TB therapeutic drug monitoring - analysis of opportunities in Romania and Ukraine.

INTRODUCTION: Therapeutic drug monitoring (TDM) could improve TB treatment outcomes by avoiding drug toxicity or underdosing. In this study, we describe the patient burden in three TB centres in Romania and Ukraine with a TDM indication, as per the current guidelines, in order to estimate the feasibility of implementing TDM.METHODS: A retrospective multi-centre study was conducted at the Iasi Lung Hospital (Iasi, Romania), Bucharest Marius Nasta Institute (Bucharest, Romania) and Chernivtsi TB Centre (Chernivtsi, Ukraine) in adult hospitalised TB patients.RESULTS: A total of 927 participants were admitted, of whom 37.8% had at least one indication for TDM, the most frequent being slow response to TB treatment (202/345, 58.6%); 55.5% had at least one cavity present on chest X-ray. Patients with a TDM indication stayed in the hospital for a median of 67 days and took on average 2 months more to reach a successful TB outcome.CONCLUSION: TDM could be a valuable tool to improve management of selected TB patients. The decision on whether to perform TDM is often delayed by 2 months due to waiting for culture results after treatment initiation. A randomised control trial should be performed in order to define TDM's precise role in TB therapy.

Aspects of physician-patient communication in the program of smoking cessation.

The doctor-smoker patient communication is essential for smokers to realize the harmful effects of tobacco on health and the benefits of smoking cessation. Nicotine found in cigarettes is a powerful drug and a direct dependency generator, which makes smoking cessation difficult, the withdrawal syndrome being hard to overcome for many smokers. The doctor-smoker patient communication is a complex process of data, information and knowledge transmission, subjected to some semiotic rules. In the Counseling Center for Smoking Cessation (CCSC) from the Rehabilitation Clinical Hospital of Iasi the medical and psychological counseling and the pharmacologic therapy for smoking cessation is ensured by the qualified personnel. CCSC was founded in 2005, when the hospital was included in European Program: "European Network Smoke-Free Hospital", and experienced an important development in 2007 with the initiation "Stop Smoking" National Program of Ministry of Health. The doctor-smoker patient communication in the CCSC was conducted during the smoker's recruitment, therapeutic and post therapeutic period, a special place being occupied by the doctor-medical staff communication, including smoker medical students. The number of people who became nonsmokers after being counseled at our center was the evidence of the effectiveness of this communication. The obtained results determined us to join the global fight against smoking and to propose the introduction of the smoking cessation program in the curriculum of the medical education institutions.

[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.

[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.

[Medium-term strategy for the specific management of pneumology hospitals and wards after the decentralization of the sanitary system]. / Strategie pe termen mediu privind managementul specific al spitalelor si sectiilor de pneumologie dupa descentralizarea sistemului de sanatate.

Identifying and promoting new management techniques for the descentralized pneumology hospitals or wards was one of the most ambitious objectives of the project "Quality in the pneumology medical services through continuous medical education and organizational flexibility", financed by the Human Resourses Development Sectorial Operational Programme 2007-2013 (ID 58451). The "Medium term Strategy on the specific management of the pneumology hospitals or wards after the descentralization of the sanitary system" presented in the article was written by the project's experts and discussed with pneumology managers and local authorities representatives. This Strategy application depends on the colaboration of the pneumology hospitals with professional associations, and local and central authorities.

[Endobronchial changes in sarcoidosis]. / Afectarea endobronsica în sarcoidoza.

The first case of endobronchial sarcoidosis was described by Benedict and Castelman in 1941. The endoscopic aspects in sarcoidosis can reveal: erythema, edema, network of capillary ectases, granularity, irregular mucosa thickening, macro and micro nodules in mucosa, bronchial and tracheal stenosis, distortions, tractions (including at the large and medium airways), sometimes bronchial ectases secondary to these modifications. The doctors must be aware of the possibility of affecting the great airways in sarcoidosis, such situation, although rare, could make for a difficult diagnosis, especially in the case of the tusigen syndrome or persistent and unexplained wheezing. The more the parenchimal disease progresses, the greater is the frequency of the airways being affected.

[The Irish lesson--when will it apply also to Romania?]. / Lectia irlandeza--pe când si la noi?

We are speaking every time about models but historically we are not considering the way made for obtaining them. In this paper we are reviewing the road for realizing common antismoking front in Ireland and where we failed in comparison in this introduction of the anti-smoking law.

[Left pulmonary agenesis diagnosed late]. / Agenezie pulmonara stânga diagnosticata tardiv.

We present the case of a 51 years old female-patient, with severe dextroscoliosis, having like unique symptom progressive dyspnea. The blood samples reveals polycythemia, the radiological exam shows the opacification of 2/3 of the left thorax, the absence of the lung structure in the other 1/3, the deviation of the mediastinum, and dextroscoliosis; the computed tomography reveals the absence of the left lung artery and the left airways, compensatory hyperinflation of the right lung and dilatation of the trunk and right pulmonary artery; the bronchoscopy does not visualize the carina or the left main bronchus, typical for pulmonary agenesis. Echocardiography confirmed the absence of left pulmonary artery and shows mild pulmonary hypertension (systolic pressure in the pulmonary artery of 33 mmHg) with dilatation of the right cavities, but good cinetics. We face a case of pulmonary agenesis lately diagnosed, with modest functional cardiologic implications, limited therapeutic options and good survival, justified by the late appearance of the pulmonary hypertension of low severity and without worsening in time.

[Sleep apnea syndrome in the elderly--another disease?]. / Sindromul de apnee în somn al vârstnicului--o alta afectiune?

Sleep apnea syndrome in elderly rises serious positive and differential diagnostic problems. Considering the epidemiological data showing an obvious increase in sleep disorders incidence in elderly, we analyzed the multiple factors that can induce sleep alteration in this age group, regarding the dys-somnias and the para-somnias. The neurologic and mechanical ailments are described. The arguments for one or another of the current therapeutic options are balanced considering a review of the most recent specialty literature. We conclude that for this age group also the CPAP is the "gold standard" for therapy and that a careful diagnosis offers new hopes for those suffering from this disease.

[Bronchial asthma and allergic rhinitis: a new therapeutic challenge. Disfunction co-morbidities--shared therapies?]. / Astmul bronsic si rinita alergica: o noua provocare terapeutica. Comorbiditati disfunctionale--terapii comune?

More and more it is spoken about this morbid association between asthma and allergic rhinitis; this two diseases are interconnected but were often distinctly approached over time. Anyway, they share interesting pathogenic and therapeutic features. The current article reviews epidemiologic data, pathogenic mechanisms, common actions as well as common elements coming from experimental medicine, everything pleading for a new concept, "one airway" or "Combined Allergic Rhinitis and Asthma Syndrome". From here we can also draw conclusions marking new therapeutic directions where anti- leukotrienes often prove to be useful.

[Inhaled corticosteroids and the local effects--a justified fear?]. / Corticoizii inhalatori si efectele locale--o teama justificata?

Inhaled corticosteroids continue to be hallmark players in asthma control. In time, they induced fear, hope, and created numerous discussions in specialty literature. Usually, the studies focus more on their beneficial effects and less on adverse effects. Surprisingly, lately more was written about systemic effects. A detailed review of some recent studies demonstrates that the most feared systemic effects (risk for osteoporosis due to calcium and phosphate metabolic changes, adrenal suppression, skin thinning, cataract, growth problems in children and teenagers, glaucoma) are very rare. The local effects, if properly addressed by the physician and patient, can be largely diminished. The conclusion of this article is that there is a non-due fear for this class of medication with certain virtues in asthma and COPD therapy.

[Diagnosis and treatment of a case of obstructive sleep apnea syndrome with AutoSet]. / Diagnosticul si tratamentul unui caz de sindrom de apnee în somn de tip obstructiv (SASO) cu AutoSet.

The author presents the case of a male patient with obstructive sleep apnoea syndrome, in which the use of classic CPAP therapy after performing an uvulo-pharyngoplasty (UVPP) led to very good results. The pressure levels determined initially after a polysomnography with Apnoe Check were compared with the results of the measurements with another device, AutoSet, used for the first time in our country. This allowed the tapering of pressure levels for CPAP and also revealed other advantages of the device, reviewed here.

[Chemical obliterans bronchiolitis after azotic acid exposure]. / Bronsiolita obliteranta chimica dupa expunere la acid azotic.

The authors present the case of a 48 years old man having an exposure to irritant gases (azotic and lactic acids) in a closed space, inhaling them for 5 minutes. Shortly after the accident the patient displayed the signs of corneal and conjunctival burn; several days afterwards respiratory symptoms appeared: shortness of breath, dyspnea to minor efforts, then nocturnal dyspnea and orthopnea. Chest X-ray, CT scan, complex lung function tests and bronchoalveolar lavaje, together with the history of recent exposure to irritant gases led to the diagnosis of hypersensitivity obliterant bronchiolitis. Oral corticoids in dose of 60 mg/day determined a substantial clinical, radiological and functional improvement. The authors make some comments on the need of early diagnosis and efficient treatment.