Spatio-Temporal Pattern of Tuberculosis Distribution in Romania and Particulate Matter Pollution Associated With Risk of Infection

The study proposes a dynamic spatio-temporal profile of the distribution of tuberculosis incidence and air pollution in Romania, where this infectious disease induces more than 8,000 new cases annually. The descriptive analysis for the years 2012-2021 assumes an identification of the structuring patterns of mycobacterium tuberculosis risk in the Romanian population, according to gender and age, exploiting spatial modeling techniques of time series data. Through spatial autocorrelation, the degree of similarity between the analyzed territorial systems was highlighted and the relationships that are built between the analysis units in spatial proximity were investigated. By modeling the geographical distribution of tuberculosis, the spatial correlation with particulate matter (PM2.5) pollution was revealed. The identification of clusters of infected persons is an indispensable step in the construction of efficient tuberculosis management systems. The results highlight the link between the distribution of tuberculosis, air pollution and socio-economic development, which requires a detailed analysis of the epidemiological data obtained in the national tuberculosis surveillance and control program from the perspective of geographical distribution.

TB therapeutic drug monitoring - analysis of opportunities in Romania and Ukraine

INTRODUCTION: Therapeutic drug monitoring (TDM) could improve TB treatment outcomes by avoiding drug toxicity or underdosing. In this study, we describe the patient burden in three TB centres in Romania and Ukraine with a TDM indication, as per the current guidelines, in order to estimate the feasibility of implementing TDM.METHODS: A retrospective multi-centre study was conducted at the Iasi Lung Hospital (Iasi, Romania), Bucharest Marius Nasta Institute (Bucharest, Romania) and Chernivtsi TB Centre (Chernivtsi, Ukraine) in adult hospitalised TB patients.RESULTS: A total of 927 participants were admitted, of whom 37.8% had at least one indication for TDM, the most frequent being slow response to TB treatment (202/345, 58.6%); 55.5% had at least one cavity present on chest X-ray. Patients with a TDM indication stayed in the hospital for a median of 67 days and took on average 2 months more to reach a successful TB outcome.CONCLUSION: TDM could be a valuable tool to improve management of selected TB patients. The decision on whether to perform TDM is often delayed by 2 months due to waiting for culture results after treatment initiation. A randomised control trial should be performed in order to define TDM's precise role in TB therapy.

Policy framework for building integrated care for TB patients in Romania: setting up the scene

Problem

Romania put many efforts for TB control, but despite a constant decreasing trend since almost two decades, TB remained a public health concern, due to the notification rate (highest in EU), the number of resistant cases and the mortality. A national strategy for TB control has been issues for 2015-2020, but its implementation was fragmentary.

Description of the Problem

Benefiting for a series of programs financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria, Romania performed a detailed analysis of the national context, on four pillars (governance and accountability, service delivery, organizational capacity, resources). Quantitative data collected through routine systems were combined to interviews with key informers and focus groups with medical staff, patients and NGOs active in supporting key vulnerable population.

Results

A national framework for strengthening the implementation of the strategy was set up under a Tailored to Transition Global Fund Grant. This framework put together the policy and the technical levels and the civil society sector. Main interventions aimed to strengthen the governance, to improve the procurement and supply mechanism, to develop the ambulatory patient-centered model of care and to create tools for improving the access of key vulnerable population to basic integrated medical and social services.

Lessons

Translating the good practice models developed by the NGO sector to permanent (governmental) structures was difficult due to more rigorous legislative framework for public systems.

Key messages

Multisectoral approach is essential for building integrated care for TB patients. Integration of services should focus not only to complex medical needs, but also to the social ones.

Genetics of colorectal cancer

The occurrence of colorectal cancer is related to the interaction that takes place at several levels between hereditary factors, environmental and individual ones. Understanding the molecular basis is important because it can identify factors that contribute to the initiation of development, maintenance of progression but also determine the response or resistance to antitumor agents. Understanding colorectal cancer at the molecular level has provided data used for genetic tests of family forms, it defined predictive markers used to select patients susceptible to certain forms of therapy and also for the development of molecular diagnostic tests to detect early non-invasive cancers.

Retrorectal dermoid cyst: a rare clinical entity

The retrorectal space represents the anatomical site at which level we identify the embryologic reminiscents in which it can develop liquid tumors - cysts or solid tumors - neoplasia. These tumors are rare but pose a diagnostic and therapeutic interest. This paper presents the case of a young 18 years-old diagnosed incidentally at a gynecological examination, with a palpable tumor developed, at the retrorectal space. Imaging examinations - transvaginal ultrasound and abdominal - pelvic computer tomographic exam - have supported the presence of a cystic tumor with a maximum diameter of 7.8 cm., in the space retrorectal. The lesion presented surgical indication, so it needed a posterior approach with resection of the coccyx enough for the control and safety of the operation. Histopathological examination revealed a dermoid cyst. Five years after surgery the patient is presented in good general condition, asymptomatic without clinical and imaging signs of local-regional recurrence.

Passivity-based current controller design for a permanent-magnet synchronous motor

The control of a permanent-magnet synchronous motor is a nontrivial issue in AC drives, because of its nonlinear dynamics and time-varying parameters. Within this paper, a new passivity-based controller designed to force the motor to track time-varying speed and torque trajectories is presented. Its design avoids the use of the Euler-Lagrange model and destructuring since it uses a flux-based dq modelling, independent of the rotor angular position. This dq model is obtained through the three-phase abc model of the motor, using a Park transform. The proposed control law does not compensate the model's workless force terms which appear in the machine's dq model, as they have no effect on the system's energy balance and they do not influence the system's stability properties. Another feature is that the cancellation of the plant's primary dynamics and nonlinearities is not done by exact zeroing, but by imposing a desired damped transient. The effectiveness of the proposed control is illustrated by numerical simulation results.

[The prevalence of smoking in physicians in Romania]

An inquiry upon the prevalence of the habit of smoking in doctors in Romania, performed in a group of 1136 doctors (p = 0.05) revealed a prevalence of 43.2%, 50.1% in men and 38.6% in women. Smoking is more frequent in group age 30-49 (47.2%). More than half of the smoking doctors smoke between 10 and 20 cigarettes a day. 45.7% of the resident doctors are smokers. Taking into account the large interface with the public, the medical staff can play an important part in the activity of reducing or stopping smoking.

Database for gynecological laparoscopy

Laparoscopy is a wonderful tool for performing gynecologic surgery. Whether or not laparoscopic surgery is advisable to diagnose or treat a particular gynecologic problem requires a careful consultation with an experienced gynecologist, who can help the patient weight the pros and cons of laparoscopy versus other options. For the management of this kind of surgical intervention we realise a computer based patient record.

[The bacterial spectrum in bronchopulmonary infections]

This study aimed to establish the bacterial profile of bronchopulmonary infections confirmed by the cytobacteriological examination of sputum, in order to find therapeutical guidelines for empirical treatment. We included in the study 408 patients with clinical signs of bronchopulmonary infection (cough and mucopurulent sputum, fever) among which 294 hospitalised patients (5.5% of the 5280 admitted in 1997) and 114 outpatients. The sputum samples collected respecting the decontamination methods were examined cytobacteriologically (smear, culture and antibiogram). The spectrum of isolated bacteria was the following: H. influenzae--198 cases, anaerobes--54, Kl. pneumoniae--53, Ps. aeruginosa--50, S. pneumoniae--17. Analyzing the diseases for which the bacterial examination was performed, we found the following distribution: COPD--66, bacterial infections in TB patients--61, chronic suppurations--33, bronchiectasis--37, pulmonary abscess--24. We noticed the high frequency of H. influenzae and important numbers of anaerobes, Kl. pneumoniae and Ps. aeruginosa especially in COPD patients and patients with chronic suppurations. We performed antibiograms for establishing the sensitivity of bacterial samples (S. aureus, Kl. pneumoniae, Ps. aeruginosa, beta-lactamase-positive H. influenzae). Most of them were multidrug-resistant.

CONCLUSIONS

1. The cytobacteriological study of sputum may be useful for choosing the right treatment, especially for the patients with multiple antibiotic treatments and infected with multidrug resistant bacteria; 2. Knowing the bacterial spectrum in certain respiratory diseases allows the choice of empirical treatment for bronchopulmonary infections in uncomplicated cases.

[The results of using a simplified questionnaire for determining the prevalence of bronchial asthma]

The aim of the study was to assign the asthma prevalence in a Romanian region, by using a simplified questionnaire, easy to fill in by every subject without specialized help. The study included 508 subjects, 280 women (55.1%) and 238 men (44.9%). The subjects proceeded from different industrial areas (cement factory, rubber processing factory, fur and leather manufacture) and from a village (214 subjects). 203 subjects, having symptoms compatible with asthma, performed lung function tests with a Flow Screen Jaeger device, determining VC, FEV1, FEV1% VC, MEF50, MEF25, and pharmacodynamic test if needed (bronchoconstrictor or bronchodilator).

RESULTS

about 40% of the subjects mentioned the wheezing, among them 18% wheezing and dyspnea. "Asthmatic bronchitis" is present at 14.8% of the subjects, including 4.5% patients with bronchial asthma diagnosed by a physician (underdiagnosis). The asthma symptoms are more frequent in the factories with exposure to inhaled allergens and air pollution. The most discriminative symptom association for asthma was: wheezing and breathlessness and a history of dyspnea in the last year. These symptoms suggest that the prevalence of asthma could be 10.43%. The positive bronchodilator or bronchoconstrictor function test associated with wheezing, present at 7.48% of the population, seems to better evaluate the prevalence of asthma, which approaches other data already published. The questionnaire we used proved that it can select with acceptable accuracy the individuals to be further investigated with lung function tests.

The anatomical variants of the profunda femoris artery and of its collaterals

The profunda femoris artery, the main nutritive artery of the thigh, has a great surgical significance. The high frequency of the occlusive arterial disease in the lower limbs caused by atherosclerosis, imposes as main therapy the reconstructive surgery. Because the profunda femoris artery remains patient in most of the cases of the occlusive arterial disease of the lower limbs, it means the only hope of saving an critically ischemic limb in a desperate attempt of a surgeon to avoid amputation.

[Spigelian hernias. The authors' own experience and a review of the literature]

There are presented nine patients with spigelian hernia operated on between 1964 and 1996 (33 years interval). These patients represent 0.19% of the totality of the patients operated for different hernias in the same period. The sex ratio female/male was 7/2. The medium age of the patients was 55 years old +/- 12-18, the extremes being 37 and 67 years. To all the patients the hernia was located on the right side of the abdomen. The main associated disease, the degree III and IV obesity was present in 8 from 9 cases. In 3 cases (33%) the evolution was complicated by incarceration of the big epiploon and to one patient (11%) by partial strangulation of a jejunum ansae, Richter's type. Two patients with very large, nonreducible hernias created possibilities of confusions with abdominal tumors. Generally, the diagnosis was established only on clinical basis. All the patients were operated on (the Bachy techniques with direct approach) without immediate or late complications (there were no recurrences).

[The epidemiological aspects of cytomegalic infection in the Banat region, Romania]

A survey was conducted on 711 patients, adults and children. The results indicated the high incidence of cytomegalovirus infection among population and confirmed the virus transmission through blood transfusion. The existence of congenital infection in newborn seems to be confirmed. Some prevention measures are suggested.

[Influence of environmental factors on the spread of lambliasis in collectivities of small children]

In 1977, coproparazitological examinations, prophylactic and therapeutical studies were carried on 225 children in 14 day nurseries and homes in Cluj-Napoca; 21.57% of children suffered from intestinal parasitosis, giardiasis being found in 92.13% of the infested children. The high incidence of giardiasis led the authors to investigate the hygienic level of the environment. The high frequency of enterobacteriaceae opportunists (77.59%), identified on the hands of the personnel and on certain objects manipulated by the children, pointed to fecal pollution and poor sanitary conditions. The contaminated objects are sources of propagation of Giardia lamblia cysts. The increased incidence of giardiasis and of enterobacteriaceae opportunists in the environment were found both in the communities with many children and in those with few children.

Specific protection against bovine leukemia virus infection conferred on cattle by the Romanian inactivated vaccine BL-VACC-RO

The Romanian BL-VACC-RO vaccine against bovine leukemia virus (BLV) infection was prepared with ethylenimine-inactivated BLV obtained from persistently infected cell lines. Intramuscular administration of two vaccine doses (each containing 0.40 mg virus glycoprotein with adjuvant), 2 weeks apart, conferred protection against challenge infection with BLV on 18 of the 20 vaccinated calves. Two calves were not protected, in spite of their positive serologic response to vaccination. The results demonstrate the efficiency of the BL-VACC-RO vaccine in preventing BLV infection.