Evaluating the Aspects of Quality of Life in Individuals with Substance Use Disorder: A Systematic Review Based on the WHOQOL Questionnaire

Substance Use Disorder (SUD) has become a significant public health concern and it profoundly impacts an individual's quality of life (QOL). This systematic review aimed to assess the QOL among patients with SUD, and to understand the differential impact of SUD on physical, mental, social, and environmental QOL domains, considering a variety of substances and identifying key factors that influence these outcomes. A comprehensive search was conducted in PubMed, Web of Science, Cochrane, and Scopus in January 2023, covering literature published until December 2022. The QOL was assessed using the World Health Organization Quality of Life (WHOQOL) instrument and the brief version of the WHOQOL, identifying the same four domains of QOL (physical, mental, social, and environmental). A total of 19 studies were selected for inclusion in the systematic review, based on individuals' polysubstance use, and excluding those using only nicotine or alcohol. The analysis included 6079 patients, with only 40.3% women, and a mean age of 36.6 years. The substances most commonly involved in SUD were cocaine (47.1%), alcohol (46.3%), and amphetamine (43.6%), considering most individuals being polysubstance users. The highest variability in QOL scores was observed in the physical domain. Mental disorders were reported in 68.3% of the patients, while long-term use of drugs, criminal history, unemployment, and low levels of education were identified as significant predictors for lower QOL by some of the studies. Similarly, sleep problems and teeth decay were also identified as significant worsening factors for QOL. This systematic review highlights that the WHOQOL survey is widely accepted and applicable for individuals with SUD worldwide. The results suggest a substantial negative impact of SUD on the QOL of affected individuals. The findings underscore the need for comprehensive interventions to address the physical, psychological, social, and environmental dimensions of QOL among individuals with SUD.

Validation of the Romanian Version of the Halitosis Associated Life-Quality Test (HALT) in a Cross-Sectional Study among Young Adults

Halitosis is a common condition with a significant impact on individuals' quality of life. The Halitosis Associated Life-Quality Test (HALT) is a reliable instrument for measuring this impact. This study aimed to introduce and validate the Romanian translation of the HALT questionnaire (R-HALT). We hypothesized that the R-HALT would demonstrate good reliability and validity in measuring the impact of halitosis on quality of life among Romanian teenagers and young adults. Our objectives were to translate and adapt the HALT, validate it among a cross-sectional group, and evaluate the extent of halitosis in this population. A multicentric cross-sectional design followed, which was approved by the Ethics Research Committee in Romania. The translation process involved independent translations, retro-translations, expert review, and pre-testing. The psychometric properties were evaluated among 150 patients (mean age 23.6 ± 1.8; 51% males) at dental clinics, including reliability, convergent, and discriminant validity, using accepted statistical measures such as Cronbach's alpha and Intraclass Correlation Coefficient (ICC). The R-HALT revealed strong internal consistency with Cronbach's alpha values ranging from 0.93 to 0.96, and an ICC value of 0.87 (95% CI = 0.70-0.99), demonstrating excellent test-retest reliability. Mean scores of individual items ranged from 0.82 ± 0.94 (Q3) to 3.23 ± 1.15 (Q11). The corrected item-total correlation ranged from 0.30 (Q2) to 0.90 (Q19). Organoleptic test scores diagnosed 41% (62 patients) with a score of 2, with increasing severity in 9% (13 patients) with a score of 5. The R-HALT exhibited robust reliability and validity in assessing the impact of halitosis among Romanian teenagers and young adults. The questionnaire is a strong tool for understanding, diagnosing, and managing halitosis in Romania, ultimately aiming to improve the quality of life of affected individuals. Further studies with diverse populations could enhance the applicability of the R-HALT.

Clinical Profile of 24 AIDS Patients with Cryptococcal Meningitis in the HAART Era: A Report from an Infectious Diseases Tertiary Hospital in Western Romania

Management of cryptococcal infections among patients suffering from acquired immunodeficiency syndrome (AIDS) represents a medical challenge. This retrospective study aims to describe the disease management and outcomes among 24 AIDS patients who suffered from Cryptococcus neoformans meningitis. The parameters evaluated from our patients’ database records include epidemiological data, clinical manifestations, biochemical and microbiological analysis of patients’ cerebrospinal fluid (CSF), treatment profiles, and disease outcomes. All patients included in the study had a lymphocyte count of less than 200 CD4/mm³. Of the 24 patients included in this study, five had been diagnosed with HIV infection since childhood, after receiving HIV-infected blood transfusions. The most prominent symptom was fatigue in 62.5% of patients, followed by nausea/vomiting and headache. Seven patients had liver cirrhosis due to hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, while Kaposi sarcoma and cerebral toxoplasmosis were found in two patients. Six out of 24 patients died due to bacterial sepsis and acute respiratory distress syndrome (ARDS). High intracranial pressure was the strongest predictive factor for mortality (OR = 2.9), followed by ARDS (OR = 1.8), seizures at disease onset (OR = 1.4), and diabetes mellitus (OR = 1.2). Interestingly, patients younger than 40 years old had a significantly lower survival rate than that of the older patients. Before developing Cryptococcal meningitis, all patients had low adherence to the early ART treatment scheme and skipped the follow-up visits. All patients received a combination of amphotericin B and flucytosine as induction therapy, adding fluconazole for maintenance. Simultaneously, AIDS HAART was initiated at diagnosis of the cryptococcal infection. A combined regimen of antifungals and highly active antiretroviral therapy showed improved patient recovery with minor side effects.