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Copyright of Farmacia is the property of Societatea de Stiinte Farmaceutice Romania and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Overweight and obesity are a health problem for populations around the world. Abdominal obesity, correlated with visceral obesity, increases the risk of cardiovascular diseases, diabetes, stroke, arthritic diseases and many other pathologies. However, it is considered that the simple determination of Body Mass Index (BMI) and abdominal circumference does not reflect the real nutritional status of the body and that other methods are needed to determine the composition of the body, such as the percentage of adipose tissue and its distribution in the body. Determining body composition can be done by several methods, some of which are expensive, sometimes unavailable, and still used for research purposes. Other methods, such as bioelectrical impedance, DXA (Dual-energy X-ray absorptiometry) are useful in our medical practice and can estimate body composition with fairly high accuracy. The results can be used to carry out targeted, personalized interventions both in the case of healthy individuals and in certain pathologies where BMI is not relevant (edema, athletic people, elderly with sarcopenia). [ABSTRACT FROM AUTHOR]

In clinical practice, professionals observed that patients with cardiovascular diseases often suffer from psychological disorders. This association creates a higher risk of cardiac morbidity and mortality. One of the most frequent associations is between cardiovascular diseases and depression. Another frequent association is represented by patients with cardiovascular disease who suffer from depression and anxiety disorder as well. Depression is an important pathological entity that frequently and negatively influences the cardiovascular disease. Patients diagnosed with severe cardiovascular diseases (myocardial infarction, congestive heart failure, atrial fibrillation) who suffer from depression as well have a higher risk of death (morbidity) in the next five years, even with a good solid multidisciplinary treatment approach. Despite the objective findings, there is not yet a clear way for the prevention and management for those patients. [ABSTRACT FROM AUTHOR]

Copyright of Medic.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Frailty is a health condition including loss of functionality leading to an increased vulnerability to stress, a medical syndrome with multiple causes and contributors that is characterized by diminished strength and endurance. There is a relationship between fragility and cardiovascular disease: fragility increases cardiovascular morbidity and mortality, while cardiovascular disease amplifies the degree of fragility in patients. It is recommended to assess fragility by specific scores for frail patients with cardiovascular disease and before planned interventions and procedures, along with an integrated and comprehensive management of these patients. The treatment of cardiovascular diseases and comorbidities will be done by evaluating the risk-benefit balance, with progressively increasing doses, adapted to each case. The family doctor has an important role in assessing the fragility and management of non-pharmacological measures, adapting diet, exercise, psychological counseling, social inclusion, as well as in adapting drug therapies, taking into account the functional and cognitive status of the patients. [ABSTRACT FROM AUTHOR]

Copyright of Medic.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medic.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Valvular heart diseases are encountered more and more often in our professional activity. Their prevalence in recent years has led to an increased concern regarding these pathologies. Today, degenerative aortic stenosis is the most frequent cardiovascular disease, after high blood pressure and chronic coronary disease (in Europe and North America). In 2017, a complex guide for the management of valvular heart disease (VHD) was published. But since 2017, new information, new studies, new epidemiological data and new recommendations have emerged for these pathologies. All these realities make the actualization and revision of the guide for the management of VHD imperative. This new document focuses on the definition of “Heart Team” and “Heart Valve Centre”, as centers of excellence that can offer maximum chances to these patients. Decision-making in VHD involves accurate diagnosis, timing of intervention, risk assessment and, based on these, the selection of the most suitable type of intervention. Valvular heart diseases are encountered more and more often in our professional activity. Their prevalence in recent years has led to an increased concern regarding these pathologies. Today, degenerative aortic stenosis is the most frequent cardiovascular disease, after high blood pressure and chronic coronary disease (in Europe and North America). In 2017, a complex guide for the management of valvular heart disease (VHD) was published. But since 2017, new information, new studies, new epidemiological data and new recommendations have emerged for these pathologies. All these realities make the actualization and revision of the guide for the management of VHD imperative. This new document focuses on the definition of “Heart Team” and “Heart Valve Centre”, as centers of excellence that can offer maximum chances to these patients. Decision-making in VHD involves accurate diagnosis, timing of intervention, risk assessment and, based on these, the selection of the most suitable type of intervention. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is currently the leading cause of death in women from developed countries. It is necessary to assess cardiovascular risk in women, taking into account both traditional and non-traditional, specific risk factors. Prophylactic measures should be instituted from an early age, by discouraging smoking and promoting a healthy lifestyle, which includes a healthy diet and regular physical activity. Health professionals and women themselves should be aware of women-specific factors that may affect the cardiovascular risk, and ensure that risk factors are assessed on each occasion. Pregnancy, menopause, polycystic ovary syndrome and inflammatory diseases require further cardiovascular risk assessments. The management of cardiovascular risk factors is similar in women and men, and is equally important. The targets to be achieved and the means used should be similar [ABSTRACT FROM AUTHOR]

Pregnancy is a prethrombotic condition due to physiological changes, increasing the risk of a thromboembolic event by 5-6 times. Women with known cardiovascular disease or multiple risk factors for thromboembolic events that require anticoagulant therapy will be evaluated both before conception and throughout pregnancy, peripartum and postpartum, a period of at least 6-8 weeks, by an entire ”pregnancy heart team”. The preferred anticoagulant therapeutic agent in pregnant women at risk of venous thromboembolism, pulmonary embolism or thrombophilia is low-molecular-weight heparin (LMWH) administered in a prophylactic dose adapted to the body weight of the pregnant woman; the periodic thromboembolic risk assessment during pregnancy is indicated. Pregnant women who suffer a peripheral or pulmonary thromboembolic event during pregnancy will receive LMWH in a curative dose, adapted to body weight and with a weekly monitoring of factor anti-Xa levels. Prophylactic anticoagulation in women wearing mechanical prostheses during pregnancy requires a different attitude depending on the need for antivitamin K, and pregnant women may receive either AVK or LMWH or low-molecular-weight heparin or unfractionated heparin. From week 36, anticoagulation with heparin is mandatory, and 36 hours before the planned birth, it is necessary to switch to unfractionated heparin therapy, which will be stopped 6 hours before birth and restarted 6 hours postpartum. During lactation, low-molecular-weight heparin or antivitamin K can be used as anticoagulants, which have the advantage that they are not secreted in breast milk in an active form. NOACs are contraindicated in both pregnant and breastfeeding women. [ABSTRACT FROM AUTHOR]

High blood pressure (hypertension) can be one of the most important causes of morbidity or mortality, both maternal and fetal. Monitoring the values of blood pressure during pregnancy and the impact on the health of the pregnant woman and the evolution of the pregnancy by the general practitioner is one of the main prophylactic measures. Surveillance of the pregnant woman, even from the first month of pregnancy, and the identification of risk factors for hypertension are the basis of a diagnosis and early therapeutic intervention, in order to prevent complications. The guidelines also address the intervention and postpartum counseling of these pregnant women on the risk of developing other cardiovascular complications over time, as well as the risk that the next pregnancy will have pregnancy-induced hypertension. The general practitioner, through these interventions, is an important link in the multidisciplinary monitoring team of pregnant women at risk for pregnancy-induced hypertension. [ABSTRACT FROM AUTHOR]

Thrombophilia is a disorder associated with an increased tendency to thrombosis. Thrombophilia can be acquired or hereditary. Only a few of the inherited thrombophilia present a major risk of thrombosis and they should be diagnosed when thromboembolic disease or miscarriages occur in pregnant women. It is important to know the personal history and the family history of the patients, to look for the cause of venous or arterial thromboembolism and to investigate the patients at risk in order to apply the prophylaxis and the anticoagulant treatment when necessary. A special attention should be given to patients with antiphospholipid syndrome, sometimes requiring anticoagulation indefinitely. [ABSTRACT FROM AUTHOR]

Child dyslipidemia is often considered a secondary pediatric problem, although its consequences over time are extremely important. Dyslipidemia often begins in childhood and adolescence and contributes to early atherosclerosis and to premature cardiovascular disease. In children with high cardiovascular risk with severe dyslipidemia, the treatment reduces the risk of cardiovascular events. The screening for lipid disorders in children at high risk begins from the age of 2 years old, and in the case of children without risk factors, two determinations of the lipid profile are necessary: in the pre-adolescence period, respectively between 16-19 years old. The management of dyslipidemia in children includes heart-healthy lifestyle changes, dietary modification, physical activity, weight loss for obese children and only in certain situations drug therapy is required. [ABSTRACT FROM AUTHOR]

During the last years, there has been an emphasis on the adverse effects of exposure to solar radiation and especially on the effects on the skin and eyes, on early skin aging and the promotion of skin cancers. However, favorable associations were found between direct sunlight, vitamin D level indirectly, regarding the protection or delay of certain diseases - cardiovascular, bone, muscular diseases, multiple sclerosis, certain cancers (colon, prostate, breast, non-Hodgkin lymphoma, bladder), Alzheimer's disease, and depression. There is evidence that the formation of nitric oxide, melatonin, serotonin, endorphins, and the immunomodulation (effects caused by chronic exposure to solar radiation) have beneficial effects on the functioning of the body and delay the onset of various diseases. On the other hand, the increased incidence of skin cancer in the last period is due to the increase of intermittent and incorrect exposure to the sun, and the use of modern tanning devices. Currently, the prolonged exposure to the sun and the insufficient exposure to ultraviolet radiation are both considered harmful. [ABSTRACT FROM AUTHOR]

In recent years, we've noticed an increase in the interest in the different gluten-related conditions. The disease is not only diagnosed in children, but also in adults. The importance of the disease is that it appears to be associated with an increased risk of long-term complications. Doctors can prevent them by timely diagnosis and by initiating a gluten-free diet. It is essential to recognize the important role of primary care, as a large-scale serological examination is currently not recommended. The physicians should improve their knowledge on the various clinical manifestations of celiac disease and diagnosis. [ABSTRACT FROM AUTHOR]

Too short or too long sleep duration increases the risk of developing cardiovascular events, hypertension, stroke and cardiovascular mortality. These findings have been confirmed by recent studies and a sleep duration of 7-8 hours a day for adults is now an important component of a healthy lifestyle. Healthy diet, avoiding excess alcohol, tobacco, caffeine or other stimulants, practicing exercise and cognitive-behavioral therapy are essential to ensuring proper sleep and helping to reduce cardiovascular risk together with other non-pharmacological measures outlined in current guides. [ABSTRACT FROM AUTHOR]

Most patients with chronic kidney disease (CKD) have hypertension, and CKD is characterized by high and very high cardiovascular disease rates. Hypertension is an important cardiovascular risk factor, and its treatment prevents major cardiovascular events and lowers mortality of all causes and especially cardiovascular mortality. Therefore antihypertensive therapy is part of the management of chronic kidney disease. Effective blood pressure control decreases not only the risk of fatal and non-fatal cardiovascular events, but also reduces the rate of progression of renal impairment. Target bloodline values are not definitively established, but most guidelines recommend lowering systolic blood pressure to values below 140-130 mmHg, depending on the presence of proteinuria. Additional studies are needed to establish the blood pressure (BP) target, especially for patients with GFR below 45 ml/min./1.73 m2, where the benefits of too aggressive BP may be outweighed by the risk of progression to renal insufficiency. Most patients with chronic kidney disease require therapy with two or three therapeutic agents, the most commonly used drugs being ACE inhibitors/ARB (if there is intolerance to ACE inhibitors), calcium channel blockers and diuretics. [ABSTRACT FROM AUTHOR]

Patients with diabetes are considered at high or very high cardiovascular risk, diabetes being considered as “coronary heart disease risk equivalent“. Coronary involvement is often multivascular, and atherosclerotic lesions are diffuse and enlarged in the coronary. Acute myocardial infarction may be manifested by nonspecific symptoms, and typical angina pain may be missed in 23-40% of cases due to diabetic neuropathy. The therapeutic attitude is the same as in the non-diabetic patient; optimal medical treatment and interventional therapy is indicated if the patient reaches the doctor in good time. In some situations (patients with DM and multivessel or complex CAD) better results are obtained by CAGB, and in other cases percutaneous angioplasty is preferred. Optimal medical treatment includes beta blockers, ACE-I/ ARBs, statins, antiplatelet and antithrombotic drugs. Renal function should be closely monitored, and insulin use is only indicated for blood glucose levels above 180 mg/dl. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease is comprised of two major disorders: ulcerative colitis and Crohn disease. Among intestinal infl ammatory diseases, there must be made a difference between extra intestinal manifestations and the complications of the disease or treatment. Anemia represents one of the most frequent extraintestinal manifestations in inflammatory bowel disease. The etiology of anemia in patients with inflammatory bowel disease can be multifactorial, often involving a combination of iron deficiency , anemia of chronic disease, vitamin B12 deficiency, folic acid deficiency, drugs or hemolysis. Patients with iron deficiency may not always manifest with signs and symptoms; so, hemoglobin levels in patients with inflammatory bowel disease must be regularly monitored for earlier detection of anemia. [ABSTRACT FROM AUTHOR]

Cardiovascular disease in patients with chronic renal disease (CKD) is commonly found in primary care. It is important to recognize chronic kidney disease, defined as abnormalities of kidney function or structure (markers of renal impairment) or eGFR of less than 60 ml / min / 1.73 m2, presented for more than 3 months. Chronic kidney disease has an estimated prevalence of 8-11% worldwide. After the age of 40 years, there may be a physiological progressive reduction in eRFG (glomerular filtration rate) of 1 ml / min / year. Chronic kidney disease is an independent cardiovascular risk factor; low glomerular filtration rate (eGFR) is associated with increased mortality, multiple cardiovascular events and multiple hospitalizations. Cardiovascular risk assessment in patients should take into account the degree of renal function. Evaluation of renal function is based on eRFG and albuminuria or creatinine / albumin ratio. On the other hand, chronic kidney disease increases the risk of fatal and non-fatal cardiovascular events. Trying to identify and to control modifiable risk factors has beneficial effects on maintaining renal function and slowing down progression. The choice of medication and therapy should be made in accordance with the degree of impairment of renal function. General measures (smoking cessation, limitation of salt intake, aerobic exercise), good control of high blood pressure, optimal glycemic control, lipid lowering therapies, antiplatelet agents help to reduce the risk of cardiovascular events and at the same time, delay progression of function kidney˝ [ABSTRACT FROM AUTHOR]

Menopause is characterized by many huge changes in the quality of women's life. Hormonal changes, accompanied by numerous symptoms cause changes in body composition and increasing the body mass index (BMI). Decreased estrogen levels cause increased visceral adipose tissue, lean mass loss, bone mineral density loss, decreased protein. In the early postmenopausal years, women who do not take estrogen therapy typically gain fat mass and lose lean mass. All these effects on body composition are major risk factors for hypertension, cardiovascular diseases, diabetes, dyslipidemia, psychiatric disorders (depression, dementia), osteoarthritis, osteoporosis. Abdominal obesity influences blood pressure by increasing insulin resistance, impaired glucose tolerance, increasing insulinemia, which causes increased adrenergic activity, producing vasoconstriction. Increased BMI in postmenopausal women is associated with increased risk of breast, endometrial and ovarian cancer. [ABSTRACT FROM AUTHOR]

Osteoporosis is a condition that affects many people in the past years. It weakens bones, making them fragile and more likely to break. Osteoporosis develops slowly over several years without any symptoms and remains undiagnosed until a minor fall or sudden impact causes a bone fracture. The most common fractures associated with osteoporosis are in the hip, spine and wrist. There are many factors which increase the risk of fractures and the first step in diagnosis osteoporosis is to use the risk assessment tools, such as FRAX and DEXA scan. The treatment for osteoporosis is based on treating and preventing fractures by taking regular exercise, avoiding alcohol consumption, giving up smoking and having a healthy diet, including foods rich in calcium and vitamin D. There are specific drugs used in the treatment of osteoporosis: bisphosphonates, denosumab, parathyroid hormone, hormone therapy and selective estrogen receptor modulators, each of them having specific indications, side effects and contraindications that should be known by any family doctor. [ABSTRACT FROM AUTHOR]

Osteoporosis is a disease that affects an increasing number of people, given the tendency of aging populations. Fragile bone and increases risk of bones breaking, their consequences, impairment of quality of life have prompted health policies to provide a greater insight into this condition. It is important to identify the risk factors and start the preventive and curative treatment as early as possible. Current guidelines recommend using the FRAX score to determine the risk of major fracture over the next 10 years, followed by DXA determination. The current guidelines highlight the importance of non-medication measures, calcium and vitamin D intake. Among the therapeutic agents used in the treatment of osteoporosis, the first line are bisphosphonates po or, in case of intolerance, bisphosphonates iv or antibodies anti RANKL (denosumab). Selective estrogen receptor modulators and hormone replacement therapy are not routinely indicated, and recombinant PTH is expensive and is intended for severe and resistant forms. The adherence to treatment is poor, so we need measures to increase prevention, screening and early treatment of osteoporosis, as well as measures to educate the population. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases cause 3.9 million deaths in Europe, being the main cause of death (about 45% of deaths). In many countries, there has been a decline in deaths from cardiovascular diseases in recent years, but the cardiovascular diseases prevalence rate has increased in younger age groups. Dietary factors, high prevalence of obesity and diabetes in children and adolescents, physical inactivity and the initiation of tobacco consumption at a small age are the most important risk factors for cardiovascular disease in adolescents. Modern life has brought new risk factors: the consumption of anabolic substances, and the excessive use of modern technologies increases the cardiovascular risk among adolescents. This is the reason why it is necessary to identify and treat more aggressively the identified risk factors at the lowest possible age, primarily by adopting a healthy lifestyle, including regular exercise practice, appropriate food patterns, and abstinence from smoking and other harmful substances. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders of women in reproductive period. Signs and symptoms often develop during puberty and it is important for the family doctor to recognize the first signs and to prevent complications and disease progression. Women with PCOS have irregular periods, elevates levels of male hormone, excess facial and body hair, sometimes severe acne, male-pattern baldness and polycystic ovaries. Women with PCOS have an increased prevalence of cardiovascular risk factors. These include obesity, impaired glucose tolerance, diabetes, hypertension, altered lipid profile mood disorders and metabolic syndrome. Early diagnosis and treatment along with weight loss through a low-calorie diet combined with moderate exercise activities and the treatment of cardiovascular risk factors may reduce the risk of long-term complications such as type 2 diabetes and heart disease and improve the quality of life. [ABSTRACT FROM AUTHOR]

Hypertension during pregnancy is one of the common causes of maternal and foetal morbidity and mortality. Therefore, it requires careful monitoring of pregnant women in order to identify risk factors and an early diagnosis of hypertension, to determine organ damage, the potential risk of preeclampsia and eclampsia. Non-pharmacological and pharmacological treatment has certain peculiarities, the drugs used must take account of the maternal risks, but also of the foetus. Besides complications during pregnancy, hypertension is an indicator of increased risk for women to develop hypertension, stroke, coronary artery disease and venous thrombosis in the next 5-15 years. [ABSTRACT FROM AUTHOR]

The General Practitioner's role in diagnosing and monitoring the pacients with rheumatoid arthritis (RA) is not very well established in Romania. RA, a chronic inflammatory disease with a progressive evolution, systemic symptoms and severe disfunctions, decreases the quality of life, leading to early retiring and the descrease of life expectancy with 5 to 10 years. Establishing PRE-RA (Personalized Risk Estimator for Rheumatoid Arthritis) for first degree relatives of the RA affected patients, according to age, gender, family history and risk behavior, allows the prevention and the delay of the disese. Some preventing measures are the following: giving up smoking, mediteranean diet, weigh control, statines therapy in order to descrese the cardiovascular risk, oral hygiene. RA begins with a prolonged asymptomatic period, characterized by the presence of asymptomatic smallairway disease, certain infections and inflammatory disease (gut, periodontium, genitourinary tract) or dysbiosis. We can find increased circulating disease specific autoantibodies or increased levels of cytokines and chemokines. A good knowledge of the first symptoms is very important for the general practitioner (GP) and could also help the rheumatologist to start the treatment immediately after the occuring of the disease. The GP could have a very important role together with the rheumatologist and the hole team in surveying the disease evolution and also the associated comorbidities, complications and possible opposite reactions to the treatment. The GP is also involved in the pacients' and their families' counciling, and his presence in the multidiscipinary teams increases the adherence, compliance and persistence to the therapy. [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this study is the evaluation of a group of patients suffering from rheumatoid arthritis depending on the administered treatment, classical remissive therapy or biological therapy. Materials and methods. We have performed a retrospective study on a group of 214 patients diagnosed with rheumatoid arthitis, admitted in the Internal Medicine and Rheumatology Clinic of „Dr. I. Cantacuzino“ Clinical Hospital Bucharest, 92 of whom were being administered biological therapy (etanercept, in fl iximab, adalimumab or rituximab) along with classical remissive therapies (methotrexate, le fl unomide, sulfasalazine), and 122 of whom were only being administered classical treatment. We have studied and supervised the in fl uence of these thera- pies on disease evolution, together with paying attention to several other health risks present in rheumatoid arthri- tis patients (cardiovascular risk, osteoporosis, joint replacement surgery, neoplasms). Results. In the studied group, the seropositive disease forms predominated (72%), in stages 2 and 3, the average patient age being 59.29±11.52 years. Systemic manifestations were present in patients who underwent biological therapy, presented seropositive disease forms, as well as a more aggresive evolution and a more decreased BMI. Female patients more frequently presented ischemic heart disease, dyslipidemia and increased cholesterol levels, thus comprising multiple cardiovascular risk factors as well as associated cardiovascular pathology. Patients treated with biological therapy have presented a signi fi cantly lower incidence of ischemic stroke as well as slight- ly decreased cholesterol levels, data which correlate with specialty literature. Treatment using statins was more frequently used in these cases. Although statistically unsigni fi cant, the most decreased cholesterol levels were recorded in patients treated with etanercept. Smokers presented a weaker response to biological therapy as com- pared to non-smokers. Osteoporosis was more frequent in the group of patients treated with classical remissive therapy as well as in those with an increased disease activity, evaluated through the DAS 28 score and increased in fl ammation markers. DAS 28 was decreased in patients treated with biological treatment (in fl iximab, adalim- umab, rituximab), and those in the third stage of disease, probably because of the more aggeresive treatement administered in these situations. Conclusions. Biological therapy has positively in fl uenced disease evolution, patients presenting decreased val- ues for in fl ammation markers as well as disease activity, evaluated using the DAS 28 score, in comparison with patients treated with classical remissive therapy. Cholesterol levels were lower in the group treated with biological therapy, as patients underwent statin treatment more frequently, thus presenting a reduced incidence of stroke. Moreover, osteoporosis was less frequent in the group treated with biological agents. These biological therapies did not in fl uence the number of viral hepatitis infections, but in some cases have determined the reactivation of a series of tuberculosis infections. Neoplasms have not presented a signi fi cantly increased incidence in the group treated with biological therapy. Adverse effects of biological treatment will be further studied, but the bene fi cial effect on disease evolution as well as other disease-associated risks is certain. [ABSTRACT FROM AUTHOR]

Medicina presupune studiu individual, dar și studiu în echipă. În decursul anilor de studenție și de rezidențiat, precum și ulterior, pe parcursul diferitelor etape de pregătire și perfecționare a cunoștințelor medicale, suntem de multe ori nevoiți să interacționăm cu colegi și să ne supunem metodelor și ritmului de învățat în grupul din care facem parte. Acest lucru nu este întotdeauna facil și la îndemâna oricui, mai ales dacă nevoile grupului și ritmul de învățare sunt total diferite de cele ale persoanei în cauză. [ABSTRACT FROM AUTHOR]

Cu siguranță, voi deschide acum o cutie a Pandorei și voi stârni aprobări și dezaprobări deopotrivă, optând să vorbesc despre alegerea pe care toți tinerii medici sunt nevoiți să o facă, aceea a specialității în care vor dori să lucreze; alegerea nu este una lesne de făcut și mulți factori pot influența favorabil sau neprielnic această opțiune. [ABSTRACT FROM AUTHOR]