Background: Despite a decline observed in smoking rates amongst adults in many high-income countries, tobacco usage among adolescents remains a significant concern, particularly in Central and Eastern Europe, Romania being no exception. This cross-sectional study aims to assess the prevalence of smoking among teenagers enrolled in several public schools in Bucharest and the surrounding county, Ilfov, while also exploring their attitudes, perceptions, and experiences regarding tobacco. Methods: A public health campaign, conducted in collaboration with multiple institutions between September 2023 and March 2024, sought to provide secondary school students with updated information on smoking and its implications through presentations at schools. Following these presentations, students voluntarily completed anonymous on-paper questionnaires consisting of 10 multiple-choice questions designed to gauge their knowledge and attitudes towards smoking, conceptually inspired by internationally validated instruments such as the Global Youth Tobacco Survey. Results: A total of 945 teenagers participated in our study, with a median age of 13.04 years (standard deviation of ±1.08). Results indicate that 22.85% (n = 216) of teenagers had attempted smoking at the time of the investigation. Additionally, 57.88% (n = 547) of respondents reported exposure to second-hand smoke at home, and 40.42% (n = 382) had been invited to smoke previously. Conclusions: Various factors influence smoking behaviors among teenagers, with peer pressure and familial background playing significant roles in shaping their attitudes toward smoking. Our study highlights the vulnerability of the young Romanian population to these influences, emphasizing the need for initiatives aimed at mitigating tobacco use and fostering a healthier future environment. Nonetheless, these findings shall serve as an instrument for the development of school-based prevention programs and stricter tobacco usage policies.

BACKGROUND:Tuberculosis (TB) remains one of the most globally impactful infectious diseases, with a recorded mortality of 1.6 million in 2022. In Romania and Ukraine, two high burden countries in the context of the WHO European region, treatment is geared towards cure; however, this path is paved with significant challenges, from morbidity to loss to follow-up. METHODS:A retrospective study was performed for drug-susceptible TB patients hospitalised in three TB expertise centres in Romania and Ukraine using routinely collected data. Univariable and multivariable logistic regression analyses were used to assess predictors of three treatment outcomes: unfavourable outcomes, loss to follow-up, and death. RESULTS:A total of 838 patients diagnosed with drug-susceptible TB were included. Median hospitalisation was 39 days (IQR 25-67), and treatment duration was 7 months (IQR 6-8). Predictive variables differed by outcome. For unfavourable outcomes, the multivariable model included age > 65 years, chronic kidney disease, at least one cavity on chest X-ray, underweight status, and persistently abnormal laboratory parameters despite intervention. Independent predictors of loss to follow-up were alcohol use, COPD, TB infection within two years prior to admission, obesity, slow treatment response, and sputum microscopy ≥2 + . Predictors of death included age > 65 years, male sex, cirrhosis, chronic kidney disease, underweight status, persistently abnormal laboratory parameters, and slow treatment response. CONCLUSION:Contextualising factors influencing drug-susceptible TB treatment outcomes in different settings can support the development of tailored interventions that enable early identification of patients at higher risk, thereby avoiding unnecessary treatment effects.

IntroductionTuberculosis (TB) is a global public health burden. Romania experiences some of the highest rates of TB compared to other European countries. TB incidence is spatially clustered throughout Romania, and the reasoning behind this is likely linked to various environmental and socio-economic factors. This study aimed to investigate the spatial distribution of TB incidence per 1,000 population between 2015 and 2021 and examined its correlation with particulate matter (PM2.5) levels, living conditions, and level of educational indicators.MethodsTB incidence data from 2015 to 2021 aggregated at the level of 3,181 administrative territorial units (UATs) in Romania were analyzed. Pearson correlation coefficients examined linear associations among total TB incidence and exploratory indicators. A Principal Component Analysis (PCA) was conducted due to the presence of multicollinearity in the Pearson correlation matrix, which grouped key housing indicators into one hybrid living condition index (PCA1). Bivariate Moran's I analyses assessed localized spatial clustering between TB incidence and two exploratory indicators: PM2.5 levels and PCA1. A spatial lag regression model accounted for spatial dependence between TB incidence and three explanatory predictors: PM2.5 levels, the percentage of the population that is illiterate, and PCA1. All significance tests were conducted at a threshold of p < 0.05.ResultsTB incidence is spatially clustered in Romania. PM2.5 levels (r = 0.261, p < 0.0001) and PCA1 (r = 0.338, p < 0.0001) are positively and significantly associated with TB incidence. Illiteracy showed no significant association with TB incidence. The spatial lag model confirmed spatial autocorrelation (Rho = 0.436, p < 0.0001) and explains 28.4% of the variation in TB incidence across Romania.Discussion/ConclusionThis is the first geospatial study in Romania that explores the link between TB incidence and exploratory indicators of air pollution, living conditions, and education level using epidemiological data obtained in the national tuberculosis surveillance and control program. Greater exposure to air pollution and worsened living conditions are correlated with higher TB incidence rates. Policymakers should highlight the need for geographically targeted interventions to improve TB control and screening in Romania.

The article analyzes the effects of psychosocial interventions on adherence to tuberculosis (TB) treatment among vulnerable populations in Romania. The study includes 4104 patients from disadvantaged groups (rural, injecting drug users, homeless), beneficiaries of a national multidisciplinary support program. Multivariate analyses conducted on drug-susceptible TB (DS-TB) patients within this cohort identified some predictors of therapeutic success, such as extrapulmonary diagnosis, peer-to-peer educational support, and a higher level of education. At the same time, men, occupationally inactive people and those in the initial phase of treatment at project entry showed lower adherence. The results support the integration of psychosocial interventions in TB management.

This article reports the case of a patient with a gastric neoplasm and total gastrectomy, presenting with severe digestive intolerance, who developed peritoneal and pulmonary tuberculosis. Standard treatment could not be administered. Therefore, treatment was initiated with isoniazid and rifampicin suppositories, and intravenous levofloxacin and amikacin, with significant remission of the digestive symptomatology. Although treatment with rifampicin suppositories has demonstrated efficacy in tuberculosis, it is rarely used in practice. This case highlights the importance of individualizing tuberculosis treatment and demonstrates that rectal administration of isoniazid and rifampicin suppositories, combined with intravenous levofloxacin and amikacin, was successfully used to treat tuberculosis in a patient with severe digestive intolerance, highlighting a potential alternative regimen when standard oral therapy is not feasible.

Obstructive sleep apnea syndrome (OSAS) is a common disorder with established cardiovascular and metabolic risks. Positive airway pressure (PAP) therapy remains the standard of care; however, its long-term effectiveness is often limited by poor compliance and adherence. This study sought to explore clinical and device-related factors influencing PAP use, with emphasis on pressure variability in Auto-PAP users and comorbidities such as COPD. We performed a retrospective analysis of 359 patients with OSAS who were treated with CPAP, Auto-PAP, or BiPAP devices at the Marius Nasta Institute of Pneumology between January 2022 and July 2024. Compliance was measured as the proportion of days the device was used, whereas adherence was estimated through average nightly hours of use. Patient data were stratified by demographic, clinical, and device-related characteristics. Statistical testing included Chi-square, Wilcoxon rank-sum, and correlation analyses. Demographics did not significantly differ between compliant and non-compliant groups. Notably, Auto-PAP users with greater pressure variability (>10 cm H2O) had significantly lower compliance (p = 0.001). Nasal mask preference was also associated with poorer compliance (p = 0.030). Multivariate models further revealed that atrial fibrillation reduced the likelihood of good adherence (OR = 0.319, 95% CI 0.137-0.746). These results highlight the importance of monitoring pressure variability, device type, and comorbidities to personalize PAP therapy and improve long-term outcomes.

Introduction: Despite advances in diagnostic technologies for tuberculosis (TB), global control of this disease requires improved technologies for active case finding in selected vulnerable populations. The integration of artificial intelligence (AI) into imaging modalities has been anticipated to assume a pivotal position in conjunction with traditional bacteriological diagnostic approaches, especially in the active diagnosis of vulnerable groups. Methods: The study was conducted as a prospective investigation spanning from November 2019 to October 2023, in Romania's national TB screening project. From total of 92,368 tested participants, 404 patients were included in the study, with 202 individuals diagnosed with TB and 202 individuals serving as controls. The initial interpretation of radiological images was performed by AI X-Vision software and patients with suspicious findings were confirmed to have TB using GeneXpert testing. The objective of this study is to discover a threshold at which the AI score can accurately assess the risk of TB, regardless of the patient's medical background. Results: The study involved a number of 404 people, among whom 202 were diagnosed with TB out of a total of 92,368 participants, and the remaining 202 patients represent the control group. The current study highlighted, at an AI threshold value of 0.4, that 89% of the screened people benefited from a correct assessment using the AI associated with the radiological examination. ROC curve analysis indicates an AUC of 0.923 (95% CI:0.893-0.947; significance level p < 0.0001) which shows that the test has a high capacity to accurately detect individuals with TB and also to rule out those who do not have the disease, with sensitivity 87.1, specificity 91.6 and criterion >0.3585. Conclusion: Our study brings to the fore the significance of integrating AI software X-vision with bacteriological diagnosis in detecting TB among vulnerable groups in Romania. This underscores the imperative at the global level to develop solutions in the prompt diagnosis of TB, particularly within vulnerable groups.

Introduction:Tuberculosis (TB) remains a global health challenge, requiring enhanced active case finding (ACF) through screening strategies. This study assesses the effectiveness of such an approach in locating TB cases among vulnerable groups, such as homeless persons, injecting drug users, those detained in prison, and people living in rural areas.Methods:The study focuses on socio-economic characteristics and TB detection rates across Romanian counties using modern techniques including computer-aided detection of lesions on chest X-ray and GeneXpert tests.Results:The results highlight the disproportionate burden of TB in vulnerable groups, by revealing significant differences in TB detection rates between regions. Notably, the TB detection rates among these vulnerable groups (250.85 per 100,000 population) are five times higher than the national incidence rate (46.1).Discussion:These findings underscore the imperative integration of ACF into National TB Program to provide customized and efficient solutions for diverse vulnerable groups, thereby informing crucial public health initiatives and interventions.

BackgroundTuberculosis (TB), and especially its drug resistant forms, is responsible for not only significant mortality, but also considerable morbidity, still under-quantified. This study used four Patient-Reported Outcome Measures (PROMS) to assess the status of persons affected by drug-susceptible and drug-resistant TB during their TB treatment or after treatment completion, in Romania, the highest TB burden country in the EU.MethodsPeople affected by TB in two different regions in Romania were included during and after treatment, following a cross-sectional design. PROMs used were SF-36, EQ-5D-5L, WPAI and the app-based audiometry screening tool 'uHear.' Descriptive statistics and relevant statistical tests were used to compare groups between themselves and with the general Romanian population.ResultsBoth patients with drug-susceptible and drug-resistant TB experience, with drug-resistant patients experiencing statistically significantly more pain and hearing loss. PROMs show some improvement in the after-treatment group; however, compared with the general Romanian population for which data were available, all groups scored lower on all outcome measures.ConclusionPROMs offer the possibility of obtaining a more comprehensive view of patients' status, by involving them directly in the medical process and could guide a rehabilitation strategy.

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.

Abstract Short wavelenght light (blue light) contributes to dysregulations of the circadian cycles. In an era where most of the light sources were replaced by Light Emitting Diodes (LEDs), a new problem regarding sleep quality and nictemeral cycle appears. Even though blue light is currently being used a treatment for sleep dysregulations and insomnia (through cycle altering), this stimuli activates the melanopsin secretory mechanism via photoreceptor cells and thus supresses the pineal secretion of melatonin. Melatonin plays a crucial role in provoking pre-sleep symptoms, inducing and maintaining sleep, improving sleep quality and multiple other effects dependant to the organ, such as being an antioxidant or its protective atribute against diabetes. This paper is a general review of the literature and brings to a single place multiple studies about the importance of sleep, physiology of melatonin secretion and the effect of light exposure on those aforementioned.

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.

In this observational cohort study, sleep quality in post-COVID-19 patients was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. This study aimed to examine aspects of sleep quality in patients who have undergone SARS-CoV-2 infection and if there is a pattern of progression or regression over time (6 months). We also observed and analyzed the results in order to identify any possible links between the severity of COVID-19 and sleep quality as measured by the PSQI questionnaire. The study group consisted of 65 adult patients with confirmed SARS-CoV-2 infection who were referred to a pulmonologist for evaluation. Sleep quality was impacted at a high rate in post-COVID-19 patients, quantified by a PSQI score ≥5. Out of 65 patients, 51% of them had scores greater than or equal to 5. Sleep was subjectively reported as unsatisfactory predominantly in mild and moderate COVID-19 patients. According to the PSQI score and a 6-month follow-up, many patients presented persistency in poor sleep quality. Investigation and individualized treatment of sleep disorders in post-COVID-19 patients should be part of the routine pneumological control, as improvement in sleep quality has an impact not only on the health but also on the psychological state of patients. Educating patients about the importance of sleep and sleep quality impairment should be a primary concern.

Bronchopulmonary cancer is the leading cause of cancer deaths globally. Rheumatoid arthritis is one of the risk factors for lung cancer, and those who use methotrexate have a higher risk of developing lung cancer. We present the case of an 80-year-old patient who is a former smoker and is known to have rheumatoid arthritis, being treated using methotrexate; they were brought by ambulance to the emergency room for coughing with ineffective expectoration, dyspnea on slight exertion, and right-lateral chest pain with onset about one month prior and progressive worsening. Imaging showed a 7 cm/6 cm LID tumorous lung formation with parietal invasion and C7 rib lysis, as well as diffuse fibrotic interstitial changes predominantly in the lower lobes. An ultrasound-guided transthoracic lung biopsy was performed, and histopathological examination established the diagnosis of invasive squamous cell lung carcinoma, G2. In conclusion, the chest pain interpreted by the patient as rheumatic pain delayed the diagnosis of lung cancer; the patient presented rather late to the hospital once respiratory failure set in.

Abstract Patients with neoplastic lung disease experience a decreased quality of life due to progressive respiratory dysfunction. The inclusion of non-invasive ventilation (NIV) in the management plan of these patients has been effective in relieving symptoms of acute respiratory failure, reducing respiratory effort and increasing sleep quality. A 48-year-old patient diagnosed with pulmonary adenocarcinoma (radio-chemo-treated) and COPD presented to the ER with the complaints of thoracalgia, dyspnoea and daytime fatigue. Initial tests showed hypoxemic respiratory failure, mild obstructive sleep apnoea syndrome and right medium pleural effusion. CPAP therapy was initiated but not tolerated by the patient and, therefore, we switched to NIV – BPAP (spontaneous mode) with satisfactory results. The literature indicates that NIV therapy has proved superior to oxygen therapy in cancer patients, relieving dyspnoea in patients with hypoxemic respiratory failure (regardless of PaCO2 level). Moreover, NIV-treated patients required lower doses of opioids and reported an improved quality of life.

Objective — to conduct a retrospective analysis of factors that affect the results of treatment of patients with tuberculosis. Materials and methods. A retrospective multi-center study was conducted on adult (> 18 years) patients diagnosed with drug-sensitive susceptible TB of any form and initiated treatment between 1st of January 2019 — 31st of December 2019. The Bucharest Marius Nasta Institute, the Iasi Lung Hospital in Romania, and Chernivtsi TB Centre in Ukraine participated in this study. The study was approved by the ethics committee of each centre (Iassi: 5483/2021, Bucharest: 10592/2019, Chernivtsi: 234/2021,). The need for written informed consent was waived due to the retrospective nature of this study. Results and discussion. It is important to study the factors that influence the course and effectiveness of TB treatment, as they can be useful for the development of new methods of diagnosis and treatment. Our retrospective study identified such factors in an Eastern European population. The risk of adverse consequences increases for the elderly, people without a permanent place of residence, patients with already diagnosed chronic kidney disease, the presence of cavities on a chest X-ray, rapid relapse of TB, under­weight or obesity.These factors may help tailor care to specific populations and may lead to improved TB scoring systems to identify patients at risk of treatment failure. Conclusions. Our study presented common risk factors for unfavourable outcomes with previous research, including age, sex, nutritional status, lifestyle, comorbidities, TB-related parameters, but introduced a new, paraclinical parameter, and highlighted differences for East Europe.

Purpose:Romania has the highest tuberculosis (TB) burden in the European Union/European Economic Area (EU/EEA) comprising almost a quarter (23.4%) of the reported patients in 2017, and a TB notification rate six times higher than the EU/EEA average. Although the overall TB notification rate in Romania declined from 154/100.000 individuals to 66/100.000 individuals in the general population between 2002 and 2017, TB notification rates remain high in certain vulnerable populations groups such as prisoners, the homeless population and among drug users.Patients and Methods:We conducted a descriptive study regarding TB monitoring data in Romania, including the aforementioned TB risk groups.Results:Analysis regarding notified TB cases among these risk groups indicates that TB rates are 7 to 18 times higher than in the general population. One of the most alarming aspects regards the exceedingly high proportion of HIV-seropositivity among drug users and the high mortality rates among the homeless population and among drug users with TB.Conclusion:This data underlines the importance of early identification among social risk groups using outreach active case-finding (ACF) activities, possibly combining TB screening with screening for other common, possibly life-threatening, co-morbidities for which an effective treatment is available. ACF could have a decisive role in TB control and eradication in Romania, when aimed at these high-risk groups.

1Department of Pneumology, Marius Nasta Institute of Pneumology, Bucharest, Romania; 23 Department – Complementary Sciences, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; 3Department of Tuberculosis Control, Regional Public Health Service Groningen, Groningen, The Netherlands; 4Department of Lung Diseases and Tuberculosis, University Medical Centre Groningen (UMCG), Groningen, The Netherlands; 5Institute for Global Health, University College London, London, UK; 6Institute of Health Informatics, University College London, London, UK; 7Find and Treat, University College Hospitals NHS Foundation Trust, London, UK; 8KNCV Tuberculosis Foundation, The Hague, The Netherlands; 9Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; 104 Department – Cardio-Thoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania