La planificación económica : un análisis del esquema del Ing. Guido di Tella

Fil: Groppa, Víctor S. Universidad de Buenos Aires. Facultad de Derecho. Cátedra de Política Económica Argentina. Buenos Aires, Argentin

La coparticipación federal de impuestos: una propuesta para salir del actual galimatías

Difficulties to match the political organization of a country with its economic activity become evident in the formulation of its tributary model and particularly in the methods of allocation of its common fiscal resources. In Argentina, the criteria to solve these conflicts have not been the result of an optimizing economic analysis; nor have they been made aiming to overcome regional imbalances. Rather, they have consolidated the status quo, responding to emergency generated disputes. On the other side, there is the risk of proposing solutionsof apparent simplicity and mutual responsibility which imply severe difficulties regarding legal and managing implementation that may generate new asymmetries and conflicts. In this article, the author proposes the elaboration of models of fiscal allocation which harmonize legal technique with economic reality and pursue fairness, efficiency and the responsibility of the actors involved.Las dificultades para compatibilizar la organización política de un país con la actividad económica que en él se desarrolla se manifiestan especialmente en la formulación de su modelo tributario y en particular en los métodos de asignación de los recursos fiscalescomunes. En nuestro país los criterios para resolver estos conflictos no se elaboraron a partir de análisis económicos optimizadores ni con un sentido superador de los desequilibrios regionales. Más bien consolidaron situaciones de hecho, respondiendo a disputas impulsadas por la emergencia. Por otra parte, se corre el riesgo de proponer soluciones de aparente simplicidad y corresponsabilidad, pero que encierran dificultades de instrumentación jurídica y de gestión que pueden generar nuevas asimetrías y conflictos. En este artículo, el autor propone la elaboración de modelos de asignación fiscal que armonicen la técnica jurídica con la realidad económica y procuren la equidad, la eficiencia y la corresponsabilidad de losprotagonistas

Linking immune-mediated damage to neurodegeneration in multiple sclerosis: could network-based MRI help?

Inflammatory demyelination characterizes the initial stages of multiple sclerosis, while progressive axonal and neuronal loss are coexisting and significantly contribute to the long-term physical and cognitive impairment. There is an unmet need for a conceptual shift from a dualistic view of multiple sclerosis pathology, involving either inflammatory demyelination or neurodegeneration, to integrative dynamic models of brain reorganization, where, glia-neuron interactions, synaptic alterations and grey matter pathology are longitudinally envisaged at the whole-brain level. Functional and structural MRI can delineate network hallmarks for relapses, remissions or disease progression, which can be linked to the pathophysiology behind inflammatory attacks, repair and neurodegeneration. Here, we aim to unify recent findings of grey matter circuits dynamics in multiple sclerosis within the framework of molecular and pathophysiological hallmarks combined with disease-related network reorganization, while highlighting advances from animal models (in vivo and ex vivo) and human clinical data (imaging and histological). We propose that MRI-based brain networks characterization is essential for better delineating ongoing pathology and elaboration of particular mechanisms that may serve for accurate modelling and prediction of disease courses throughout disease stages

Особенности синдрома Рейно у пациентов c cистемной cклеродермией

Discipline of Nephrology and Rheumatology, Medical Clinic No 5, Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaIntroducere. Fenomenul Raynaud (FR) este definit ca un atac recurent de ischemie digitală, care evoluează în trei faze de culoare – paloare, cianoză şi roşeaţă, provocate, de obicei, de expunere la frig şi emoţii. Sclerodermia sistemică (SS) este o patologie generalizată a ţesutului conjunctiv ce se caracterizează prin dezvoltarea proceselor degenerative şi inflamatorii cu o afectare obliterantă a vaselor mici şi medii, precum şi a fibrozei pielii şi organelor interne (cordul, plămânii, rinichii, tractul gastrointestinal). Particularităţile sindromului Raynaud la pacienţii cu sclerodermie sistemică Expunerea la frig şi stresul emoţional poate induce vasospasm, ceea ce cauzează episoade caracteristice de înălbire sau cianoză a degetelor. De obicei, are loc afectarea bilaterală a degetelor mâinilor, uneori şi a picioarelor. Infarctele tisulare la vârful degetelor pot duce la ulceraţii, cicatrice stelate sau chiar la o gangrenă adevărată. În sclerodermia limitată sindromul Raynaud este un fenomen universal, precedând uneori ani şi chiar decenii, apariţia altor simptome ale sclerodermiei difuze. Fenomenul Raynaud este prezent la 75-85% dintre pacienţii cu SS. Absenţa lui este asociată cu un risc crescut de dezvoltare a afectărilor renale. Mai des sunt afectate porţiunile arteriolare ale vaselor, dar pot fi afectate arterele digitale sau alte vase mai mari de calibru mediu ca a. ulnaris. Procesele similare pot fi observate microscopic în patul unghial, efectuând o capilaromicroscopie, evidenţiind micşorarea numărului de capilare, sinuozitatea şi dilatarea vaselor rămase, numite teleangiectazii. Obiectivele studiului: evaluarea frecvenţei şi variantelor de prezentare a sindromului Raynaud la bolnavii cu sclerodermie sistemică în Republica Moldova. Material şi metode În studiu au fost incluşi 80 de pacienţi care asociau sclerodermie sistemică, dintre care doar 5 au fost de sex masculin. Vârsta medie a subiecţilor, incluşi în studiu, a constituit 45,1 ± 2,2 ani. Durata medie a maladiei – 13,1 ± 1,4 ani. Dintre ei 67 (83,75%) de pacienţi au prezentat Scl forma limitată, iar 13 (16,25%) – forma difuză a bolii. Activitatea medie a maladiei a fost de 4,5 ± 0,6 (conform scorului EUSTAR). Diagnosticul a fost stabilit conform criteriilor ACR (American College of Rheumatism), propuse în anul 1980. Pacienţii au fost examinaţi clinic şi paraclinic complex, inclusiv efectuându-li-se investigaţii imunologice (anticorpi antinucleari, anticentromeri, antitopoizomerază, antiribonuclează). Rezultate obţinute La pacienţii, incluşi în studiu, boala a debutat prin semnele sindromului Raynaud în 72 (90%) de cazuri. Perioada de până la apariţia primelor semne non-Raynaud a fost în mediu de 13,4 ± 0,4 luni. Caracterul trifazic al sindromului a fost observat doar la 15 (18,75%) dintre pacienţi, bifazic – la 49 (61,25%) şi monofazic, cu paloarea tegumentelor, la 16 (20%) dintre pacienţii evaluaţi. Ca factori declanşatori ai atacurilor, pacienţii au menţionat: frigul 72 (90%), emoţiile 32 (40%), fumul de ţigară 4 (5%), aer condiţionat 2 (2,5%), vântul 3 (3,75%), ridicarea vocii 1 (1,25%). Ulcere digitale sau consecinţele acestora (cicatrice) au fost semnalate la 21% dintre bolnavii incluşi în studiu. Severitatea sindromului Raynaud (conform duratei şi frecvenţei atacurilor, prezenţei ulcerelor digitale) a corelat direct cu scorul cutanat modificat Rodnan, cu presiunea sistolică în ventriculul drept (determinat ecografic), cu cantitatea anticorpilor anticentromeri şi cu antitopoizomeraza. Concluzii 1. Sindromul Raynaud este o manifestare frecventă (90%) şi precoce a sclerodermiei sistemice. 2. Caracterul clasic trifazic s-a înregistrat doar în 18,75% dintre cazuri; s-a observat prezenţa a mai multor factori declanşatori decât frigul şi emoţiile, fapte care indică necesitatea unei elaborări mai minuţioase a anamnezei la pacienţii cu sclerodermie sitemică. 3. Severitatea sindromului Raynaud a corelat direct cu scorul cutanat modificat Rodnan, cu presiunea sistolică în ventriculul drept şi cu cantitatea anticorpilor anticentromeri şi antitopoizomerazei

Directional deep brain stimulation for Parkinson's disease: results of an international crossover study with randomized, double-blind primary endpoint

Objective: Published reports on directional deep brain stimulation (DBS) have been limited to small, single-center investigations. Therapeutic window (TW) is used to describe the range of stimulation amplitudes achieving symptom relief without side effects. This crossover study performed a randomized double-blind assessment of TW for directional and omnidirectional DBS in a large cohort of patients implanted with a DBS system in the subthalamic nucleus for Parkinson’s disease. Materials and Methods: Participants received omnidirectional stimulation for the first three months after initial study pro gramming, followed by directional DBS for the following three months. The primary endpoint was a double-blind, randomized evaluation of TW for directional vs omnidirectional stimulation at three months after initial study programming. Additional data recorded at three- and six-month follow-ups included stimulation preference, therapeutic current strength, Unified Parkinson’s Disease Rating Scale (UPDRS) part III motor score, and quality of life. Results: The study enrolled 234 subjects (62 ± 8 years, 33% female). TW was wider using directional stimulation in 183 of 202 subjects (90.6%). The mean increase in TW with directional stimulation was 41% (2.98 ± 1.38 mA, compared to 2.11 ± 1.33 mA for omnidirectional). UPDRS part III motor score on medication improved 42.4% at three months (after three months of omnidi rectional stimulation) and 43.3% at six months (after three months of directional stimulation) with stimulation on, compared to stimulation off. After six months, 52.8% of subjects blinded to stimulation type (102/193) preferred the period with directional stimulation, and 25.9% (50/193) preferred the omnidirectional period. The directional period was preferred by 58.5% of clinicians (113/193) vs 21.2% (41/193) who preferred the omnidirectional period. Conclusion: Directional stimulation yielded a wider TW compared to omnidirectional stimulation and was preferred by blinded subjects and clinicians

Особенности течения системной красной волчанки у пациентов с вирусным гепатитом С и туберкулезом

This article is dedicated to researching therapeutic issues related to patients with systemic lupus erythematosus in association with severe infections such as hepatitis and tuberculosis. The article reproduced a clinical case of patient with hepatitis C infection and tuberculosis affecting the spine. We discuss issues of systemic autoimmune inflammation by these serious infections. Glucocorticosteroid and chemotherapy treatment modalities are presented in the presence of specific chronic infections. This review of clinical case is useful for medical practice in view of the high rate of tuberculosis and liver viruses among the population of the Republic of Moldova.Эта статья описывает трудности терапевтического ведения пациентов с системной красной волчанкой, ассоциированной с такими тяжелыми инфекциями, как вирусный гепатит С и туберкулез позвоночного столба. В статье обсуждаются проблемы персистенции иммунного системного воспаления, вызванного вышеназванными хроническими специфическими инфекциями, в связи с чем представлены примеры лечения глюкокортикоидами и цитостатиками. Учитывая высокую частоту заболевания туберкулезом и вирусным гепатитом в Республике Молдова, описание этого клинического случая актуально в медицинской практике

Spontaneous intracerebral supratentorial hemorrhage: general aspects and updates in surgical treatment

Laboratory of Neurosurgery Anesthesia and Reanimation, Institute of Neurology and Neurosurgery, Department of Neurology, Institute of Emergency Medicine, Department of Radiology and Medical Imaging, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Spontaneous intracerebral hemorrhage (SIH) accounts for 9 to 25% of all strokes and is associated with a high morbidity and mortality, with less than 40% of affected persons surviving 1 year. The condition commonly presents a sudden onset of focal neurological deficits with accompanying headache, nausea, vomiting, elevated blood pressure and altered consciousness. Medical treatment commonly includes airway support, blood pressure control, management of cerebral edema, symptomatic therapy such as anticonvulsive medication, anticoagulation reversal etc. Different surgical options such as open craniotomy, stereotactic aspiration, endoscopic evacuations with or without thrombolysis have also been considered. Most of these techniques have already been implemented successfully in the Republic of Moldova. According to the data of the Institute of Neurology and Neurosurgery and the Institute of Emergency Medicine for the period 2011-2014, just within these two institutions were performed 137 neurosurgical interventions, including 67 interventions involving minimally invasive techniques with local fibrilolysis and 70 interventions involving other minimally invasive surgery or conventional craniotomy. The obtained results are in concordance with those reported by other European institutions. Conclusions: The continuous efforts to improve the outcome of SIH during the recent years have led to the development of a variety of minimally invasive techniques, most of which have already been adopted by the autochthonous surgeons. New randomized controlled trials are required to establish the suitability of these techniques for different clinical situations and SIH localizations

Подагра у женщин

Catedra Medicină Internă nr.1, USMF “Nicolae Testemiţanu”, Conferinţa Ştiinţifico-Practică „Medicina modernă, actualităţi şi perspective”, consacrată aniversării de 40 de ani ai Spitalului Clinic al Ministerului Sănătăţii, 27-28 mai, 2010, Chişinău, Republica MoldovaMost rheumatic diseases are characterized by a moderate or marked female predominance. But women are a minority group of people affected by gout. An analysis of 19 cases shows that women represented only a proportion of 5.1%. Other statistics reveal the incidence of this disease ranged from 0.9% in Japan to 17.7% in the Netherlands.Большинство ревматических заболеваний встречается и преобладает у женщин. Вместе с тем, женщины редко страдают подагрой. Анализ 19 случаев подагры из общего числа обследованных больных свидетельствует, что женщины составляют 5,1%. По данным литературы данное заболевание у женщин колеблется от 0,9% в Японии до 17,7% в Нидерландах

Подагра у мужчин и сопутствующие заболевания

Discipline of Nephrology and Rheumatology, Medical Clinic No 5, Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaScopul. Studierea patologiilor concomitente ale organelor interne la bărbaţii cu gută. Material şi metode Au fost cercetaţi 130 de bărbaţi cu diagnosticul de gută (conform criteriilor ARA), cu vârsta cuprinsă între 18-72 de ani, cu durata medie a maladiei de la 2 până la 38 de ani. Au fost efectuate: analiza generală a sângelui, analiza generală a urinei, s-a apreciat în sânge nivelul colesterolului, trigliceridelor, glucozei, protrombinei, ureei, creatininei, proteinei totale, calciului seric, ECG, EcoCG, USG organelor interne, aprecierea indicelui greutăţii corporale. Rezultate În rezultatul cercetărilor au fost depistate următoarele maladii concomitente – la 87 (67%) de pacienţi a fost depistată hipertensiunea arterială, la 76 (58%) pacienţi – obezitate (gr. I-III), la 54 (41%) – creşterea trigliceridelor, la 47 (36%) bolnavi a fost depistată urolitiaza, la 39 (30%) – diabet zaharat tip II, la 34 (26%) de pacienţi – pielonefrită cronică, la 29 (22%) de bolnavi – insuficienţă renală cronică (gr. I-V după K/DOQI), la 5 (4%) bolnavi – în anamneză infarct miocardic acut, la 3 (2%) bolnavi – hemoragie gastrică în anamneză (pe fundalul tratamentului cu AINS). Concluzii Datele obţinute sunt sugestive pentru prezenta corelaţie între gută şi patologia organelor interne. Depistarea precoce a tuturor maladiilor concomitente în gută ne va permite să adaptăm corect tratamentul şi, astfel, să preîntâmpinăm apariţia complicaţiilor

Особенности хронической нефропатии у пациентов с системной склеродермией

Catedra Medicină Internă nr. 1, USMF “Nicolae Testemiţanu”, Centrul Naţional Ştiinţifico-Practic Medicină de Urgenţă, Chişinău, Conferinţa Ştiinţifico-Practică „Medicina modernă, actualităţi şi perspective”, consacrată aniversării de 40 de ani ai Spitalului Clinic al Ministerului Sănătăţii, 27-28 mai, 2010, Chişinău, Republica MoldovaImpaired renal vessels in systemic scleroderma (SS) are characterized by a specific lesion of small arteries (diameter 150-500 mm) by the proliferation of intima, media thickening and increased deposition of collagen in adventitious. The study included 70 patients with SS, of which only 3 were male. The average age of subjects included in the study was 43.4 years. The average duration of disease was 16.5 years. It was established that chronic nephropathy is diagnosed relatively frequently (21.4%) in patients with SS, especially as disease duration increases, and with an accuracy of 76.5% some factors (disease duration, spreading sclerodermic skin damage, treatment with D-penicillamine) may be considered important for its development.Поражение почечных сосудов при системной склеродермии (СС) характеризуется специфическими изменениями малых артерий (диаметром 150-500 мм): пролиферацией интимы, сгущением средней оболочки и отложением коллагена в адвентиции. В исследование были включены 70 пациентов с СС, из которых 3 были мужчины. Средний возраст больных, включенных в исследование, был 43,4 лет. Средняя продолжительность заболевания - 16,5 лет. Было установлено, что хроническая нефропатия регистрируются довольно часто, в среднем, в 21,4% случаев. Длительность заболевания, распространение склеродермических повреждений кожи и лечение D-пеницилламином могут в значительной степени способствовать развитию хронической нефропатии, увеличивая ее частоту до 76,5%