Alexandru Vasincu

Background and Objectives: Potentially inappropriate medication (PIM) use is associated with adverse clinical outcomes in older adults. Several explicit screening tools are available for identifying PIMs, but Romanian data regarding the application of updated criteria remain limited. This study aimed to assess PIM identification according to the STOPP v3, Beers, EU(7)-PIM criteria and PRISCUS v2, to compare PIM counts and PIM presence across criteria, and to explore associations between PIM counts and selected patient characteristics. Materials and Methods: A retrospective observational study with a cross-sectional design was conducted in a single family medicine practice in Iasi, Romania, including 100 patients aged ≥ 65 years with at least one chronic condition and receiving at least two medications. Medications documented between January and June 2024 were assessed using the four explicit PIM criteria. One-way ANOVA with Bonferroni correction, repeated-measures ANOVA, agreement analyses, and Poisson regression models were used to examine differences between criteria and associations with patient characteristics, multimorbidity, and medication burden. Results: Mean PIM counts ranged from 0.75 for PRISCUS to 1.31 for STOPP. At least one PIM was identified in 73% of participants according to STOPP, 62% according to Beers, 60% according to EU(7)-PIM, and 53% according to PRISCUS. STOPP identified significantly more PIMs than each of the other three criteria (p < 0.001), while pairwise kappa coefficients ranged from 0.506 to 0.777. Among the 16 one-way ANOVA comparisons, only the association between obesity and EU(7)-PIM counts remained significant after Bonferroni correction (p < 0.001). In adjusted Poisson models, medication burden was associated with PIM counts according to STOPP (p < 0.001), Beers (p = 0.016), and EU(7)-PIM (p = 0.018). Obesity remained associated with EU(7)-PIM counts (p = 0.001), multimorbidity with STOPP PIM counts (p = 0.049), and sex with PRISCUS PIM counts (p = 0.030). Age, type 2 diabetes mellitus, and dyslipidemia were not independently associated with PIM counts. Conclusions: PIM identification varied according to the explicit criteria applied, with STOPP identifying the highest mean PIM count. Medication burden was the factor most consistently associated with PIM counts in adjusted analyses, while other patient characteristics showed criterion-specific associations. Given the small sample, single-practice setting, and non-probability sampling approach, these findings should be considered exploratory and require confirmation in larger, multicenter primary care studies.

Neurodegenerative diseases (NDs) encompass a group of chronic conditions, characterized by neuronal losses in large areas of the brain, leading to cognitive and behavioral impairments. Alzheimer’s Disease (AD), the most common form of dementia, is a progressive ND, characterized by the accumulation of amyloid β and tau protein, entails cognitive decline, neuroinflammation, mitochondrial dysfunction, and blood–brain barrier impairment, with oxidative stress playing a critical role in its pathogenesis. To date, the available pharmacotherapy has shown limited efficacy, and multitarget activity of plant-derived neuroprotective bioactive compounds is currently in focus. This review synthesizes experimental evidence regarding Ocimum species with neuroprotective potential in AD, particularly Ocimum sanctum and Ocimum basilicum. These plants are rich in bioactive compounds including polyphenols, flavonoids, essential oils, and triterpenoids that synergistically scavenge reactive oxygen/nitrogen species, upregulate endogenous antioxidant enzymes (SOD, CAT, and GPx), and reduce lipid peroxidation. Furthermore, these extracts have demonstrated the ability to decrease β-amyloid accumulation and tau protein levels, key pathological features of AD. Even though additional research is required to fully assess their potential as therapeutic agents for NDs, by diving into the specific mechanisms through which they improve neurodegenerative processes, important steps can be made towards this endpoint.

Cognitive decline is one of the most important challenges related to the aging process, due to its important impact on individuals. Several studies have reported that physical exercise with a specific intensity and frequency is beneficial for maintaining cognitive health in the ageing population. The present study investigated the impact of general physical exercise on cognitive health in the older population in Romania. The study involved 60 individuals (60% male, 40% female), with a mean age of 60.78 years (SD = 2.97). The Health Interview Survey and The Minnesota Heart Survey assessed exercise frequency and intensity, while the Montreal Cognitive Assessment (MoCA) determined mild cognitive impairment (MCI) levels. The results of the statistical analysis showed that high-intensity physical exercise at a frequency of three to four times a week at the age of 40–50 years is recommended in order to significantly reduce cognitive decline. In addition, for the age of 60 years old, the results established that engaging in physical activities of a moderate intensity with a frequency of 2–3 times per month is sufficient to maintain healthy cognition. The findings suggest that exercise can serve as a behavioral intervention to mitigate cognitive dysfunction and complement past research on its cognitive health advantages.

Autoimmune diseases (AIDs) emerge due to an irregular immune response towards self- and non-self-antigens. Inflammation commonly accompanies these conditions, with inflammatory factors and inflammasomes playing pivotal roles in their progression. Key concepts in molecular biology, inflammation, and molecular mimicry are crucial to understanding AID development. Exposure to foreign antigens can cause inflammation, potentially leading to AIDs through molecular mimicry triggered by cross-reactive epitopes. Molecular mimicry emerges as a key mechanism by which infectious or chemical agents trigger autoimmunity. In certain susceptible individuals, autoreactive T or B cells may be activated by a foreign antigen due to resemblances between foreign and self-peptides. Chronic inflammation, typically driven by abnormal immune responses, is strongly associated with AID pathogenesis. Inflammasomes, which are vital cytosolic multiprotein complexes assembled in response to infections and stress, are crucial to activating inflammatory processes in macrophages. Chronic inflammation, characterized by prolonged tissue injury and repair cycles, can significantly damage tissues, thereby increasing the risk of AIDs. Inhibiting inflammasomes, particularly in autoinflammatory disorders, has garnered significant interest, with pharmaceutical advancements targeting cytokines and inflammasomes showing promise in AID management.

The Renin–Angiotensin System (RAS) has attracted considerable interest beyond its traditional cardiovascular role due to emerging data indicating its potential involvement in neurodegenerative diseases, including Alzheimer’s dementia (AD). This review investigates the therapeutic implications of RAS modulators, specifically focusing on angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and renin inhibitors in AD. ACEIs, commonly used for hypertension, show promise in AD by reducing angiotensin (Ang) II levels. This reduction is significant as Ang II contributes to neuroinflammation, oxidative stress, and β-amyloid (Aβ) accumulation, all implicated in AD pathogenesis. ARBs, known for vasodilation, exhibit neuroprotection by blocking Ang II receptors, improving cerebral blood flow and cognitive decline in AD models. Renin inhibitors offer a novel approach by targeting the initial RAS step, displaying anti-inflammatory and antioxidant effects that mitigate AD degeneration. Preclinical studies demonstrate RAS regulation’s favorable impact on neuroinflammation, neuronal damage, cognitive function, and Aβ metabolism. Clinical trials on RAS modulators in AD are limited, but with promising results, ARBs being more effective that ACEIs in reducing cognitive decline. The varied roles of ACEIs, ARBs, and renin inhibitors in RAS modulation present a promising avenue for AD therapeutic intervention, requiring further research to potentially transform AD treatment strategies.

Recently, research has greatly expanded the knowledge of the endocannabinoid system (ECS) and its involvement in several therapeutic applications. Cannabinoid receptors (CBRs) are present in nearly every mammalian tissue, performing a vital role in different physiological processes (neuronal development, immune modulation, energy homeostasis). The ECS has an essential role in metabolic control and lipid signaling, making it a potential target for managing conditions such as obesity and diabetes. Its malfunction is closely linked to these pathological conditions. Additionally, the immunomodulatory function of the ECS presents a promising avenue for developing new treatments for various types of acute and chronic inflammatory conditions. Preclinical investigations using peripherally restricted CBR antagonists that do not cross the BBB have shown promise for the treatment of obesity and metabolic diseases, highlighting the importance of continuing efforts to discover novel molecules with superior safety profiles. The purpose of this review is to examine the roles of CB1R and CB2Rs, as well as their antagonists, in relation to the above-mentioned disorders.

Access to quality healthcare service is a challenge for many patients, especially in situations which impose movement restrictions, such as the COVID-19 pandemic. Although it has the disadvantage of lacking a physical consultation, high accessibility makes telemedicine alongside teleconsultation preferred in numerous situations, contributing to high treatment adherence in patients. An important pathology addressed through telemedicine is diabetes mellitus, due to its possible commorbidities and negative impact. This study consisted of the analysis of the electronic files of 260 patients, between April and December 2020. A high adherence in prescription days covered was observed (89.91%). The increase of teleconsultations which was maintained even after the ease of lockdown measured suggested a good adherence to this method. Teleconsultation is an efficient method, with future prospects for providing healthcare.

Brain neurodegenerative diseases (BND) are debilitating conditions that are especially characteristic of a certain period of life and considered major threats to human health. Current treatments are limited, meaning that there is a challenge in developing new options that can efficiently tackle the different components and pathophysiological processes of these conditions. The renin-angiotensin-aldosterone system (RAS) is an endocrine axis with important peripheral physiological functions such as blood pressure and cardiovascular homeostasis, as well as water and sodium balance and systemic vascular resistance—functions which are well-documented. However, recent work has highlighted the paracrine and autocrine functions of RAS in different tissues, including the central nervous system (CNS). It is known that RAS hyperactivation has pro-inflammatory and pro-oxidant effects, thus suggesting that its pharmacological modulation could be used in the management of these conditions. The present paper underlines the involvement of RAS and its components in the pathophysiology of BNDs such as Parkinson’s disease (PD), Alzheimer’s disease (AD), multiple sclerosis (MS), Huntington’s disease (HD), motor neuron disease (MND), and prion disease (PRD), as well as the identification of drugs and pharmacologically active substances that act upon RAS, which could alleviate their symptomatology or evolution, and thus, contribute to novel therapeutic approaches.

Neurodegenerative diseases are an increasing cause of global morbidity and mortality. They occur in the central nervous system (CNS) and lead to functional and mental impairment due to loss of neurons. Recent evidence highlights the link between neurodegenerative and inflammatory diseases of the CNS. These are typically associated with several neurological disorders. These diseases have fundamental differences regarding their underlying physiology and clinical manifestations, although there are aspects that overlap. The endocannabinoid system (ECS) is comprised of receptors (type-1 (CB1R) and type-2 (CB2R) cannabinoid-receptors, as well as transient receptor potential vanilloid 1 (TRPV1)), endogenous ligands and enzymes that synthesize and degrade endocannabinoids (ECBs). Recent studies revealed the involvement of the ECS in different pathological aspects of these neurodegenerative disorders. The present review will explore the roles of cannabinoid receptors (CBRs) and pharmacological agents that modulate CBRs or ECS activity with reference to Alzheimer’s Disease (AD), Parkinson’s Disease (PD), Huntington’s Disease (HD) and multiple sclerosis (MS).