Ioana Dana Alexa

Universitatea de Medicina si Farmacie Grigore T. Popa Iasi, Socola, Iaşi, Romania

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Publications (58)11.9 Total impact


  • No preview · Article · Sep 2015 · European geriatric medicine

  • No preview · Article · Sep 2015 · European geriatric medicine

  • No preview · Article · Sep 2015 · European geriatric medicine

  • No preview · Article · Sep 2015 · European geriatric medicine
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    Teodora Alexa · Anti Lavinia · Andrei Luca · Lucian Miron · Ioana Dana Alexa
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    ABSTRACT: To compare patient's characteristics, clinical data, and rates of chemotherapy discontinuation in advanced NSCLC (non-small cell lung cancer) patients treated with platinum-based association chemotherapy (elderly vs. younger counterparts). To evaluate if there are certain factors that can predict discontinuation of chemotherapy. A retrospective analysis of all cases of advanced NSCLC treated with either cisplatin-gemcitabine or cisplatin-vinorelbine at the Regional Institute of Oncology Iaşi between January 2012 and December 2013 was performed. Patients were divided into two groups: over 70 years old and under 70 years old. Patient's characteristics and clinical data (including whether or not the patient discontinued treatment) were recorded for each case. The elderly patients had more comorbidities (p = 0.003), were prescribed a larger number of pills (p = 0.02), and had longer periods of hospitalisation (p = 0.005). No difference in toxicity was noted between the two groups. Five patients chose to discontinue chemotherapy in the elderly group. Only two patients made the same choice (p = 0.02) in the younger group. Correlation analysis revealed that refusal of further chemotherapy was associated with the length of hospital stay, number of pills per day, and smoking status. Geriatricians should minimise iatrogeny and polypharmacy by optimising long-term treatment. This will increase the chance that elderly patients will not discontinue chemotherapy. Hospital stay should be reduced to a minimum. As life span increases so does the number of elderly patients with cancer; it is vital to understand and prevent the causes of chemotherapy discontinuation in order to achieve optimal therapeutic results.
    Full-text · Article · Nov 2014 · Contemporary Oncology / Wspólczesna Onkologia

  • No preview · Article · Sep 2014 · European geriatric medicine

  • No preview · Article · Sep 2014 · European geriatric medicine

  • No preview · Article · Sep 2014 · European geriatric medicine
  • Vasile Cepoi · Ioana Dana Alexa · Adina Carmen Ilie · Ovidiu Alexa
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    ABSTRACT: In this study we focused on the ethical dilemmas that confront physicians while approaching therapeutical management of elderly patients, especially those exposed to polypragmasy and iatrogeny. We explore the main universal ethical principles such as autonomy, beneficence, non-maleficence, justice and equity and the challenges the medical team faces while trying to reconcile them with several particular aspects characteristic to elderly patients such as: fragility, disability, comorbidity, cognitive and functional impairment, and a greater risk of polypharmacy, polypragmasy, and iatrogeny. Building a strong physician - patient relationship based on mutual trust and respect is the key to understanding the needs and desires of the elderly, which may be completely different from other age groups, and their possibilities to adhere to medical recommendations. Multidisciplinary teams, representing professionals from diverse disciplines coordinated by the general practitioner and/or the geriatrician should help solving difficult ethical dilemmas.
    No preview · Article · Jul 2014 · Revista românǎ de bioeticǎ
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    Beatrice Ioan · Teodora Alexa · Ioana Alexa
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    ABSTRACT: Introduction. the correct registration of the external traumatic lesions is extremely important in the clinical management of the trauma, as well as in its forensic and judicial assessment. Nevertheless, the quantity and quality of the information registered in the observation charts may be suboptimal, thus significantly affecting the forensic assessment regarding the cause of death, the relationship between lesions and death, and therefore the judicial implications of the case. Material and method. We have conducted a study on a sample of 77 consecutive deaths by violence, all examined at the Institute of Legal Medicine in Iasi. A comparative analysis was conducted of the external lesions documentation in the observation chart and the forensic autopsy report, and a degree of consistency was established between the two. For each case a series of data was collected and then statistically analyzed in order to observe the existence of a correlation between the degree of accordance and of the two examinations and the registered parameters. Results. the present study has found 62.3% discordant cases. From the selected parameters, three were correlated to the degree of concordance, having the capacity to foretell whether an external lesion would be registered correctly in the observation chart: the biochemical analysis level - patients who received complete blood investigations were more frequently subject to complete skin examination in the clinic; the existence of a surgical intervention - concordance was higher in patients who suffered a surgical intervention during hospitalization; cause and context of death - patients who died as a result of burns or electrocution showed perfect concordance in 100 % of cases, while less than 3 % of patients who died in the context of aggression were recorded all types of injury. Conclusions. Better documentation of external injuries in hospital is many times essential for the medico-legal evaluation and the subsequent judicial implications. While there are factors that may explain the disregard of the registration of all traumatic marks, in the context of lack of time and the need for quick delivery of treatment, the importance of the observation sheet as a document of medico-legal and legal value must be recognized by all physicians.
    Full-text · Article · Jun 2014 · Romanian Journal of Legal Medicine
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    ABSTRACT: Hypoalbuminemia is considered an independent predictor of mortality, especially in elderly patients. It is common in patients with congestive heart failure, when is due to several mechanisms: increased volume of distribution, significant stasis in the mesenteric circulation and altered protein metabolism in the liver. These alterations are even more pregnant when tricuspid regurgitation is associated or aggravated by different risk factors (recent infections, anemia, hyperthyroidism). We present the case of an elderly patient with severe hypoproteinemia and important hypoalbuminemia associated with congestive heart failure and aggravation of tricuspid regurgitation. The differential diagnosis concluded that hypoalbuminemia was influenced by tricuspid regurgitation as it enhanced liver dysfunction and enteral protein absorption due to increased stasis in mesenteric system. On the other hand, hypoalbuminemia contributed to the progression of heart failure by favoring myocardial edema, volume overload, and diuretic resistance. This is why correct management of this situation should include removal of subclinical excess of fluid and renutrition. A multidisciplinary approach is needed in order to achieve a good control of the symptoms and a significant improvement of quality of life.
    No preview · Article · Apr 2014
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    ABSTRACT: Aim: The present study aims to evaluate whether ascorbic acid (AA) and curcumin, two substances with redox properties, have similar effects on different models of pain in mice. Materials and methods: This study included a total of 28 mice that were divided into four groups. One group (AA) received intraperitoneally 500 mg/kg b.w. AA for 21 days and the 2-nd group (curcumin) received 120 mg/kg b.w. curcumin by gastric gavage for two weeks. Other two groups serve as control and received vehicle in a dose--time manner similar to that of the treated groups. The pain models (oro-facial formalin induced pain, paw formalin induced pain and visceral pain) were performed 24 h after the last dose. Results: When compared with control groups, curcumin significantly decreases pain perception in oro-facial (p = 0.01 1-st phase, p = 0.002 2-nd phase) and paw formalin induced pain (p = 0.04 1-st and 2-nd phase) while AA stimulates pain perception in acid acetic induced visceral pain (p = 0.05) and increases oro-facial inflammatory pain induced by formalin ( p = 0.02) but demonstrates analgesic effects on paw formalin induced pain (p = 0.003 1-st phase, p = 0.01 2-nd phase). Conclusions: ROS production is important in pain modulation. Structures involved in the process of pain have different antioxidant defense capacities. Curcumin and AA are able to modulate pain perception, but beside their antioxidant capacities, there are other mechanisms involved.
    No preview · Article · Apr 2014
  • Ioana Dana Alexa · Adina Carmen Ilie · Anca Moroşanu · Ana Voica
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    ABSTRACT: Ageing is inevitably associated with a decline in physiologic reserves. Frailty results from reaching a threshold of decline across multiple organ systems. By consequence, it is associated with a high vulnerability and reduced ability to maintain homeostasis. This vulnerability is not only age-related, but also related to disability and comorbidity, as illustrated by three clinical cases. Sarcopenia, which is defined as age-related loss of muscle mass, is considered to be a central manifestation of frailty. In addition to being highly prevalent in elderly population, frailty also exerts a substantial impact on quality of life. As it is extremely challenging by defying conventional medication and involving new therapeutically approaches, frailty fully qualifies as a new geriatric syndrome.
    No preview · Article · Feb 2014
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    ABSTRACT: Self-medication is a widespread practice to treat health problems, being involved in delayed diagnosis, worsening of disease evolution and the occurrence of adverse effects.
    No preview · Article · Jan 2014
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    ABSTRACT: Schizophrenia as severe mental disorder is characterized by a disintegration of the process of thinking and of emotional responsiveness whereas the underlying mechanisms of schizophrenia are complex and still discussed. The objective of this study is to find out if patients with schizophrenia and their healthy first-degree relatives have abnormal autonomic nervous system (ANS) activity by measuring cardiac indices as QT variability index (QTVI). Moreover, it is useful to study if ANS dysfunction could play an important role in schizophrenia and if abnormal functioning could be retrieved by patients' healthy first degree relatives. Also, a parallel experiment monitored QTVI in healthy controls before, during and after a new complex stress test named Mannheim Multicomponent Stress Test (MMST). As QT variability analysis results were not significantly different during MMST versus normal state, we concluded that short-term stress has no fundamental impact on ECG morphology in healthy subjects. However, patients with schizophrenia revealed an increased QTVI that indicates structural changes of ECG morphology in those patients. These findings were obviously independent from the findings regarding to healthy subjects under stress and healthy subjects (basic measurement of 30min).
    Full-text · Conference Paper · Nov 2013
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    ABSTRACT: Therapeutic adherence represents the extent to which the patient's behavior follows medical recommendations. It is a complex process that strongly influences the quality of life of the each and everyone. We performed a retrospective study that included 126 very old patients (≥ 80 years old). Patients' data were recorded in a database that contained demographic and clinical data and information about patient's current medication. Information about therapeutical adherence was collected for each person by way of a questionnaire, which consisted in verifying their knowledge about their diet and medication and comparing it with information from past medical records or family members. We found several factors that influence adherence to treatment: living in the urban area, the number of pills prescribed by the general practitioner and a strong familial and financial support. Fighting non-adherence should rely upon two complementary directions: the multidisciplinary medical approach and the telemonitoring and e-health systems.
    No preview · Conference Paper · Nov 2013
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    ABSTRACT: A complex goal in biomedical information technology today is the design and implementation of telemedicine and e-health solutions, which provide (chronic) patients and elderly people services that can enhance their quality of life. We used wireless sensor network technology, low-power integrated embedded systems and wireless communications, which have enabled us the design of low-cost, miniature, precise and intelligent physiological sensor modules. These modules are capable of measuring, processing, communicating one or more physiological parameters, and can be integrated into a wireless personal area network (WPAN). We have designed, deployed, produced and tested both hardware and software medical sensors for WPAN, dedicated to vital signs acquisition, processing and transmitting, as well as the whole telemedical system for these physiologic parameters monitoring in real time. This paper is dedicated to the most complex Romanian telemedical pilot project, TELEMON, that has as goals the design and implementation of a system for automatic and complex telemonitoring, everywhere and every time, in (almost) real time, of the vital signs of persons with chronic illnesses, of elderly people, of those having high medical risk and of those living in isolated regions. The final objective of this pilot project is to enable personalized telemedical services, and to act as a basis for a public service for telemedical procedures in Romania and abroad.
    No preview · Article · Aug 2013
  • Gabriel Prada · Alexa I · Nacu R · Tapelea E · Prada S · Ignat I · Fita I

    No preview · Conference Paper · Jun 2013
  • C I Axinte · Teodora Alexa · Irina Cracana · Ioana Dana Alexa
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    ABSTRACT: When assessing an acute coronary syndrome (ACS) by means of high serum levels of creatine kinase (CK) and its MB fraction (CK-MB), one must keep in mind that there are several other causes for an increase of these markers, such as myocarditis, pericarditis, heart failure, severe aortic stenosis, stroke, renal failure, malignant hyperthermia, Reye syndrome, polymyositis, and borreliosis (1). Also, there are cases when CK-MB is falsely increased due to certain abnormalities that occur in the CK isoenzymes. One such example is the formation of the so-called macro-creatine kinase complexes (macro-CK) that give a false increase of the CK-MB fraction. We report two clinical cases where macro-CK was the cause of apparent increase in serum CK and CK-MB: in a 79-year old male with a history of coronary disease and a 82-year old female with permanent atrial fibrillation.
    No preview · Article · May 2013
  • O. Alexa · B. Veliceasa · R. Malancea · I.D. Alexa
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    ABSTRACT: Obtaining an informed consent is both a legal and a moral obligation before every surgery. Postoperative permanent cognitive disorder is a common complication in elderly people, influencing prognosis regarding mortality and quality of life, rarely mentioned in the informed consent form. MATERIALS AND METHODS: We performed a prospective study that included 50 patients, 65 or older who underwent total hip replacement (THR) between 2009 and 2012. Every patient was evaluated by MMSE in order to assess cognitive status; the evaluation was performed in a preoperatory stage, on a daily basis following surgery and as well 3 months after surgery. According to the results, patients were divided in two groups: group A- MMSE ≥ 25 and group B - MMSE < 25. RESULTS: Following MMSE testing we have identified 33 patients whose score was ≥ 25 (group A) and 17 patients with MMSE score < 25 (group B). Patients in group A had a mean MMSE of 27.8 pre-operatively, with no change at discharge and after 3 months postoperatively; in group B, the average obtained for preoperatory MMSE was 22.8 points, 20.82 (p = 0.0028) at discharge and lower at 3 months (p = 0.013). The factors that mostly influenced the cognitive status at 3 months postoperatory were the preoperatory MMSE value (p< 0.0001) and the value of cognitive status at the time of discharge (p<0.0001). CONCLUSIONS: The main post-surgery cognitive decline risk factor in geriatric patients is the pre-surgery cognitive status, and based on the data obtained, we are recommending a pre-surgery cognitive evaluation, as well as informing the patient over that possible complication following THR.
    No preview · Article · Jan 2013 · Revista Romana de Bioetica