New scientific evidence raises awareness concerning the human-specific interplay among primary environmental conditions, such as the light–dark cycle, activity–rest alternation, nutritional patterns, and their reflection on the physiological and pathological characteristics that are displayed uniquely by every individual. One of the critical aspects in the clinic is to understand the role of circadian rhythms as remarkable modulators of the biological effects of drugs and to aim for an optimal overlapping of the time of administration of medicines with the physiologic release of certain hormones, the time-dependent expression of genes, or the key-regulatory protein synthesis, which are all circadian-driven processes. The pharmacokinetics and pharmacodynamics profiles, as well as the possible drug interactions of neurotropic and cardiovascular agents, are intensely subjected to endogenous circadian rhythms, being essential to identify as much as possible the patients’ multiple risk factors, from age and gender to lifestyle elements imprinted by dietary features, sleep patterns, psychological stress, all the way to various other associated pathological conditions and their own genetic and epigenetic background. This review chapter will highlight the involvement of biological rhythms in physiologic processes and their impact on various pathological mechanisms, and will focus on the nutritional impact on the circadian homeostasis of the organism and neurologic and cardiovascular chronotherapy.
Obiective. Hemoragiile peri-intraventriculare (HPIV) pot determina la sugarii născuţi prematur diferite grade de retard neuropsihomotor. Un studiu prospectiv efectuat în IOMC pe o perioadă de 4 ani (2009-2012), pe un lot de 160 prematuri, a urmărit prevalenţa gradelor de HPIV diagnosticate prin ecografie transfontanelară (ETF), identificarea factorilor de risc asociaţi şi a severităţii afectării neurologice la aceşti pacienţi prin urmărirea lor pe o perioadă de 12 luni. Material şi metodă. Pe perioada studiului, prematurii internaţi în IOMC au fost examinaţi sistematic prin ETF, printr-un protocol standardizat; aprecierea gradelor HPIV s-a efectuat conform clasificării Papile. Evaluarea neurologică a fost efectuată sistematic până la vârsta de 1 an. Rezultate. Cel mai frecvent înregistrate au fost HPIV I şi II – 45%, respectiv 37,5% din numărul total de pacienţi. HPIV gradul IV au reprezentat 4,4%. În HPIV grad I şi II afectarea neurologică a fost uşoară, această corelaţie având semnificaţie statistică (p < 0,01) pentru ambele forme. Hemoragiile gradul III şi IV au fost asociate cu o evoluţie neurologică nefavorabilă, corelaţia între HPIV grad IV şi sechelele neurologice majore având semnificaţie statistică (p < 0,01). Concluzii. ETF efectuată de rutină tuturor prematurilor permite diagnosticul precoce şi stadializarea HPIV, aprecierea evoluţiei neurologice cu instituirea precoce a tratamentului şi asigurarea consilierii adecvate.
Objectives. In preterm babies, peri-intraventricular hemorrhages (PIVH) might cause various degrees of neuropsycho-motor impairment. A 4-year prospective study (2009-2012) performed in the IOMC, was aimed to determine the prevalence of different degrees of PIVH diagnosed by head ultrasound (HUS) among 160 admitted preterm babies, the associated risk factors, along with the neuro-developmental effects on a 12-month follow-up period. Material and methods. In the above-mentioned period all admitted preterms were examined by transfontanelar ultrasound according to a standardized protocol based on Papile’s PIVH classification. For those preterms included in the study a 12-month systematic neurologic follow-up was performed. Results. PIVH grade I (45%) and II (37,5%) were the most prevalent types. Grade IV PIVH represented 4,4% from all PIVH cases. The good neurological outcome of grade I and II PIVH, was found to be statistically significant (p < 0.01) for both types. Severe neurological sequelae were associated with grade III and IV and a statistically significant correlation (p<0.01) was found only for grade IV hemorrhages. Conclusion. Systematic HUS screenings for all preterm babies is useful for early diagnosis and PIVH staging, for neurologic outcome prediction, providing the appropriate management strategy and a well-suited parental counseling.
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