Tuberculosis impacts multiple aspects in quality of life in a Romanian cohort of drug-susceptible and drug resistant patients: A patient-reported outcome measures study.

BACKGROUND: Tuberculosis (TB), and especially its drug resistant forms, is responsible for not only significant mortality, but also considerable morbidity, still under-quantified. This study used four Patient-Reported Outcome Measures (PROMS) to assess the status of persons affected by drug-susceptible and drug-resistant TB during their TB treatment or after treatment completion, in Romania, the highest TB burden country in the EU. METHODS: People affected by TB in two different regions in Romania were included during and after treatment, following a cross-sectional design. PROMs used were SF-36, EQ-5D-5L, WPAI and the app-based audiometry screening tool 'uHear.' Descriptive statistics and relevant statistical tests were used to compare groups between themselves and with the general Romanian population. RESULTS: Both patients with drug-susceptible and drug-resistant TB experience, with drug-resistant patients experiencing statistically significantly more pain and hearing loss. PROMs show some improvement in the after-treatment group; however, compared with the general Romanian population for which data were available, all groups scored lower on all outcome measures. CONCLUSION: PROMs offer the possibility of obtaining a more comprehensive view of patients' status, by involving them directly in the medical process and could guide a rehabilitation strategy.

Associated Bacterial Coinfections in COVID-19-Positive Patients.

Background and Objectives: The aim of this study was to identify specific rhino- and oropharyngeal microbiological pathogens as well as associated comorbidities that favor SARS-CoV-2 infection and corelate them. Materials and Methods: This prospective clinical study enrolled 61 patients (28 COVID-19-positive and 33 controls) who were tested for other comorbidities and co-existence of associated oral pathogenic microbiota. Results: A total of 247 bacterial isolates were identified in the bacterial cultures in both groups. Viral hepatitis type A was more prevalent in the COVID-19-positive group (p = 0.026), as was the presence of oral candidiasis (p = 0.006). In the control group, a moderate direct relationship was observed between the Beta hemolytic streptococcus group G and dermatitis, and strong direct relationships were observed between the Beta hemolytic streptococcus group G and external otitis, Streptococcus pyogenes and dental alveolitis, and Streptococcus pyogenes and chronic lymphocytic leukemia. In the test group, strong direct relationships were observed between Hemophilus influenzae and pulmonary thromboembolism; Staphylococcus aureus and autoimmune thyroiditis; post-viral immunosuppression, chronic coronary syndrome, and hypernatremia; Beta hemolytic streptococcus group C and rheumatoid polyneuropathy; Beta hemolytic streptococcus group G and hyperkalemia, hypothyroidism, secondary anemia, and splenomegaly; and active oral candidiasis and SARS-CoV-2 viral pneumonia. The following relationships were strong, but inverse: Beta hemolytic streptococcus group G and acute respiratory failure, and active oral candidiasis and SARS-CoV-2 viral bronchopneumonia. Conclusions: Briefly, COVID-19-positive patients have the predisposition to build up associated comorbidities and coinfections, which can be the expression of the immune burden that this virus generates to the host.

Active Case-Finding: An Effective Solution for Tuberculosis Detection in Vulnerable Groups - The Romanian Experience.

Introduction: Tuberculosis (TB) remains a global health challenge, requiring enhanced active case finding (ACF) through screening strategies. This study assesses the effectiveness of such an approach in locating TB cases among vulnerable groups, such as homeless persons, injecting drug users, those detained in prison, and people living in rural areas. Methods: The study focuses on socio-economic characteristics and TB detection rates across Romanian counties using modern techniques including computer-aided detection of lesions on chest X-ray and GeneXpert tests. Results: The results highlight the disproportionate burden of TB in vulnerable groups, by revealing significant differences in TB detection rates between regions. Notably, the TB detection rates among these vulnerable groups (250.85 per 100,000 population) are five times higher than the national incidence rate (46.1). Discussion: These findings underscore the imperative integration of ACF into National TB Program to provide customized and efficient solutions for diverse vulnerable groups, thereby informing crucial public health initiatives and interventions.

Sleep Quality Aspects in Post-COVID-19 Patients.

In this observational cohort study, sleep quality in post-COVID-19 patients was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. This study aimed to examine aspects of sleep quality in patients who have undergone SARS-CoV-2 infection and if there is a pattern of progression or regression over time (6 months). We also observed and analyzed the results in order to identify any possible links between the severity of COVID-19 and sleep quality as measured by the PSQI questionnaire. The study group consisted of 65 adult patients with confirmed SARS-CoV-2 infection who were referred to a pulmonologist for evaluation. Sleep quality was impacted at a high rate in post-COVID-19 patients, quantified by a PSQI score ≥5. Out of 65 patients, 51% of them had scores greater than or equal to 5. Sleep was subjectively reported as unsatisfactory predominantly in mild and moderate COVID-19 patients. According to the PSQI score and a 6-month follow-up, many patients presented persistency in poor sleep quality. Investigation and individualized treatment of sleep disorders in post-COVID-19 patients should be part of the routine pneumological control, as improvement in sleep quality has an impact not only on the health but also on the psychological state of patients. Educating patients about the importance of sleep and sleep quality impairment should be a primary concern.

Co-Occurrence of Rheumatoid Arthritis and Lung Cancer-Coincidence or Not?

Bronchopulmonary cancer is the leading cause of cancer deaths globally. Rheumatoid arthritis is one of the risk factors for lung cancer, and those who use methotrexate have a higher risk of developing lung cancer. We present the case of an 80-year-old patient who is a former smoker and is known to have rheumatoid arthritis, being treated using methotrexate; they were brought by ambulance to the emergency room for coughing with ineffective expectoration, dyspnea on slight exertion, and right-lateral chest pain with onset about one month prior and progressive worsening. Imaging showed a 7 cm/6 cm LID tumorous lung formation with parietal invasion and C7 rib lysis, as well as diffuse fibrotic interstitial changes predominantly in the lower lobes. An ultrasound-guided transthoracic lung biopsy was performed, and histopathological examination established the diagnosis of invasive squamous cell lung carcinoma, G2. In conclusion, the chest pain interpreted by the patient as rheumatic pain delayed the diagnosis of lung cancer; the patient presented rather late to the hospital once respiratory failure set in.

Tuberculosis Surveillance in Romania Among Vulnerable Risk Groups Between 2015 and 2017.

Purpose: Romania has the highest tuberculosis (TB) burden in the European Union/European Economic Area (EU/EEA) comprising almost a quarter (23.4%) of the reported patients in 2017, and a TB notification rate six times higher than the EU/EEA average. Although the overall TB notification rate in Romania declined from 154/100.000 individuals to 66/100.000 individuals in the general population between 2002 and 2017, TB notification rates remain high in certain vulnerable populations groups such as prisoners, the homeless population and among drug users. Patients and Methods: We conducted a descriptive study regarding TB monitoring data in Romania, including the aforementioned TB risk groups. Results: Analysis regarding notified TB cases among these risk groups indicates that TB rates are 7 to 18 times higher than in the general population. One of the most alarming aspects regards the exceedingly high proportion of HIV-seropositivity among drug users and the high mortality rates among the homeless population and among drug users with TB. Conclusion: This data underlines the importance of early identification among social risk groups using outreach active case-finding (ACF) activities, possibly combining TB screening with screening for other common, possibly life-threatening, co-morbidities for which an effective treatment is available. ACF could have a decisive role in TB control and eradication in Romania, when aimed at these high-risk groups.

The Efficiency of Photodynamic Therapy in the Bacterial Decontamination of Periodontal Pockets and Its Impact on the Patient.

Research in the field of periodontal disease continues to focus on disease-associated microorganisms, as the microbial plaque and the host immune responses are considered to be important causative factors, that are highly responsible for the progression of this disease. The purpose of this article is to compare the reduction in the number of specific periodontopathogens in two test groups according to different therapeutic approaches in periodontal disease and to show possible differences. This article is based on a prospective clinical study involving eighteen subjects with forty-four average periodontal pockets assigned to study groups treated by two different methods, SRP and SRP followed by a single PDT application. Efficiency in removing specific bacterial species was evaluated by PCR testing, at baseline and immediately after treatment. The hypothesis that using SRP + aPDT results in an increased decontamination potential was confirmed statistically, when all five specific bacterial pathogens were investigated together. When the pathogens were considered separately, two of the five microorganisms tested were significantly lower in the SRP + PDT group (p < 0.00), and important germ counts reductions were also observed for the other three. There is also a statistically significant relation between the pain at 48 h postoperatively and the type of treatment the patients received, as resulted from the Questionnaire Form. Our results demonstrate that aPDT, as an adjunctive treatment to conservative mechanical cleaning of root surfaces at sites affected by periodontitis, represents an effective tool in terms of reducing specific periodontopathogen germs.

An Up-to-Date Literature Review on Ventricular Assist Devices Experience in Pediatric Hearts.

Ventricular assist devices (VAD) have gained popularity in the pediatric population during recent years, as more and more children require a heart transplant due to improved palliation methods, allowing congenital heart defect patients and children with cardiomyopathies to live longer. Eventually, these children may require heart transplantation, and ventricular assist devices provide a bridge to transplantation in these cases. The FDA has so far approved two types of device: pulsatile and continuous flow (non-pulsatile), which can be axial and centrifugal. Potential eligible studies were searched in three databases: Medline, Embase, and ScienceDirect. Our endeavor retrieved 16 eligible studies focusing on five ventricular assist devices in children. We critically reviewed ventricular assist devices approved for pediatric use in terms of implant indication, main adverse effects, and outcomes. The main adverse effects associated with these devices have been noted to be thromboembolism, infection, bleeding, and hemolysis. However, utilizing left VAD early on, before end-organ dysfunction and deterioration of heart function, may give the patient enough time to recuperate before considering a more long-term solution for ventricular support.

Surgical reconstruction of post-tumoral facial defects.

PURPOSE: The face is an unfortunate location for any type of tumor - malignant or not - with significant esthetic and functional outcomes. To reconstruct a facial defect may seem simple, but can be rather complicated. The aim of this study is to analyze and discuss our results in order to conclude with specific surgical strategies correlated with the morphopathological results. The most important objective for us is to offer the highest level of expertise to our patients and to prove that the symbiosis between the surgical treatment and the work of the Department of Morphopathology is essential in order to maximize the quality of medical care provided for our patients. PATIENTS, MATERIALS AND METHODS: A retrospective study was conducted on 116 patients diagnosed with facial malignant tumors, 70 of which were confirmed as basal cell carcinomas (BCCs), 35 confirmed as squamous cell carcinomas (SCCs) and 11 malignant melanomas (MMs). Most BCC cases (57) showed ulceration, with a long clinical evolution (more than 10 years) in 48 cases. Only in 12 SCC cases, patients showed inflammation and ulceration, with a shorter evolution period (2-5 years). For complete microscopic diagnosis, immunohistochemical (IHC) examination was necessary in 46 cases. The BCC "deceiving" clinical behavior and the generally aggressive character of the MM were found in our patients as well. RESULTS: The most frequent sites were the orbital region (27 cases) and the nasolabial sulcus (26 cases). In order to reconstruct the postexcisional defects, we had to perform local flaps in 62 cases (14 frontal flaps for orbital defects, 32 glabellar flaps for medial epicanthus, lower lid and nasal region, 15 nasolabial flaps for lower lid or nasal alae and one "Z"-plasty for the submental region). Oncological follow-up was performed in all patients and in 15 cases re-excision was necessary (11 BCCs, two SCCs and two MMs). Cervical lymph node metastasis occurred in six cases (three BCCs, one SCC and two MMs). CONCLUSIONS: The cooperation between surgeons and pathologists allowed for good outcomes and the pathology examination can guide the surgical approach towards better results both functionally and esthetically.

Associations of smoking with cardiometabolic profile and renal function in a Romanian population-based sample from the PREDATORR cross-sectional study.

BACKGROUND: The impact of smoking on morbidity is well known, but in Romania, limited data are available regarding the smoking prevalence and relationship with cardiometabolic profile and kidney function. OBJECTIVES: To assess the association of smoking with cardiometabolic traits and kidney function, in a Romanian population-based sample from the PREDATORR study. METHODS: PREDATORR was an epidemiological cross-sectional study. Between 2012 and 2014, participants were randomly selected from the lists of general practitioners and enrolled if they were aged 20 to 79 years, born and living in the past 10 years in Romania. Sociodemographic and lifestyle characteristics were collected through interviewer-administered questionnaires. RESULTS: Overall, 2704 participants were included in the analysis, 18% of them being current smokers and 30.8% former smokers. Current smokers compared to non-smokers had higher total cholesterol (220.6 ± 50.4 versus 213.9 ± 86.8 mg/dl, P = 0.017), LDL-cholesterol (137.8 ± 45.2 versus 130.7 ± 83.7 mg/dl, P = 0.004) and glomerular filtration rate (96.9 ± 16.8 versus 90.7 ± 19.1 ml/min/1.73 m2, P <0.001) in women and higher triglycerides (170.7 ± 129.8 versus 144.3 ± 94.2 mg/dl, P = 0.007), glomerular filtration rate (97.6 ± 17 versus 90.3 ± 18 ml/min/1.73 m2, P < 0.001) and lower HDL-cholesterol (48 ± 15.5 versus 50.4 ± 14.1 mg/dl, P = 0.002) in men. Active smoking was associated with hypercholesterolaemia [OR: 1.40 (95% CI: 1.01-1.96), P = 0.04] and low HDL-cholesterolaemia [OR: 1.39 (95% CI: 1.01-1.91), P = 0.04] and negatively associated with overweight/obesity [OR: 0.67 (95% CI: 0.48-0.94), P = 0.02]. Male former smokers had higher prevalence of abdominal obesity (82.4% versus 76.4%, P = 0.02), hypertriglyceridaemia (43.6% versus 35.6%, P = 0.01), hypertension (64% versus 56.4%, P = 0.01) and ischaemic vascular disease (40.5% versus 30.9%, P = 0.003) than male non-smokers. CONCLUSION: The PREDATORR study showed a high prevalence of smoking in the adult Romanian population providing data on the association of smoking with cardiometabolic traits.

Second-hand Smoking and CV Risk.

OPINION STATEMENT: Issues related to passive smoking have recently been addressed in the specialty literature, and they are particularly relevant from two perspectives: the effects on health and implications in the initiation of smoking among youth. The mechanisms by which tobacco smoke is involved in the pathology of heart disease are numerous, and are based not on a single action, but involve multiple factors. The effects of "second-hand" smoking on the cardiovascular system are evident in cardiovascular disease biomarkers seen in nonsmokers and the increased risk of mortality. In 2003, the World Health Assembly adopted the Framework Convention on Tobacco Control (FCTC), which was negotiated under the auspices of the World Health Organization (WHO) and is an evidence-based treaty promulgated with the intent of implementing effective policies for tobacco control. The effects of such policies have been documented in numerous studies. For example, the number of ER patients presenting with acute coronary events (myocardial infarction) has decreased 27-40 % in the U.S., 13 % in Italy, and 17 % in Scotland. The harmful consequences of passive smoking in cardiovascular and other organ systems must be confronted across the medical community. Cardiologists should unite with other specialists to encourage concerted legal action, economic measures, and public education as we work toward the tobacco endgame.

[Does the electronic cigarette have a future in medicine?]. / Tigara electronica are vreun viitor în medicina?

The electronic cigarette is a subject of lively debate in the literature and the legislative. We will review the updates regarding progress on this issue by analyzing the device, the electronic cigarette composition, legislative issues and medical strategy. All will be analyzed in terms of the benefits, but also the immediate and remote consequences

[Tobacco--will finally come to an end?]. / Tabagismul--va fi în final un sfârsit?

End of smoking is the dream of every antismoking fighter. But the way for realising this is extremely long. In this article we try to synthesize the ways to obtain an endgame, to implement strategies, posible dilemmas and limits. The key of success resides in combining anti-smoking policies of ministry of health and governments, assistance of strong addictive smokers and education of the population.

[Non-invasive ventilation in Romania -- results of an inquiry among lung physicians]. / Ventilatia non-invaziva în Romania -- rezultatele unui chestionar aplicat pneumologilor.

Non-invasive ventilation (VNI), although it is a validated strategy for many years with serious scientific studies, remains a matter of acceptance by Romanian colleagues. In this investigation on 140 valid questionnaires we found that VNI was used by 22.1% of lung physicians, with the highest percentage of those under 40 years (30.8%); the home ventilation was indicated by 35.7% of colleagues, but actually only very few of them (5.2%) have experience which enables them to assert that they have a current practice. The major part of indications are related to COPD, chronic hypercapnic respiratory failure. Shortages in this field are manifold: from lack of knowledge concerning the VNI benefits who generates uncertainty in guidance and monitoring, to zero home insurance coverage and shortage of equipment in hospitals and ambulatory services.

[Recurrent venous thromboembolic events--a prospective study]. / Trombembolismul venos recidivat--un studiu prospectiv.

UNLABELLED: The reccurency rate after venous thromboembolism (VTE) is high and risk factors for recurrent thromboembolic events were investigated only on a small scale. OBJECTIVES: estimating the cumulative incidence of recurrent venous thromboembolism after a first episode of venous thromboembolism, identification of risk factors for recurrent venous thromboembolism, of the optimal methods of diagnosis and establish a proper treatment protocol. METHOD: we conducted a prospective study for 2 years on 401 patients with objectively verified symptomatic VTE. Medical records were reviewed for all patients during follow-up and episodes of recurrent thromboembolism were recorded. RESULTS: the incidence of recurrent venous thromboembolic events at 2 years was 16.54% after a first episode of VTE. The incidence of fatal pulmonary embolism after 2 years was 4.54%. Proximal deep venous thrombosis (DVT), malignancy and history of venous thromboembolism predict an increased risk of recurrent events. Postoperative DVT and long-term oral anticoagulant treatment involve a lower risk of recurrent events. Sex, age, initial antithrombotic therapy or immobilization did not affect the risk of a recurrent event. Correctly managed anticoagulant therapy decreases the reccurency rate. CONCLUSIONS: The recurrence rate after a symptomatic DVT is high. Patients with proximal DVT; diagnosed cancer, short-term oral anticoagulant treatment or a history of thromboembolic events had a higher risk of recurrent events, while patients with postoperative DVT, but without neoplasia had a lower recurrence rate.

[Adherence to CPAP- "eternal" issue]. / Aderenta la CPAP--o problema "eterna".

Adherence to CPAP is and will remain the touchstone for patients with obstructive sleep apnea syndrome. The authors try to clarify the many difficulties encountered regarding this matter, its epidemiological implications, factors predicting non-adherence to treatment, and which are the most effective ways to alleviate it. Therefore a practitioner can increase the degree of adherence and he can decisively influence the favourable effect of this type of therapy on a short-term as well as long-term basis.

Assessment of sagittal and vertical skeletal patterns in Romanian patients with obstructive sleep apnea.

OBJECTIVE: To establish the sagittal and vertical skeletal pattern of the Romanian patients with obstructive sleep apnea (OSA). PATIENTS AND METHODS: Lateral cephalograms of forty patients, divided in two groups, group I--twenty patients with OSA (15 males and five females) and aged between 34-76 years and group II (control group)--twenty patients with class II malocclusion (eight males and 12 females), aged between 22-40 years, were analyzed for linear and angular skeletal parameters. RESULTS: For group I--most often, the mandible was in posterior position, the mean value for SNB angle being 76.77 degrees; maxilla tended to be retruded, too. The maxillo-mandibular antero-posterior (AP) relationship was class II in 90% of the cases. A clockwise rotation of the mandible was registered in a vertical plane (mean value SN, ML: 29.82 degrees), the facial height ratio being in a normal range of values. There was a medium positive correlation between ANB angle and apnea/hypopnea index (AHI), while SNA showed a quadratic relationship with AHI. Using t-test, in order to compare the sagittal and vertical skeletal pattern of the two groups, it can be stated that there is a statistical significant difference for antero-posterior (AP) position of the mandible, for the group II mandible retrognathia being more pronounced than in group I. CONCLUSIONS: Romanian patients with OSA had a retrognathic sagittal pattern with a class II antero-posterior relationship. A statistical significant positive correlation between AHI and ANB suggests that the class II antero-posterior maxillomandibular relationship can predispose to OSA.

[Sternal chondrosarcoma and the complications poststernectomy]. / Condrosarcomul sternal si complicatiile poststernectomie.

Primary tumors of the sternum are unusual, and, of these chondrosarcoma is extremely rare. Prior cases were more frequent in men. It is the consensus that central (axial) skeletal lesions are always suspected of malignancy. It is difficult to deduce from the roengenographic and pathologic findings the presence of a sternal tumor. This case report of primary sternal chondrosarcoma illustrated an extremely rare cartilaginous lesion in a male 64 years old. Extensive sternal excision was indicated despite the apparent benignity of the tumor. This aggressive surgical method facilitated the diagnosis of a malignant tumor with moderate cellular differentiation G2 chondrosarcoma. After surgery done, bilateral pleural empiema occurred.

[Prevalence of sleep apnoea syndrome--the experience of "Marius Nasta" Institute of Pneumology, Bucharest]. / Prevalenta sindromului de apnee în somn--experienta Institutului de Pneumologie "Marius Nasta" Bucuresti.

UNLABELLED: The study is a retrospective one based on the analysis of the records of the patients who have been diagnosed with Sleep Apnoea Syndrome (SAS) in "Marius Nasta" Institute of Pneumology sleep laboratory between 1997-2007. The study demonstrated a SAS prevalence of 64,4% in a specific population. Snoring is the main symptom which brings the patients to the doctor (74,5%); regarding the severity of the disease 62,4% were moderate and severe cases. CONCLUSIONS: Sleep Apnoea Syndrome is a frequent disease, relatively easy to diagnose and to treat. If we want to have real epidemiological data regarding SAS prevalence in Romania we should have large epidemiological studies in all the regions of the country.