Tuberculosis remains a public health problem in Romania.

BACKGROUND: Tuberculosis (TB) remains a major public health problem in Romania, which has the highest TB incidence in the European Union. METHODS: We undertook a retrospective study to describe changing trends in the main epidemiological indicators of TB in Romania from 1995 to 2016. Data were obtained from the Marius Nasta Institute of Pneumology, Bucharest, official data published by the National Center for Public Health Statistics and Informatics in Health Statistics Yearbooks, the European Health For All database and the World Health Organization 2017 global TB report. RESULTS: Overall TB notifications in Romania declined after 2002, from 142.2 to 74/100 000 in 2016. For new TB cases, the incidence declined after 2002, from 118.9 to 54.5/100 000 in 2016. After peaking in 2002, at 23.3/100 000, the notification rate of relapses declined to 11.8/100 000 in 2014, but almost doubled the following year. The number of multidrug-resistant TB cases decreased from 624 in 2009 to 530 in 2012, but then increased to 670 in 2015. The number of extensively drug-resistant TB cases tripled between 2012 and 2015, from 22 to 68 cases. CONCLUSION: Although the decline in TB nationwide after 2002 confirms the effectiveness of control measures, the current TB burden in Romania remains very high by European standards.

Measuring Patient Safety Culture in Romania Using the Hospital Survey on Patient Safety Culture (HSOPSC).

Purpose To explore patient safety culture among Romanian staff, using the U.S. Hospital Survey on Patient Safety Culture (HSOPSC). MATERIAL AND METHODS: A cross-sectional study was carried out in six hospitals, located in four Romanian regions (Craiova, Cluj-Napoca, Bucharest and Brasov), based on staff census in the Units/hospitals which volunteered to participate in the study (N=1,184). The response rate was 84%. The original questionnaire designed by the American Agency for Healthcare Research and Quality was translated into Romanian (with back translation), pre-tested before application and psychometrically checked. It consists of 42 questions grouped in 12categories, covering multiple aspects of patient safety culture (dimensions). Percentages of positive responses (PPRs) by question and category were analyzed overall and by staff profession. RESULTS: Most respondents were nurses (69%). The main work areas were surgery (24%) and medicine (22%). The highest PPRs were for Supervisor/Manager Expectations & Actions Promoting Safety (88%), Teamwork Within Units (86%), Handoffs and Transitions (84%), Organizational Learning-Continuous Improvement (81%), Overall Perceptions of Safety (80%), Feedback & Communication About Error (75%). The lowest PPRs were for: Staffing (39%), Frequency of Events Reported (59%) and Non-punitive Response to Errors (61%). Nurses exhibited significantly higher PPRs than doctors. CONCLUSIONS: This small-scale study of staff's attitude towards patient safety in Romanian hospitals suggests that there is room for future improvement, especially within the doctor category. Further research should assess the relationship between patient safety culture and frequency of adverse events.

Left Pleuropericardial Cyst.

INTRODUCTION: Cysts of the mediastinum, which are benign masses, are usually detected by chance, and constitute a small but important diagnose group, representing 7 to 18% of all primary mediastinal tumors. Pleuropericardial cysts, located most frequently in the left anterior and inferior mediastinum, are identified in the fourth or fifth decade of life affecting females more than males with a sex ratio of 8:4. MATERIAL AND METHOD: We present the case of a 52 year old woman diagnosed with pericardial cyst located in the left cardiophrenic angle. CPP was rather big and was initially diagnosed as encysted pleurisy. Ultrasound guided exploratory thoracentesis was performed evacuating 300 ml "water spring" like fluid very scarce in cells. We further investigated our patient for differential diagnosis but the patient refused surgery and she is now managed conservatively with a close follow-up. CONCLUSIONS: A pericardial cyst should always be suspected when a cystic lesion is detected in the mediastinum. Pleuropericardial cysts are usually suspected after an abnormal chest X-ray is obtained. If the patient is asymptomatic and the information provided by CT indicates a benign tumoral process suggestive for a pleuropericardial cyst, conservative management with careful follow-up is justified.

[A survey of the perception of COPD by physicians (I)]. / Sondaj asupra perceptiei BPOC de catre medici (I).

Observing the great importance of COPD nowadays, the authors aimed to check the doctors' opinions concerning this matter. 300 questionnaires including 53 questions were mailed to doctors in the whole country. 103 filled-in questionnaires (34.34%) were recovered from 36 pulmonologists (PNF), 24 internal medicine specialists (Int) and 43 general practitioners (Gen). One could sometimes note important differences between the answers depending upon the specialty. Thus, the quality of the COPD assistance is considered unsatisfactory by many PNF. All doctors consider COPD as a concerning problem. The diagnosis is always established using clinical criteria (cough, dyspnea). There are differences between the doctors in using the X-ray and the lung function tests as diagnosis criteria, due to accessibility to these tests, but also to the interpretation. COPD may often be mixed up with other obstructive diseases, especially asthma, and many doctors include also the obstructive post-TB syndromes in COPD. All the doctors, no matter the specialty, consider themselves capable of diagnosis COPD. Despite the scarce participation to the questionnaire (due to lack of courage or of interest), the questionnaire can make up an image of the concern of the Romanian doctors for the COPD medical assistance, making also the consequences of the limited access to the newest informations.

[A survey of recommended measures in COPD (II)]. / Sondaj asupra masurilor preconizate în BPOC (II).

The authors aimed to test the doctors' opinion-general practitioners (Gen), internal medicine specialists (Int) and pulmonologists (PNF) about the therapeutic approach in COPD. 300 questionnaires including 53 questions were mailed; 103 filled-in questionnaires were recovered (33.34%). Most of the doctors consider necessary the initial diagnosis in hospital. The Gen send the patients mostly to the Int and less to the PNF. Most doctors accept that the treatment should be started in pulmonology clinics. All the doctors prescribe teophillins; the beta-agonists are prescribed twice as much by the PNF than Int, and very little by Gen. The oral corticosteroids are used by half of the doctors; the inhaled corticoids are prescribed seldom and only by PNF. The i.v. corticoids are used by half of Int. All the doctors recommend smoking cessation. Only the PNF drag the attention upon the bacterial infections. The kinesitherapy is seldom recommended, even by PNF.