[Estimation of direct medical costs of chronic obstructive pulmonary disease over 12 months]. / Evaluarea costurilor medicale directe ale bronhopneumopatiei cronice obstructive pe 12 luni.

UNLABELLED: Chronic obstructive pulmonary disease (COPD) is a prevalent and expensive disease, the burden of disease involving the patient, the family and also the society. AIM: Estimation of direct medical costs of COPD in one patient, by adding the costs of all the medical events related to the disease over one year: exacerbations admitted to hospital or ambulatory, chronic treatments, follow-ups. Data were obtained using a questionnaire applied to 85 COPD patients approached in "Marius Nasta"lnstitute of Pulmonology in 2004. RESULTS: 85 patients were questionned, mean age was 62.5 years, mean FEV1 was 36.65% predicted (72 patients were GOLD stages Ill and IV). In the previous year they had a mean of 2.2 exacerbations. They received various chronic treatments (bronchodilators, inhaled steroids, combination therapy) but not constant, between 3 and 8 months per year. The direct medical costs of COPD per patient in one year were estimated at 5243.4 lei (1456.5 euro), 83% of costs represented the exacerbations (82.5% hospital admittances) and 17% the stable disease costs (16.5% chronic medication). Long term oxygen therapy, transportation, indirect costs were not included. CONCLUSIONS: Even if the costs are underestimated, COPD remains an expensive disease especially due to hospital exacerbations. Cost-effective interventions are needed for preventing exacerbations, redistributing resources and improving patients quality of life.

[Tuberculosis in Romania. Problems and solutions]. / Tuberculoza in România. Probleme si solutii.

UNLABELLED: The analysis of the Management Unit of the National TB Programme (NTP) database, together with the reports of the TB county managers, allowed to the authors to identify some weaknesses of TB control in Romania in the recent years and to propose the appropriate measures. PROBLEMS: The marked decrease in the reduction of TB cases reported annually from 2,761 in 2005-2006, to 145 in 2007-2008 and the stagnation of mortality rate: 7.5 per ten thousand in 2007 and 7.6 per ten thousand in 2008. Deficiencies in data recording and reporting through informatic system of the NTP. Lack of financial resources for system maintenance and upgrade. Deficiencies in monitoring and control of mycobacterium resistance to antituberculous drugs phenomenon at national level. Sensitivity testing only for a small percentage of culture confirmed new TB cases (21%). Higher percentage of MDR in new TB cases compared to the results of national survey of mycobacterium drug resistance 2003-2004. Lack of personnel: 16 TB dispensaries without any pulmonologist, vacancies for 259 doctors, 436 nurses and 433 auxiliary personnel. Important deficiencies in the NTP network's infrastructure and logistics countrywide. Discontinuities in the supply with first and second line antituberculous drugs resulting in interruption of treatments. Lack of an officially endorsed protocol for the diagnosis, treatment and monitoring of cases with TB/HIV co-infection. Solutions: Revitalization of monitoring-supervision activities of the NTP running countrywide, provision with necessary financial resources to perform the scheduled visits in counties. Providing maintenance and upgrade of the informatic system for data collection. Implementation of the necessary measures in order to attract and maintain the personnel in the NTP network. Conduct the national survey of mycobacterium susceptibility to first and second line antituberculous drugs and drug susceptibility testing of the most culture confirmed TB cases. Restore the centralized procurement of TB drugs. Finalization and official endorsement of the protocol for TB/HIV co-infection initiated in 2004.

[Clinical and epidemiological aspects of TB cases registered in persons aged > or =65 between 2002-2006, at the TB dispensary of sector 4, Bucharest]. / Aspecte clinico-epidemiologice ale cazurilor de tuberculoza înregistrate la persoanele de > or =65 ani în perioada 2002-2006 la dispensarul de pneumoftiziologie al sectorului 4, Bucuresti.

The study objectives were to find clinical and epidemiological aspects of TB cases registered between 2002-2006 in persons aged > or =65 years that belong to the TB Dispensary of the Sector 4-Bucharest. TB incidence in Romania at age group 265 years was in 2006 94% per hundred thousand (68.6% per hundred thousand in Sector 4-Bucharest). 153 new cases and 28 relapses were registered during 2002-2006, the highest percentage was between 68 and 78 years old. In 96.7% the tracking was passive and relatively delayed, with a 2.5 month mean from the onset of symptoms. The anatomical-radiological forms, caseous-extended and cavitary, represented 36% of the cases and the peripheral lymphatic node TB was the most frequent between the extrapulmonary forms--9.8%. The bacteriological confirmation was 81.7% in new TB cases. DOT strategy was applied in 76.8% of cases (139). The success rate of the therapy in the all cohort was 73.9% and the mortality was 20.4%. The introduction of a clinical surveillance system of the persons aged 65 years with a risk to develop the disease remain to be realised along with the application of the National Programme for TB Control 2007-2011.

Romanian anti-TB drugs resistance surveillance 2003-2004.

UNLABELLED: Romania decided and initiated a DRS for anti-TB drugs at national level using the standardized methodology proposed by WHO and IUATLD. The DRS protocol was designed with technical assistance from WHO; the surveillance started in June 2003 and ended in June 2004. It was tested the susceptibility to the 4 first line anti-TB drugs: Isoniazide (H), Rifampicin (R), Streptomycin (S), Ethambutol (E). Drug susceptibility testing used: indirect absolute concentration method. There were included in the survey 1251 TB patients from the 60 clusters: 869 new cases and 382 previously treated. From the penitentiary system were included 85 TB patients, 47 new cases and 38 previously treated. RESULTS: [table: see text]. Estimations of the trend of anti-TB drug resistance in Romania for the next period was proposed.

[Preliminary assessment of Streptococcus pneumoniae, pneumonia, economical and clinical burden in Romania]. / Impactul medical si economic al pneumoniei pneumococice in România: evaluare preliminara.

BACKGROUND: In Romania there is a significant number of persons at-risk to develop pneumococcal diseases, especially the elderly over 65 years old. Costs of health care for these patients both for inpatient and outpatient facilities are high, due to increased Streptococcus pneumoniae drug resistance and due to additionally co morbidities these patients usually have. However, the real burden of pneumococcal disease in Romania remains unknown. OBJECTIVE: To assess the epidemiological and economical burden of pneumococcal pneumonia in Romania. MATERIAL AND METHOD: Epidemiological data reported over the past 5 years by the' Centrul de Calcul, Statistica Sanitara si Documentare Medicala,' were analyzed (1999-2004). A retrospective analysis was performed by M. Nasta Institute from Bucharest and Pneumology Hospital in Iasi, based on data from medical records and costs registered for a representative sample of patients treated in both inpatient facilities and on a survey conducted among physicians in outpatient facilities. RESULTS: It has been estimated that during 2004, there were registered 10,000 pneumococcal pneumonia cases that needed hospitalization and 38,200 patients that were treated in outpatient facilities. The global cost estimated for health care of pneumococcal pneumonia were 30 millions RON (8.3 millions) 86% were spent for hospitalized cases and 14% for ambulatory care. CONCLUSIONS: This first assessment reveal that the Pneumococcal pneumonia the Romanian Health Care System and for the National Insurance House, as well. The use of antipneumococcal vaccine can be an effective tool for decreasing the costs related to Streptococcus pneumoniae respiratory infections health care. However, further cost- analysis assessments are needed (strongly recommended).

[National Program for TB Control (NPTC): report of 2005 activities, evolution of endemic disease, challenges, priorities]. / Programul national de control al tuberculozei (PNCT): raportul activitatilor desfasurate în anul 2005, evolutia endemiei, probleme, prioritati.

The authors analyze the current status of anti-TB activity in Romania, in which several factors are involved: the pneumo-phthisiology network, the central unit (M. Nasta Institute of Pneumology), the Health Insurance, Health Ministry as well as international funding and technical assistance units (Global Fund, World Health Organisation). Current TB incidence data are reviewed, as well as the events in NPTC during 2005: training of the personnel involved in TB care (pneumologists and general practitioners, nurses, laboratory staff), improving TB care in risk groups (children, inmates, HIV positives, gypsies), improving the functionality of bK laboratory network, improving access of multidrug resistant TB patients to good quality services, improving the system for acquiring and distributing medication, developing a functional system for monitoring the NPTC, integrating TB in the national system for transmissible diseases survey, elaborating guidelines on different aspects of TB care. In 2005, WHO performed an evaluation mission in Romania, finally proposing solutions for current issues: the Government Decision of the NPTC actions, establishing the status of the county NPTC managers, using incentives for patients, improving drug management by application to international organisms, increasing the personnel numbers in national reference laboratories, improving the informational circuits between factors involved in NPTC.

[Bilateral lung consolidations related to accidental exposure to parrots]. / Procese de condensare pulmonare legate de expunere accidentala la papagali.

The authors present the case of a 32 years male patient admitted for lung consolidations with bilateral extension tendency, associated to fever, respiratory failure and hepatic involvement, with a sudden onset two weeks after contact with apparently healthy parrots. Bronchiolo-alveolar lavage was suggestive for a hypersensitivity pneumonia, but the clinical evolution was good with antibiotics (macrolides, than doxycycline). Radiologic resolution was spectacular. Serum antibodies anti-ch. Psittaci were present in low titre, at the limit of significance. Final diagnosis was chlamydia psittaci pneumonia.

[Cost analysis in patients admitted with COPD in 2002]. / Analiza costurilor BPOC la pacientii internati.

UNLABELLED: The aim of the study was to assess the costs of hospital admission for COPD patients in a high level unit ("Marius Nasta" Institute of Pulmonology) in order to appreciate the financial burden of the disease. We analyzed retrospectively the medical charts of patients admitted between January and September 2002. 181 charts were included. We extracted data regarding the patient (age, sex, smoking habits, income), disease (duration, severity) and hospital admittance (number of days, tests performed, medication received). Data were processed in EpiInfo 6. RESULTS: mean duration of admittance was 17, 18 days. Mean cost of admittance was 25,448,348 lei (727 Euro), divided in: mean costs of the lab tests - 5,936,812 lei (170 Euro), mean cost of medication--4,428,000 lei (126 Euro), with obvious dominance of COPD medication: 4,310,022 lei; mean cost of hospital stay (including hotel, food and personnel expenses) was 15,120,094 lei (432 Euro). COPD severity was judged on the spirometry at discharge. Mean FEV1 was 45.66% of predicted value. According to GOLD, 10 pts (5.52%) were in stage I, 44 pts (24.3%) in stage II, 69 (38.12%) in stage III and 58 pts (32.03%) in stage IV. Costs per patient were similar for stages I, II and III and significantly higher for stage IV CONCLUSIONS: admitted COPD patients are in severe stages, with a long duration of admittance. Overall costs are much smaller than in Europe, more than half of these costs are due to hospital stay.

[Right pneumonectomy for multiple secretory metastasis of adenocarcinoma in a patient with a left lower lobe resection]. / Pneumonectomie dreapta pentru metastaze pulmonare secretante de adenocarcinom la o pacienta cu lobectomie inferioara stânga.

The authors present the case of a female patient with a left lower lobe resection 30 years before, performed for bronchiectasis, operated 6 years before for a secretory adenocarcinoma of the uterus, presenting for severe dyspnea and cough with abundant serous sputum secretion (over 500 ml per day). In the right lung there were several great cysts which proved to be metastasis of the uterine adenocarcinoma. The patient had severe loss of lung volumes, respiratory failure and a single left lobe. Nonetheless a right pneumonectomy was performed for palliation, addressing the cough and huge expectoration. After surgery the symptoms improved significantly and the patient survived another 6 months in decent condition.