NEW INSIGHTS ON THE INVOLVING OF AMYLOID BETA PEPTIDE IN ALZHEIMER’S DISEASE PATHOLOGY

Alzheimer’s disease (AD) is the most common neurodegenerative disorder that affects millions of people worldwide causing massive economic burden and the number of cases is expected to rise dramatically. Currently, there is no treatment that can stop or reverse the effects of AD. This review attempts to present the current status of research, bio-pathological approach mechanisms, biomarkers and therapeutic interventions of AD