Associated factors for bacterial colonization in patients admitted to the intensive care unit of the Clinical Hospital of Infectious Diseases.

Introduction: This study aimed to identify isolates from colonization and assess the risk factors for bacterial colonization and the risk of death in patients admitted to the intensive care unit (ICU) of the Constanta County Infectious Diseases Hospital between September 2017 and September 2019. Methods: This was a retrospective case-control study in a single center that included all patients admitted to the ICU in Constanta, Romania, who underwent bacteriological screening upon admission and 7 days after admission, between September 2017 and September 2019. In total, 253 patients were included in this study. The nasal exudate, pharyngeal exudate, and rectal swab samples were screened. Results: In this study, 253 patients were screened bacteriologically, of which 53 had bacterial colonization and 200 did not. Among the bacterial strains, Klebsiella spp. (43.39%) was the most frequently isolated. The predominant resistance mechanism detected in the bacterial isolates was extended-spectrum ß-lactamase (ESBL). Multivariate analysis identified a Carmeli score of 3 as an independent risk factor for acquiring bacterial colonization in the ICU. The mortality rate of patients with bacterial colonization was 11.32% and 6% for the patients without colonization (p>0.05). Conclusions: Our study revealed an increased prevalence of Enterobacterales colonization in the ICU. Risk factors for acquiring bacterial colonization differed depending on the type of bacterial colonization, such as ESBL, carbapenemases, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE). An independent risk factor for acquiring bacterial colonization was the Carmeli score of 3.

Perceptions and Attitudes of Romanian People Toward Autopsy Procedures According to the Level of Knowledge.

In the last decade, Romanian hospitals have been facing a decline in autopsy rates. This has had a negative impact on medical education and the training of young doctors. Quite a number of caregivers strongly oppose the carrying out of autopsies on their deceased loved ones who have died in hospital. Hence, this study was designed to evaluate how autopsies are perceived by an average person and whether improved knowledge about autopsies would help reduce people's reluctance toward them. The study involved 216 willing participants who had either never had a loved one die in hospital or had never had the power to make a decision about their dead loved ones' body. The method of data collection used was a medical inquiry-based questionnaire. Two questionnaires were used, one before and one after brief information regarding autopsy procedures. Only a small percentage of subjects really knew the meaning of an autopsy. Initially, they accepted that it was easier to consent to their own autopsy than to the autopsy of a loved one. This difference in opinion reduced after they were informed about autopsies. As for arguments against autopsies, the most frequent were integrity of the body and religious reasons. It is extremely useful to ensure people have proper information, in order to help them understand and appreciate the benefits of postmortem examinations. Religious, social, and cultural arguments might be put aside if proper information and new educational programs are put in place.

EPIDEMIOLOGIC RESEARCH REGARDING THE IMPACT OF RISK FACTORS ON HEALTH-RELEATED QUALITY OF LIFE IN CANCER PATIENTS.

AIM: To assess the health-related quality of life in cancer patients and the relative and attributable risks for the degree of dissatisfaction related to intrinsic and extrinsic factors. MATERIAL AND METHODS: Our research included 128 cancer patients treated at the Surgical Clinic II of the Iasi Regional Cancer Institute between December 2014 and June 2015. Thus, data were collected by using an inquiry sheet derived from the SF-36 questionnaire, which included closed and open questions about the quality of life, socioemographic data and such risk factors as smoking, alcohol use, related diseases and risk behaviours. Results: The patient sample had a mean age of 60.85 years, 51.6% of them lived in urban areas, were high school graduates, and of low economic status. DISCUSSION: As to the behavioural risk factors we found that over 80% of the patients were non-smokers, did not use alcohol, and were normal weighted. Pain was experienced by 70.7% of the cancer patients and depression affected 74% of the study cases. Patients were asked to self-assess their own health status on a scale of 0 (worst) to 100 (the best health status). CONCLUSIONS: Our study showed a poor health status (mean score 65) in the study cancer patients. The relative and attributable risks for the degree of dissatisfaction related to intrinsic and extrinsic factors were calculated and ranked factors in decreasing order: smoking, depression, pain, alcohol use, male gender, obesity, low income. We found that prolonged'suffering affects the psyche and causes depression and that the patients of low financial status, most of them living in villages, have difficulty in accessing medical care. The obtained data about the quality of life in relation with risk factors are in agreement with the data in the literature.

A novel method to combat the cholera epidemic among the Romanian Army during the Balkan War - 1913.

The history of cholera, a specific infection caused by Vibrio Cholerae, starts in ancient times. The sixth pandemic that began in 1899 and lasted until 1923, started in India and came to Eastern Europe through Russia. The expansion of the epidemic in the Balkans was facilitated both by the 2 Balkan Wars and the First World War. Romania, as a participant in these wars was affected by cholera, which was especially common among the army during the Balkan War. If the original source of the cholera issue is still controversial, both Romanians and Bulgarians accusing each other of being the basis of the outbreaks south of the Danube, it is widely recognized that the extent of the disease was facilitated by the sanitary conditions of food preparation and drinking water sources among both Romanian soldiers and in the civilian population. Under these conditions, in addition to numerous measures against cholera taken by the Ministry of War, Prof. I. Cantacuzino successfully experiments outbreak vaccination for the first time in the world with a vaccine prepared by himself and his collaborators. The vaccine containing 25 breeds of vibriones was a success in terms of rapid development of a preparation, the application of which was achieved through a quick campaign and proved extremely efficient, imposing the Romanian method as an effective way to combat a disease in full outbreak.

Consumption of untested pork contributed to over two-thousand clinical cases of human trichinellosis in Romania.

Trichinellosis is an important zoonosis that is difficult to diagnose and that can lead to disability, death and economic losses for the meat processing industry. The outbreaks are related to the consumption of insufficiently cooked pork containing larvae of Trichinella spiralis (Owen, 1833). Here, we describe epidemiological features of the disease in a region where incidence rates are typically elevated (Brasov County, Romania). Our descriptive, retrospective epidemiological study spanned a period of 25 years (1983-2007) in a group of 3 345 consumers of infected meat, of whom 2179 became infected. Both raw pork and processed pork products were consumed, typically during winter and spring holidays. Pigs bred and slaughtered by households were not always tested prior to consumption. The imposition of greater hygiene and testing has decreased the burden of disease in recent years, but the tradition of raising swine for familial consumption without prior testing continues to threaten health, even among groups, not typically suspected of facing elevated zoonotic risk such as children and residents of urban areas. Most outbreaks took place at family celebrations during which pork raised locally was consumed. Higher rates of clinical disease in women may reflect their greater participation in such events, but may alternatively reflect greater exposure to raw pork during meal preparation.

Retrospective epidemiological survey of diagnostic errors and their implications in the development of human trichinellosis in Brasov County-Romania over a period of 10 years.

Trichinellosis is a disease that is difficult to diagnose because its symptoms are polymorphic and can be easily confused for several other diseases (Dupouy-Camet et al., 2002). Consuming pork from untested pigs bred in private households elevates risk of contracting trichinellosis. The aims of this paper were to document the frequency and character of misdiagnoses in a ten-year period in an endemic locale (Brasov County, Romania) and to determine whether implementation of an integrated surveillance program significantly reduced the interval between disease and accurate diagnosis and significantly reduced the average length of hospitalization. All 699 cases of trichinellosis in the County were studied from 1983-1992, of which 314 (44.9%) were initially misdiagnosed. The most frequent misdiagnoses (41.7%) attributed disease to digestive disorders, closely followed by respiratory system disorders (32.5%), allergic reactions 4.4%, kidney problems 4.1%, eyes 2.8% and even neurophysical disorders 4.4%. Implementation of a surveillance program substantially shortened the interval prior to accurate diagnosis, and shortened the length of hospitalization.

Identifying risk factors for symptoms of severe trichinellosis--a case study of 143 infected persons in Brasov, Romania 2001-2008.

The presence of the parasite Trichinella spiralis in humans does not always manifest itself with obvious clinical symptoms; the clinical manifestations of trichinellosis are polymorphic and can cause diagnostic difficulties. Our aim was to identify risk factors that can be linked to the severity of the disease. We conducted a retrospective analysis of 143 cases of trichinellosis admitted to the Infectious Disease Hospital in Brasov, Romania during 2001-2008. We found that children 10 and younger were less prone to exhibit medium or severe symptoms. Patients with leukocytosis had a 1.75 times higher risk of developing medium to severe symptoms relative to those with normal white blood cell counts. Patients with high eosinophil counts had a 2.05 times higher risk of exhibiting average or serious symptoms relative to those with low or normal eosinophil counts. Repeated consumption of contaminated meat increased the chances of developing discernible forms of the disease by 5.25 fold when compared to those who only occasionally ate meat contaminated with Trichinella. Regular consumption of raw or undercooked meat increased the chances of developing medium or severe forms of this disease by 1.67 times when compared to those who consume meat that had been thoroughly cooked.

Results of the follow-up of the former trichinosis patients from Brasov County--Romania.

The objective of the study was to monitor for a period of 2 years (at 1, 3, 6, 9, 12, and 24 months) a group of former trichinellosis patients (n=699) registered in Brasov county before the initiation of the National Supervision and Control Programme for trichinellosis in humans. During the study, immediate complications up to 6 months from hospital release, and related complications occurring up to 24 months from hospital release were identified. Immediate complications were cardiovascular (31%), muscular (19%), neurological (18%), ophthalmic (17%), allergic (9%), respiratory (1%), and other (5%). Complications were more frequent in children from the studied group, even if the trichinellosis disease manifestation was mild or moderate. Complications were also more frequent in female as compared to male patients, and in urban areas as compared to rural environments. Paraclinical data showed eosinophilia in 8-22% of patients, GPT and GOT within normal limits, and hypoproteinemia in the case of 178 former patients (31%). Hypocalcaemia and hypomagnesaemia persisted in the case of 401 former patients (71%). Two months following illness, 53 (9.4%) of the former patients remained ill, and 26 of them had retired on medical grounds. Nine months following illness, 212 (37.8%) of the former patients reported fatigue, myalgia (especially in the inferior limbs), cardiovascular disorders, neurological, psychiatric, and allergic illnesses. After one year, 102 (18%) of the former patients reported improvements in asthenia, muscular pains, allergic reactions, hypertension, cardiac arrhythmia, and angina pectoris crises. Trichinosis in humans cannot be considered only an acute disease that, once properly treated, etiologically, pathogenically, and symptomatically improves, but it can also become a chronic illness.