Levodopa-Carbidopa-Entacapone Intestinal Gel in Advanced Parkinson Disease: A Multicenter Real-Life Experience.

BACKGROUND: For Parkinson disease (PD) patients who have been diagnosed with advanced disease that can no longer be effectively controlled with optimized oral or transdermal medications, a range of device-aided therapies (DAT) are available, comprising either deep brain stimulation or infusion therapies providing continuous dopaminergic stimulation. Levodopa-entacapone-carbidopa intestinal gel (LECIG) infusion is the latest DAT for advanced PD (APD) that was approved in Romania in 2021. STUDY QUESTION: What is the experience to date in real-world clinical practice in Romania regarding the efficacy and tolerability of LECIG in APD? STUDY DESIGN: A retrospective evaluation of 74 APD patients treated with LECIG at 12 specialized APD centers in Romania. MEASURES AND OUTCOMES: Demographic data and various clinical parameters were recorded, including Mini Mental State Evaluation score or Montreal Cognitive Assessment Test score. Levodopa-equivalent daily dose and the administered doses of levodopa and other PD medications were evaluated at baseline and after starting LECIG treatment. The efficacy of LECIG in reducing daily hours of off time, motor fluctuations, and dyskinesias were assessed. Any percutaneous endoscopic gastrojejunostomy system or device complications after starting LECIG treatment were noted. RESULTS: At baseline, patients were taking oral levodopa for a mean of 5.3 times per day, with a high proportion also taking concomitant add-on therapies (dopamine agonists, 86%, monoamine oxidase type-B inhibitors, 53%; catechol-O-methyltransferase inhibitors, 64%). LECIG treatment significantly reduced daily off time versus baseline from 5.7 h/d to 1.7 hours per day ( P < 0.01). Duration and severity of dyskinesias was also significantly reduced versus baseline, and improvements were observed in Hoehn and Yahr Scale scores. LECIG treatment also allowed a significant reduction in the use of concomitant oral medications. CONCLUSIONS: These findings suggest that LECIG treatment is an effective DAT option in APD that can simplify the treatment regimen.

The Motivation of Medical Staff and the Work Interestedness in the Context of the COVID-19 Pandemic, in a Tertiary Hospital in Romania.

The purpose of this study was to evaluate the impact of the COVID-19 pandemic on the motivation and work interestedness of employees in a tertiary hospital located in the northwest of Romania. In the study, 2230 employee satisfaction questionnaires distributed during 2019-2021 in the Oradea Emergency County Clinical Hospital (CCEHO) were analyzed. The percentage of those who declare themselves motivated at the hospital level remains relatively constant, at around 75%. There were differences between staff categories. The percentage of those who evaluate work interestedness with the qualifier "high" decreased from 45.45% for the year 2019 to 41.78% for the year 2021. The degree of motivation and work interestedness showed a significant increase for TESA staff during the pandemic period compared to the year 2019. A non-significant statistical increase in the percentage of motivated staff was observed among physicians, auxiliary staff and the radiology department staff. The motivation of nurses and laboratory staff decreased, but statistically insignificantly. The COVID-19 pandemic brought statistically significant changes at the level of motivation of the hospital staff only for the administrative staff, and the work interestedness for physicians and nurses decreased statistically significantly, especially in the second year of the pandemic. Older staff with an average level of education are more likely to be unmotivated, as shown by the regression model.

Quality of acute stroke care in Romania: Achievements and gaps between 2017 and 2022.

Romania has one of the highest incidences of stroke and one of the highest mortality rates in Europe. The mortality rate due to treatable causes is also very high and is associated with the lowest public spending on healthcare in the European Union. Nonetheless, significant achievements in acute stroke care have been made in Romania in the last 5 years, most notably the increase of the national thrombolysis rate from 0.8% to 5.4%. Numerous educational workshops and constant communication with the stroke centers led to a solid and active stroke network. Due to the joint efforts of this stroke network and the ESO-EAST project, the quality of stroke care has significantly improved. However, Romania still faces many problems: a major lack of specialists in interventional neuroradiology and consequently a low number of stroke patients treated by thrombectomy and carotid revascularization procedures, a low number of neuro-rehabilitation centers and a country-wide lack of neurologists.

Evaluation of Geriatric Sarcopenia and Nutrition in the Case of Cachexia before Exitus: An Observational Study for Health Professionals.

It is important to assess the physical and nutritional status of the body using a bioelectrical impedance analyzer (BIA) in patients with cachexia; however, the correlation between cachexia and nutritional evaluations remains unclear. The objective of this study is to follow the effects of diet therapy in patients with cachexia/sarcopenia, using parameters measured by BIA, clinical parameters, and other nutrition-related assessments in patients with osteoporosis. This study aims to clarify the correlation between BIA-measured parameters, clinical parameters, and other nutrition-related assessments. Methods: Measurements of body composition, a clinical assessment of the sarcopenia/cachexia, and nutritional goal setting/a nutrition care process were performed. Results: The number of subjects was 200, of which 15 people (7.5%) were diagnosed with sarcopenia/cachexia. Univariate analyses showed that participants with a high body-fat mass tend to develop sarcopenic obesity (p = 0.029), those who lost a significant and progressive amount of muscle mass tend to develop sarcopenia (p = 0.001), as well as those with malnutrition (p < 0.001). The regression study shows not only the correlation but also the cause of the correlation, as is the case with obesity. As obesity increases, so does the sarcopenic index (this can explain sarcopenic obesity), and as fat mass decreases it leads to muscle mass loss, increasing the risk of cachexia with age. Conclusions: There was an improvement, but statistically insignificant, in cachexia and the nutritional objectives (p > 0.05); at the same time, correlations were established between the independent parameters (sex, age) and malnutrition parameters (hemoglobin and amylase) with the parameters of the research.

Oral Health among Elderly, Impact on Life Quality, Access of Elderly Patients to Oral Health Services and Methods to Improve Oral Health: A Narrative Review.

Dental health is often neglected among the elderly because of the numerous comorbidities in this population, such as cardiovascular diseases. However, dental health influences general health and quality of life by impacting both the general health and the psychological state of the individual. The present review highlights the main dental comorbidities in the elderly population, their impact on the quality of life, the barriers towards access to dental care in the elderly and methods to improve their dental health. Information related to dental care and its importance must be provided both to older individuals and their caregivers in order to detect dental pathology and treat it adequately. Ensuring dental health involves the whole society of elders, caregivers, dental care providers, the public sector, health policymakers, and the private sector.

Diabetic neuropathy: A narrative review of risk factors, classification, screening and current pathogenic treatment options (Review).

Diabetic neuropathy (DN) is a frequent complication of diabetes mellitus (DM) with severe consequences as it progresses and influences all human body systems. This review discusses the risk factors for DN, the main characteristics of the clinical forms of DN, the screening methods and the current therapeutic options. Distal symmetric DN is the primary clinical form, and DM patients should be screened for this complication. The most important treatment of DN remains good glucose control, generally defined as HbA1c ≤7%. Symptomatic treatment improves life quality in diabetic patients. Pharmacological agents such as alpha (α)-lipoic acid and benfotiamine have been validated in several studies since they act on specific pathways such as increased oxidative stress (α-lipoic acid exerts antioxidant effects) and the excessive production of advanced glycosylation products (benfotiamine may inhibit their production via the normalization of glucose). Timely diagnosis of DN is significant to avoid several complications, including lower limb amputations and cardiac arrhythmias.

Distress in neurocognitive disorders due to Alzheimer's disease and stroke.

Patients with neurocognitive disorders experience subjectively the concept of quality of life; this is the reason why researchers avoid approaching this concept and prefer to focus attention on the emotional profile of the caregivers. Many studies highlight the efforts both emotional and financial made by caregivers in case of patients diagnosed with neurocognitive disorders. The present study shows the differences between the patients diagnosed with neurocognitive disorder due to Alzheimer's disease and patients diagnosed with stroke, as well as the Romanian norms for the short form of Geriatric Depression Scale. The study group consisted of the clinical population (N=45), selected according to the inclusion/exclusion criteria, following the principles of Helsinki Declaration for Ethical Medical Research. The study was conducted at the Neuropsychiatry section of the Municipal Clinical Hospital, Dr Gavril Curteanu, Oradea, Romania. The results showed significant differences between the two types of patients in terms of quality of life, t(43)=-7.99, P=0.001, affective distress, t(43)=5.10, P=0.001 and perceived stress, t(43)=3.81, P=0.001. The internal consistency of the scale is high, the coefficient KR-20 being 0.86.

Intradiploic epidermoid cysts - a series of three cases and our experience with literature data.

Intracranial epidermoid cysts are rare, representing almost 1% of all primary tumors and when are located in the diploe result from entrapped ectodermal embryonic remnants. Because of frequent complications, imaging studies are mandatory for highlighting erosions of both outer and inner table of the calvaria and treatment preparation. We enlisted three female patients within our study, comparing imaging with histopathology aspects. Even though the bone destruction was evident, no atypia or malignant signs were highlighted in serial sections. The interesting fact that we present is that our patients are all females, opposed to what is written in literature. Although the positive diagnosis can be made by imaging, histopathological examination of these cysts is mandatory for identifying malignant behavior.

Legal medicine implications in fibrinolytic therapy of acute ischemic stroke.

BACKGROUND: Before the advent of fibrinolytic therapy as a gold standard method of care for cases of acute ischemic stroke in Romania, issues regarding legal medicine aspects involved in this area of medical expertise were already presented and, in the majority of cases, the doctors seem to be unprepared for these situations. MAIN TEXT: The present research illustrates some of the cases in which these aspects were involved, that adressed a clinical center having 6 years of professional experience in the application of fibrinolytic treatment for stroke. The following cases report either situations in which the afore mentioned therapy was not rightfully administrated or legal aspects regarding the obtainment of informed consent. CONCLUSION: Obtaining informed consent is a mandatory procedure, which takes time, to the detriment of application of fibrinolytic treatment.

Improving performance of a pharmacy in a Romanian hospital through implementation of an internal management control system.

According to general principles of good practice, adopted at the international level, quality control is a key function in management and not just a simple means of verification. In a clinic or hospital pharmacy, the chief pharmacist has the training and authority to take the control measures necessary to develop and implement an Internal Managerial Control System (IMCS). The present article analyzes and describes the case of the County Hospital of Oradea, Romania, and presents how the IMCS was adopted and integrated. Quality assessment in the health services takes place via an accreditation process and quality certification, as well as through an internal audit of the hospital pharmacy. The authors report a retrospective and descriptive study carried out from 2012 to 2017, analyzing how current legislative standards are applied. The IMCS in the hospital pharmacy is a dynamic process of continuous transformation, permanently adapted to hospital requirements, achieved under the direction of the chief pharmacist and involving all pharmacy employees, as well as through good coordination practices applied by hospital management. In this specific case, the IMCS features 11 annually updated compliance standards, classed under the headings of work procedures, risk register, job descriptions and staff training. The pharmacy's good practice model for IMCS development, was adopted by all of the hospital's sectors, services and departments.

General aspects of the morbidity in Alzheimer's dementia during 2003-2005 at the Neurology and Psychiatry Clinical Hospital Oradea.

UNLABELLED: This paper proposes to study some general aspects about the morbidity due to Alzheimer's dementia at the Neurology and Psychiatry Clinical Hospital Oradea. MATERIAL AND METHOD: The study was made based on the observation sheets of the patients with Alzheimer disease hospitalised at the Clinical Hospital of Neurology and Psychiatry Oradea, in 2003-2005. RESULTS: From 34 hospitalised cases the most affected age group was that coresponded to 71 - 80 years old with 64.71%; the women are prevalent with 64.71%; 55.88% occurred at the rural population and 52.95% have an elementary level of education. CONCLUSIONS: The percentage of patients with Alzheimer's in the psychiatric section of the Clinical Hospital of Neurology and Psychiatry, in 2003-2005, was of 1%. Alzheimer's dementia is prevalent in women. The frequency of Alzheimer's disease among the rural population is bigger than the urban population and is greater at the people who have an elementary educational level. Most of the patients showed an improved general health condition when leaving the hospital.

Incidence, antibiotic resistance and clonal relations of MRSA strains isolated from a Romanian university hospital.

Our aim was to estimate the frequency and characteristics ofmethicillin-resistant Staphylococcus aureus (MRSA) strains occurring in a Romanian teaching hospital. We retrospectively studied isolates from infected or colonized patients treated at the intensive care and surgical units during January 2004-December 2005. The antibiotic susceptibility of MRSA strains and the presence of mecA gene were determined. Consecutively occurring strains isolated through a three-month period were typed using pulsed field gel electrophoresis. A total of 423 S. aureus strains were identified, methicillin-resistance was detected in 211 (49.9%) strains. Most of them were multiresistant. One of the MRSA genotypes identified by PFGE was commonly recovered from patients treated in the intensive care unit. According to our results, MRSA strains were frequently isolated pathogens in our hospital and there is an urgent need to enhance infection control efforts.

[Chemoresistance of mycobacteria in a group of patients with tuberculosis from Mures county]. / Chimiorezistenta micobacteriilor la un lot de pacienti mureseni cu tuberculoza.

AIM: We studied tuberculosis drug-resistance cases related to risk factors involved, in Mures district. METHODS: We used clinical files of 91 patients with tuberculosis drug resistance from 2006 at all, diagnosed during 2002-2006 at the Ambulatory department of Tuberculosis Clinic in Tg. Mures town and cities nearby. RESULTS. Mycobacterium drug resistance is more frequent at men (96.8%), because of multiple tuberculosis risk factors involved, also is more frequent in rural areas (52.8%) because of low access to medical services. Drug resistance rate have a direct growing related to number of treatments made before, at patients with therapeutic failure and chronic cases. In our study, first year was dominated by single drug resistance to NIH, with a decrease in 2004 and no cases in 2006; and also multi-drug resistance was placed on the first place by frequency in 2006. CONCLUSIONS: We sustain the needs to intensify the general efforts on tuberculosis early diagnosis, also to increase the medical education on all levels, government financial support and trained staff a good monitoring program during tuberculosis evolution in specific centers of diagnostic and treatment of multi-drug resistance cases in Mures district.

Zygote arrest 1 gene in pig, cattle and human: evidence of different transcript variants in male and female germ cells.

BACKGROUND: Zygote arrest 1 (ZAR1) is one of the few known oocyte-specific maternal-effect genes essential for the beginning of embryo development discovered in mice. This gene is evolutionary conserved in vertebrates and ZAR1 protein is characterized by the presence of atypical plant homeobox zing finger domain, suggesting its role in transcription regulation. This work was aimed at the study of this gene, which could be one of the key regulators of successful preimplantation development of domestic animals, in pig and cattle, as compared with human. METHODS: Screenings of somatic cell hybrid panels and in silico research were performed to characterize ZAR1 chromosome localization and sequences. Rapid amplification of cDNA ends was used to obtain full-length cDNAs. Spatio-temporal mRNA expression patterns were studied using Northern blot, reverse transcription coupled to polymerase chain reaction and in situ hybridization. RESULTS: We demonstrated that ZAR1 is a single copy gene, positioned on chromosome 8 in pig and 6 in cattle, and several variants of correspondent cDNA were cloned from oocytes. Sequence analysis of ZAR1 cDNAs evidenced numerous short inverted repeats within the coding sequences and putative Pumilio-binding and embryo-deadenylation elements within the 3'-untranslated regions, indicating the potential regulation ways. We showed that ZAR1 expressed exclusively in oocytes in pig ovary, persisted during first cleavages in embryos developed in vivo and declined sharply in morulae and blastocysts. ZAR1 mRNA was also detected in testis, and, at lower level, in hypothalamus and pituitary in both species. For the first time, ZAR1 was localized in testicular germ cells, notably in round spermatids. In addition, in pig, cattle and human only shorter ZAR1 transcript variants resulting from alternative splicing were found in testis as compared to oocyte. CONCLUSION: Our data suggest that in addition to its role in early embryo development highlighted by expression pattern of full-length transcript in oocytes and early embryos, ZAR1 could also be implicated in the regulation of meiosis and post meiotic differentiation of male and female germ cells through expression of shorter splicing variants. Species conservation of ZAR1 expression and regulation underlines the central role of this gene in early reproductive processes.