Drug Susceptibility Patterns in MDR-TB Patients: Challenges for Future Regimen Design. A Cross-Sectional Study.

Globally, there is substantial concern regarding the challenges of treating complex drug resistance patterns in multidrug resistant tuberculosis cases. Utilising data from three different settings (Estonia, Latvia, Romania) we sought to contrast drug susceptibility profiles for multidrug resistant tuberculosis cases, highlight the difficulties in designing universal regimen, and inform future regimen selection. Demographic and microbiological surveillance data for multidrug resistant tuberculosis cases from 2004-13 were analysed. High levels of additional resistance to currently recommended second line drugs were seen in all settings, with extensive variability between countries. Accurate drug susceptibility testing and drug susceptibility testing data are vital to inform the development of comprehensive, flexible, multidrug resistant tuberculosis guidance.

Interoperable computerized smart card based system for health insurance and health services applied in cardiology.

In 1999 Romania started its health care reform by promulgating the Health Insurance Law. A functional and efficient health care system needs procedures for monitoring and evaluation of the medical services, communication between different service providers and entities involved in the system, integration and availability of the information. The final goal is a good response to the needs and demands of the patients and of the real life. For this project we took into account, on one hand, the immediate need for computerized systems for the health care providers and, on the other hand, the large number of trials and experiments with health smart cards across Europe. Our project will implement a management system based on electronic patient records to be used in all cardiology clinics and will experiment the health smart cards, will promote and demonstrate the capabilities of the smart card technology. We focused our attention towards a specific and also critical category of patients, those with heart diseases, and also towards a critical sector of the health care system--the emergency care. The patient card was tested on a number of 150 patients at a cardiology clinic in Bucharest. This was the first trial of a health smart card in Romania.

[Tuberculosis continues to be a concern]. / Tuberculoza, în continuare în atentie.

Tuberculosis (TB) has not been eliminated from none of the world's regions up to now. Trends of TB endemic were constantly favorable in Romania in the recent years: number of new cases and relapses decreased with 13 235, incidence rate with 42%, incidence rate in children with 51% and mortality rate with 44%, from 2002 to 2011. The highest TB risk is being observed in men living in rural area and in those of 45-54 age group. The counties with the highest TB incidence rates are those in the South-West part of the country. The favorable trend of TB endemic in Romania has been achieved through a constant case detection rate over 70% and a treatment success rate over 80% in the recent years. The current major concerns in TB control in the country, as well as all over the world, are TB-HIV co-infection and micobacterial drug-resistance. Also, a negative aspect of TB endemic in Romania is that a number of severe forms of TB, TB-HIV, MDR-TB or deaths are still reported in children under 15 years old, each year. The response of health system to the TB problem consists in the development of the National TB Programme, which achieved many successes in the recent years, but in the same time is confronted with many challenges. However, the programatic control of the disease can be obtained by health services only in partnership with other services, institutions and organizations, which may offer economic and social support to the patients and their families.

[Mortality of tuberculosis in Romania, a marker for severity of the endemic]. / Mortalitatea prin tuberculoza in România, un marker al gravitatii endemiei.

After reaching the lowest level of tuberculosis mortality rate in 1980, 3.7% hundred thousand (830 deaths), followed by a few years with low levels of mortality, the period following the year 1985 was marked by a gradual increase in the mortality rate and in 1995 it reached 11.3% hundred thousand (2560 deaths). The implementation since 1997 of TB control programmes on medium-term (under technical assistance of WHO experts) has led to a decrease in tuberculosis mortality rate to 1482 deaths, 6.9% hundred thousand, in 2010. Compared to standardized TB mortality rate in Europe, Romania is far from the countries of Western and Central Europe, with a rate 6.6 times greater than in the EU. Standardized mortality rate by sex reveals that the rate for males in Romania, in 2009, was 6.5 times higher than in women. Similar to 2009, in 2010, the deaths have reached a maximum per age group at 45-54 years old. In 2010 the tuberculosis fatality was 4.7% and the lethality was 0.6%. Consistency of tuberculosis control strategy, regarding both measures for early detection of tuberculosis and establishing TB treatment under the direct observation, represent the safety elements in the reduction of tuberculosis mortality rate. It should be reminded that one of the goals of Stop TB Partnership is reducing mortality rate in 2012 at half compared to 1990, Romania being one of the 18 countries included in this plan initiated by the WHO Europe Region Office.