Romanian Patients Research Articles

Cross-Cultural Adaptation and Validation of the Romanian Marx Activity Rating Scale for Anterior Cruciate Ligament Reconstruction

Aim: We aimed to translate, cross-cultural adapt and validate the Marx activity rating scale (MARS) of the knee for Romanian patients with anterior cruciate ligament (ACL) injury. Method: The original English form was translated according to guidelines. We included patients with ACL injury undergoing reconstruction in two centers over 3 years. Subjects completed the translated MARS, International Knee Documentation Committee (IKDC) subjective knee form and EuroQol EQ5D. The examining physician completed the Tegner Lysholm scale as an objective evaluation. Re-testing was obtained after one month. We used Spearman`s correlation to evaluate construct validity and reproducibility, Cronbach’s alpha for internal consistency and intraclass correlation for test-retest reliability. Results: We collected valid forms from 99 patients (32.1 ± 8.8 years, 64.6% males) during the preoperative evaluation and 45 were re-tested. Significant, very good correlations were found between the MARS and Tegner Lysholm (Spearman’s r = 0.712, p < 0.0001) and IKDC (Spearman’s r = 0.801, p < 0.0001). Cronbach’s alpha was 0.893 at the initial completion and 0.799 at re-test. The intraclass correlation coefficient was 0.895. Conclusions: The Romanian-translated MARS is a valid, consistent and reliable physical activity outcome measure in patients with anterior cruciate ligament reconstruction.

Hereditary Angioedema Due to C1-Inhibitor Deficiency in Romania: First National Study, Diagnostic and Treatment Challenges.

Hereditary angioedema (HAE) is a rare genetic potentially life-threatening disease characterized by episodic non-pruritic subcutaneous and submucosal edema attacks in different parts of the body. To assess the status of Romanian HAE patients after the recent introduction of a new therapy through a nationwide program. This cross-sectional observational study included patients from the Romanian HAE Registry. The study included 84 patients with HAE type I (91.7%) and type II (8.3%). The mean delay in diagnosis was 2.4 years in children and 16.7 years in adults (p=0.019). Stress and tiredness were the most frequent trigger factors. The majority of the HAE episodes involved subcutaneous (89.3%), abdominal (77.4%), genital (51.2%), facial (41.7%), and laryngeal (39.3%) symptoms during the preceding 12 months. One or several misdiagnoses were reported in 83.33% patients and 44.1 % of the patients were subjected to or proposed unnecessary surgery during abdominal episodes. Plasma-derived C1-INH (pdC1-INH) and recombinant C1-INH (rhC1-INH) were respectively used in 10 (11.9%) and 13 (15.5%) of the HAE patients for life-threatening attacks over the past 12 months. Forty-three (51.19%) patients practiced home treatment with subcutaneous injection of the bradykinin B2-receptor antagonist for acute HAE attacks. The significantly lower delay observed in children suggests an improvement in the awareness of C1-INH-HAE among physicians in recent years. The management of HAE in Romania has been somewhat enhanced as the majority of HAE patients have recently gained access to pdC1-INH, rhC1-INH, and bradykinin B2-receptor antagonist.

How do Romanian patients perceive and experience public and private rehabilitation services?

The quality of medical and rehabilitation services is a constant topic of debate. Health service quality is defined as the degree and direction of discrepancy between patients’ perceptions and expectations. The present study is a conclusive direct investigation that aims, among other things, to record the differences between private and public rehabilitation systems, and compare the results obtained from questionnaires applied to patients. The main hypothesis from which we started this research was that there were differences in terms of patient-physiotherapist relationship and quality of services between public and private rehabilitation systems. This research was carried out using the following methods: bibliographic study method, observation method, questionnaire method, mathematical and statistical processing method, and graphical method. The study was conducted over a period of ten months (June 2018 - April 2019) in seven private rehabilitation institutions and two public rehabilitation institutions in Târgu Mureș, Romania, on a total of 260 patients. Data analysis revealed statistically significant quality gaps between rehabilitation services offered by private versus public institutions. Following the investigation, interpretation, and analysis of recorded results, we can say that the hypothesis has been confirmed. Public rehabilitation institutions failed to meet patients’ expectations in all major areas of service quality.

Predictive Factors for the First Recurrence of Clostridioides difficile Infection in the Elderly from Western Romania.

Background and objectives: At present, Romania and parts of the European Union are facing an increasingly challenging public health problem consisting of nosocomial Clostridioides difficile infection (CDI), mostly in the elderly. Relapse cases have become more frequent, which present higher morbidity and mortality rates than the initial CDI infection. The aim of this study is to determine the predictive factors for recurrence, with the purpose of reducing the exposure of patients diagnosed with CDI, as well as aiming to initiate early treatment. Materials and Methods: In this retrospective descriptive study, we analyze a database from the First Department of Infectious Diseases at the Dr. Victor Babes Clinical Hospital for Infectious Diseases and Pulmonology in Timisoara, looking for patient history of CDI recurrences. We analyzed CDI recurrence in patients aged ≥65 years from 1 January 2016 to 31 December 2019, identifying 77 cases of CDI recurrence. The determination of predictive factors for recurrence involved the formation of a randomized control group, consisting of 74 patients aged ≥65 years who were diagnosed with C. difficile enterocolitis, but did not suffer a recurrence and survived ≥2 weeks after symptom onset. Results: Immunocompromised status, pre-existing gastrointestinal disease, and fever on initial hospitalization for CDI were all found to be significant independent positive predictive factors for the condition recurring in elderly Romanian patients. Conclusions: As the geriatric population in Romania grows, the national health system becomes increasingly overburdened, both from a financial standpoint and a human resources perspective. The analysis of factors predictive for CDI recurrence is, thus, of the utmost importance, particularly for the early identification of patients most at risk of CDI recurrence. Our findings could help physicians to identify recurrence early, consequently benefitting patients by a rapid intervention with a potential decrease in the associated complications and mortality.

Evolution of Inflammatory and Oxidative Stress Markers in Romanian Obese Male Patients with Type 2 Diabetes Mellitus after Laparoscopic Sleeve Gastrectomy: One Year Follow-Up.

Geography is one of the key drivers of the significant variation in the etiopathogenic profile and prevalence of type 2 diabetes mellitus (T2DM) and obesity, therefore geographically based data are fundamental for implementing the appropriate interventions. Presently, the selection criteria of T2DM and obesity patients for laparoscopic sleeve gastrectomy (LSG) have not reached a worldwide consensus—highlighting the need for sharing experts’ guidance in the preoperative evaluation, choice of the interventional procedure, perioperative management and patient long-term care. The aim of the current study was to evaluate the impact of LSG on T2DM (T2DM) remission in Romanian obese male patients, based on a multiparametric, prospective investigation. We have conducted a randomized controlled study on 41 obese male participants with the body mass index (BMI) ≥ 30 kg/m2, aged 30–65 years, which were randomly divided in two study groups: one receiving conventional treatment and the second undergoing LSG. The clinical and anthropometrical parameters, resting metabolic rate, general biochemical status, adipocytes profile, gastrointestinal hormones levels, proinflammatory, oxidant and antioxidant profiles were determined at three time points: V1 (baseline), V2 (after six months) and V3 (after 12 months). Glycated hemoglobin (HbA1c), blood glucose levels, BMI, weight, visceral fat level, HDL-cholesterol, incretin hormones, proinflammatory and the oxidative stress status were significantly improved in the LSG versus conventional treatment group. This is the first study reporting on the evaluation of metabolic surgery impact on Romanian obese male patients with T2DM. Our results confirm that LSG could contribute to T2DM remission in patients with diabesity, but this beneficial effect seems to be critically influenced by the duration of T2DM rather than by the obesity status. Our results show that, in addition to the parameters included in the prediction algorithm, the proinsulin levels, proinsulin/insulin ratio and the visceral fat percentage could bring added value to the assessment of metabolic status.

Allogeneic Stem Cell Transplantation for Adult T-Cell Leukemia/Lymphoma-Romanian Experience.

Adult T-cell leukemia/lymphoma (ATLL) is a rare and aggressive mature T-cell malignancy caused by the human T lymphoma virus I (HTLV-I) affecting 3–5% of HTLV-1 carriers and is usually diagnosed in endemic regions. Romania is a region with high prevalence of HTLV-1 infection and ATLL and with low median age at diagnosis for aggressive types. We performed a retrospective analysis of post-transplant outcome in the first Romanian patients with ATLL receiving hematopoietic stem cell allotransplant. The study population included eight patients (three males, five females), with median age of 39.5 (range 26–57), with acute (one case) and lymphoma type (seven cases) that received peripheral stem cells (PBSC) from matched related (MRD) and unrelated donors (MUD) after reduced intensity conditioning. Graft versus host disease (GVHD) developed in six patients. Relapse occurred in four cases (50%) at a median time of 5-months post-transplant. Six patients died: four cases with disease-related deaths and two patients with GVHD-related deaths. The median survival post-transplant was 19.5 months (range 2.3–44.2 months). The post-transplant survival at 1-year was 62.5%, at 2-years 50%, and at 3-years 37.5%. In our opinion allogeneic transplant improves outcome in aggressive type ATLL.

Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients.

BackgroundParkinson’s disease (PD) is the second most common progressive neurodegenerative disease. In the advanced stages, the continuous delivery of levodopa (LD) as levodopa-carbidopa intestinal gel (LCIG) has demonstrated significant improvement of motor and nonmotor complications and improvement of the patients’ quality of life (QoL). Despite the growing global experience with this treatment, anumber of unsolved practical issues remain, and currently, the data on the reasons that can lead to the discontinuation of LCIG are scarce.ObjectiveIn the present study, we aimed to analyze the causes that led to the discontinuation of LCIG therapy.MethodsIn this retrospective study, after 10 years of experience with LCIG as a therapeutic option in advanced PD, we analyzed the data of all dropout cases among the 204 patients that initiated LCIG therapy in two Romanian centers.ResultsOf the 204 patients enrolled, 43 patients dropped out. Disease duration until LCIG infusion was significantly longer (11.67±4.98 vs 9.44±3.44) and the overall clinical picture more sever (both regarding motor symptoms and cognitive decline) in dropout patients (compared to patients who continued treatment). The dropout patients also presented significant differences regarding the incidence of polyneuropathy (32.5% vs 11.18%). The main cause of discontinuation was death.ConclusionThe causes of discontinuation from LCIG therapy in Romanian patients are similar to those from other centers; however, the rate of dropouts is somewhat lower. The clinician’s experience in selecting and treating the patients in advanced stages of PD can increase therapeutic adherence. Also, the presence of a well-trained caregiver along with the availability of a proper aftercare system is mandatory for maintaining the long-term benefits of the therapy and the overall best outcome possible. Targeted prospective studies are needed to confirm whether a more severe stage of the disease and cognitive impairment at the time of initiation, respectively, the association of polyneuropathy can be considered as predictive factors for dropout.

Mucopolysaccharidosis type I - Clinical and genetic characteristics of Romanian patients

Abstract Background: Mucopolysaccharidosis type I (MPS I) is an autosomal recessive lysosomal storage disorder caused by a deficiency of α-L-iduronidase (IDUA), which leads to the accumulation of partially digested glycosaminoglycans (dermatan sulfate and heparan sulfate) in the lysosomes and induces multisystemic alteration. Hurler (severe), Scheie (mild), and Hurler/Scheie (intermediate) syndromes are clinical subtypes of MPS-I. To date, more than 290 IDUA mutations have been reported. The purpose of this study was to present the clinical and genetic characteristics of Romanian MPS I syndrome patients and their genotype-phenotype correlation. Patients and methods: Seven patients (5 girls and 2 boys) with MPS type I, belonging to 4 unrelated families, aged 0,75-17.9 years, were enrolled. The study methods consisted in: clinical and standard auxological assessment, bone radiographs, joint ultrasonography, goniometry, neurological and psychological evaluation, hepatic and splenic ultrasonography, cardiological evaluation, otorhinolaryngology examination, ophthalmological examination, spirometry, α-L-iduronidase enzyme activity assay and molecular analysis. Results: The seven patients originated from 4 unrelated families, three patients with severe, two patients with intermediate and two with attenuated clinical phenotype. Each patient presented the classical picture of MPS type I picture, represented by: variable coarse facial features, arthropathy, hepatosplenomegaly, cardiac involvement, respiratory dysfunction and neurological impairment. Five patological variants, three point mutations (p.Q70 *, p.I238Q and p.K324R), two deletion c.1045_1047delGAC, c.46_57delTCGCTCCTG) and an insertion (c.1389 insC) were identified in both alleles of the ADUA gene in homozygous or heterozygous form. Two novel mutations (p.K324R and c.1389 insC) were reported. The p.Q70*(c.208C&gt;T) variant was identified in 2 families with severe form of disease (Hurler syndrome) in homozygous status in one family and in compound heterozygous status in the other family. Conclusion: The p.Q70* missense variant was the most frequent, correlated in all the cases who presented it with severe form, Hurler syndrome, the other mutations being usually isolated and particular for each patient, associated in our patients with less severe MPS I phenotype, as Hurler-Scheie or Scheie syndrome. The results of this study indicated the mutational heterogeneity of the IDUA gene and the difficulty to indicate some correlation between the genotype and phenotype in MPS I patients.

Long-term improvement of dyslipidaemia, hyperuricemia and metabolic syndrome in patients undergoing laparoscopic sleeve gastrectomy.

The aim of the study was to assess the long-term impact of laparoscopic sleeve gastrectomy (LSG) on lipid profile, uric acid level and metabolic syndrome. A prospective study was performed between 2009-2014, evaluating long-term percentage of excesso body mass index loss (%EBMIL), lipid profile, uric acid level and metabolic syndrome. Overall sixty subjects were followed-up. %EBMIL increased significantly, reaching a maximum (86,9 ± 6,3%) at 5 years post-LSG. Therapeutic success rate (%EBMIL ≥ 60%) was 80% at 5 years. The triglyceride level decreased significantly (148 ± 72.1 mg/dL baseline vs 130.7 ± 57.5 mg/dL at 1 month vs 110.7 ± 42.6 mg/dL at 3 months vs 92.5 ± 35.2 mg/dL at 1 year vs 84.2 ± 32.3 mg/dL at 5 years; p < 0.05 for all). HDL-cholesterol increased and uric acid decreased significantly in the first year postoperatively, remaining stable afterwards (46.9 ± 12.3 mg/dL baseline vs 47.4 ± 10 mg/dL at 1 month vs 49.8 ± 9.3 mg/dL at 3 months vs 55.4 ± 10.2 mg/dL at 1 year; p < 0.05 for all for HDL-cholesterol and 6.4 ± 2 mg/dL baseline vs 6 ± 1.7 mg/dL at 1 month vs 5.2 ± 1.3 mg/dL at 3 months vs 4.8 ± 1 mg/dL at 1 year; p < 0.05 for all for uric acid). The prevalence of metabolic syndrome decreased from 66.7% baseline to 8.3% at 5 years postoperatively (p < 0.01). LSG was effective in terms of %EBMIL and metabolic traits improvement for Romanian patients.

Amputation, psychological consequences, and quality of life among Romanian patients

Abstract Amputation of the limb is a major psychological health issue that was not fully studied. Patients and their families struggle with symptoms of depression, posttraumatic stress disorder, anxiety, phantom limb phenomena, etc. There is also a tremendous impact on the person’s quality of life. Aim: This study aimed to assess the psychological symptoms of depression, anxiety, and the quality of life among persons suffering from amputation of the limb. Methods: 31 respondents agreed to participate in the study. They were recruited from the Department of Orthopaedics and Traumatology, University Emergency Hospital, Bucharest, Romania. The medical conditions and the socio-demographic data (i.e., gender, marital status, income, etc.) along with the assessment of the psychological conditions and quality of life were contributions to the statistical analysis of the study. Results: This study showed that levels of depression are moderate to severe for a significant percent of the population (i.e., a “moderate to severe” or “severe” level of depression was presented by 29% of the patients according to the PHQ-9 test, and 16.1% of the patients according to Beck’s Depression Inventory). Moreover, the levels of anxiety were relatively higher than those of the general population (i.e., severe anxiety was confirmed by the GAD-7 test in the case of 38.7% of the patients) and for most of them the quality of life was impaired. Discussion: Amputation occurs mainly in adults/elderly aged over 50 years, married, living in urban areas, with different levels of depression and anxiety. At least half of them had a self-perceived health condition that was deteriorated, their physical and role functioning being primarily affected. Conclusion: There is a need for psychological support of the patients suffering from limb amputation as most of the studies showed high prevalence of depression and anxiety. Socio-demographic factors also represent important elements in defining the quality of life of those patients.

547-P: Associations between Bladder Symptoms and Diabetic Neuropathy in a Romanian Cohort of Patients with Diabetes

Lower urinary tract symptoms (LUTS) are commonly reported by men and women with diabetes and may share a common pathogenic mechanism with diabetic peripheral neuropathy (DPN). We aimed to evaluate associations between DPN and self-reported LUTS in a cohort of Romanian patients with diabetes phenotyped for DPN with the Michigan Neuropathy Screening Instrument (MNSI). Clinical DPN was defined as MNSI exam score of &amp;gt;2; symptomatic DPN as MNSI questionnaire score of ≥4. LUTS was assessed with the validated American Urological Association Symptom Index and defined as 0-7 none/mild and ≥8 moderate/severe. Preliminary data is shown for 174 participants [51% men, mean age 67 years, 95% type 2 diabetes, mean diabetes duration 16 years, mean hemoglobin A1c (HbA1c 8%)]. Sixty% and 64% met the criteria for clinical and symptomatic neuropathy, respectively and 53% of men and 47% of women reported moderate/severe LUTS. MNSI questionnaire scores were significantly associated with LUTS in both men (p&amp;lt;0.001) and women (p&amp;lt;0.001) after adjusting for age and HbA1c. These data demonstrate that patients with symptomatic neuropathy are more likely to present with bladder dysfunction. Disclosure C.L. Vonica: Other Relationship; Self; AstraZeneca. C.I. Bondor: Consultant; Self; Wörwag Pharma. D. Sima: None. D.T. Cosma: Other Relationship; Self; Wörwag Pharma. I. Veresiu: None. N. Gavan: None. R. Pop-Busui: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Consultant; Self; Bayer Healthcare Pharmaceuticals Inc., Novo Nordisk Inc. Research Support; Self; AstraZeneca. Other Relationship; Self; American Diabetes Association. A.V. Sarma: None. Funding Woerwag Pharma GmbH &amp; Co. KG

Evaluation of oxidative stress levels in obesity and diabetes by the free oxygen radical test and free oxygen radical defence assays and correlations with anthropometric and laboratory parameters

BACKGROUNDObesity and diabetes are associated with high levels of oxidative stress. In Romanian patients with obesity and (or) diabetes, this association has not been sufficiently explored.AIMTo evaluate oxidative stress in obese and (or) diabetic subjects and to investigate the possible correlations between oxidative stress and anthropometric/biochemical parameters.METHODSOxidative stress was evaluated from a single drop of capillary blood. Reactive oxygen species (ROS) were evaluated using the free oxygen radical test (FORT). The free oxygen radical defence (FORD) assay was used to measure antioxidant levels.RESULTSFORT levels were higher in obese subjects (3.04 ± 0.36 mmol/L H2O2) vs controls (2.03 ± 0.14 mmol/L H2O2) (P < 0.0001). FORD levels were lower in obese subjects (1.27 ± 0.13 mmol/L Trolox) vs controls (1.87 ± 1.20 mmol/L Trolox) (P = 0.0072). Obese diabetic subjects had higher FORT values (3.16 ± 0.39 mmol/L H2O2) vs non-diabetic counterparts (2.99 ± 0.33 mmol/L H2O2) (P = 0.0233). In obese subjects, FORT values correlated positively with body mass index (BMI) (r = 0.48, P = 0.0000), waist circumference (WC) (r = 0.31, P = 0.0018), fasting plasma glucose (FPG) (r = 0.31, P = 0.0017), total cholesterol (TC) (r = 0.27, P = 0.0068) and uric acid (r = 0.36, P = 0.0001). FORD values correlated negatively with BMI (r = -0.43, P = 0.00001), WC (r = -0.28, P = 0.0049), FPG (r = -0.25, P = 0.0130), TC (r = -0.23, P = 0.0198) and uric acid (r = -0.35, P = 0.0002). In obese diabetic subjects, FORT values correlated positively with BMI (r = 0.49, P = 0.0034) and TC (r = 0.54, P = 0.0217). FORD values were negatively associated with BMI (r = -0.54, P = 0.0217) and TC (r = -0.58, P = 0.0121).CONCLUSIONOxidative stress levels, as measured by the FORT and FORD assays, were higher in obese subjects vs controls. ROS levels were elevated in diabetic obese patients vs obese non-diabetic patients and controls.

Dyslipidemia: A Trigger for Coronary Heart Disease in Romanian Patients with Diabetes.

Previous studies have reported age and gender disparities in the occurrence and therapeutic approach of dyslipidemia and (or) coronary heart disease (CHD) in patients with type 2 diabetes mellitus (T2DM). We aimed to investigate these differences in Romanian patients with T2DM. A cross-sectional, observational, retrospective study was conducted using the medical records of T2DM patients who attended the outpatient facility of the Internal Medicine Clinic of the Clinical Emergency Hospital of Bucharest, Romania for routine check-ups in a six-month period. We analyzed the records of 217 diabetic patients (mean age 69 ± 11 years; 51.15% women). We found no significant gender differences in the occurrence of dyslipidemia, CHD or CHD + dyslipidemia or in terms of statin prescription. However; patients aged 65 years or older were significantly more affected by dyslipidemia, CHD or CHD + dyslipidemia, versus subjects aged <65 years. Further, they were more likely to be prescribed statin therapy (p < 0.0001 for all). Statins were prescribed to 67.24% of the patients with dyslipidemia; 61.01% of the subjects with CHD; and to 91.48% of the patients who had both conditions. e recorded no gender differences in the occurrence of CHD and (or) dyslipidemia in Romanian T2DM patients. Patients aged 65 years or older had a higher prevalence of CHD and/or dyslipidemia, and were more likely to be prescribed statins, versus younger counterparts. However, many T2DM patients with CHD and (or) dyslipidemia were undertreated: Nearly 33% of the subjects with dyslipidemia, and nearly 40% of the ones with CHD were not prescribed statins.

The Influence of Socio-Demographic Factors, Lifestyle and Psychiatric Indicators on Adherence to Treatment of Patients with Rheumatoid Arthritis: A Cross-Sectional Study.

Background and Objectives: Rheumatoid arthritis (RA) is a severe autoimmune disease characterized by chronic inflammation of the joints accompanied by the progressive deformation and destruction of cartilage and joint bones. This study aims to gain insight into the outcomes related to adherence in patients with rheumatoid arthritis. Predicting the medication adherence in RA patients is a key point to improve the treatment outcome. Materials and Methods: A number of 119 Romanian patients with RA were included and divided into two groups: first group included 79 patients treated with conventional therapy and second group included 40 patients treated with biologic therapy. A CQR-9 (compliance questionnaire rheumatology with nine items) and PDSQ (psychiatric diagnostic screening questionnaire) were performed to assess correlations between medication adherence, patient sociodemographic variables, 11 psychiatric scales (major depressive disorder, posttraumatic stress disorder, obsessive-compulsive disorder, panic disorder, psychosis, agoraphobia, social phobia, drug abuse/dependence, generalized anxiety disorder, somatization disorder, hypochondriasis) and lifestyle (bulimia, alcohol intake). Results: Whilst modelling factors associated with adherence, it was found that women and patients with higher education are more adherent. From the psychiatric indicators, only major depressive disorder and post-traumatic stress disorder were found to be positively correlated with therapeutic adherence. None of the assessed lifestyle factors influenced the adherence of RA patients. Conclusion: The knowledge of factors that impact on treatment adherence can be useful for clinicians to guide patient-centred care.

Cardiac resynchronization therapy in Romania – results from the European Society of Cardiology CRT Survey II

The European Cardiac Resynchronization Therapy Survey II is the second CRT survey of the Heart Failure Association and European Heart Rhythm Association designed to observe implantation and follow-up practices across European countries. These data allow, for the fi rst time, a valuable insight on CRT implantation strategies for Romanian patients.

Measuring Stress – Methods and Tools

Abstract To validate PSS-14 Romanian version and identify reliable and simple tools which can be used for measuring stress level in current practice. Materials and methods: PSS-14 Romanian version, a five-level qualitative scale and a decimal scale were applied to 928 Romanian subjects, selected through the “snowball method”, for measuring perceived stress level. Intraclass correlations and Alpha Cronbach coefficient were used for assessing internal consistency of PSS-14 and Spearman coefficient for testing correlations. Results: Cronbach’s Alpha values for PSS-14 items were ≥0.700 (0.746 and 0.878 for standardized coefficient), showing internal consistency. Spearman correlation (0.375, p&lt;0.05) revealed positive, medium and significant correlations between simple scales scores and PSS-14 scores. Conclusions: PSS-14 RO is an adequate tool for measuring the perceived stress level in Romanian patients. When appropriate, a simple Likert qualitative scale or a decimal self-assessment scale can quickly provide to health professionals results with indicative value.

Potentially Inappropriate Prescriptions in Ambulatory Elderly Patients Living in Rural Areas of Romania Using STOPP/START (Version 2) Criteria.

BackgroundRational use of medications and monitoring of prescriptions in elderly patients is important to decrease the number and duration of hospitalizations, emergency medical consultations, mortality, as well as medical costs.PurposeTo identify potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs), and determine their prevalence based on the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) v2 criteria and Screening Tool to Alert doctors to Right Treatment (START) v2 criteria for patients aged >65 years.MethodsThis cross-sectional study was conducted in two rural counties in Romania based on electronic prescriptions for chronic conditions (EPCCs) issued from 30 days to 90 days by a specialist or general practitioner. Collected EPCCs were evaluated by an interdisciplinary team of specialists based on 26 STOPP v2 criteria and 10 START v2 criteria.ResultsPIM prevalence was 25.80% and PPO prevalence was 41.72% for 646 EPCCs. The mean age of patients was 75 years and the mean number of drugs per EPCC was four. The most frequently identified PIMs were treatment duration (6.65%), theophylline administration (5.72%), drug indication (4.64%), cyclo-oxygenase-2 non-steroidal anti-inflammatory drugs (1.39%), and zopiclone prescription (0.77%). Statins (24.76%), beta-blockers (8.04%), and beta-2 agonist/antimuscarinic bronchodilators (5.88%) were the most frequently identified PPOs.ConclusionPPOs were more prevalent than PIMs for elderly populations living in the two rural counties in Romania we studied. Health practitioners (family physicians, specialists, and pharmacists) should focus on prophylactic and curative considerations when prescribing agents to decrease the morbidity and mortality of elderly rural Romanian patients.

Measuring Patients’ Perception and Satisfaction with the Romanian Healthcare System

Measuring patient satisfaction of healthcare service quality represents a significant element of a healthcare’s system (HS) overall evaluation. It is the starting point for creating policies in national healthcare. The purpose of this paper was to evaluate Romanian patients’ perception and satisfaction of the quality of the national HS as a whole and of its components. Exploratory and descriptive research was used. Data were collected through face-to-face interviews with Romanian patients, based on a questionnaire. Out of the 2305 respondents, 83% used the Romanian HS in the past 12 months and 58% of the respondents did not trust the system. The accommodation, food, and other facilities of Romanian hospitals were perceived as being at a low level. One third of the respondents were unsatisfied and very unsatisfied with respect to the overall impression of the Romanian HS. In addition, our research found a statistically significant relationship between confidence in the HS, age, and gender, and also between the overall impression on the HS, age and income.

P026 The impact of different dietary factors in the etiopathogenesis of inflammatory bowel disease: a retrospective case–control study

Abstract Background Inflammatory bowel disease development has been associated with several environmental factors, among which diet can play a key role, probably due to a westernised lifestyle. However, its involvement in the pathogenesis of IBD is difficult to be demonstrated. The aim of this study was to analyse dietary composition in a Romanian and Belgian population with IBD. Methods We conducted an observational retrospective comparative study using two European cohorts (Romanian and Belgian). The IBD group included 76 Romanian and 53 Belgian patients with an IBD diagnosis while the control group included 56 healthy persons (35 Romanians and 21 Belgians). All subjects were interviewed and asked to fill in a questionnaire regarding diet. Results The baseline characteristics of the patients included in the two cohorts were described in the table. Figures 1 and 2 illustrated the consumption of different foods in Romanian, respectively, Belgian IBD patients before the onset of the disease vs. healthy controls (variables were compared with Fisher’s exact test). In the entire IBD cohort (Romanian+Belgian), we found a significantly increased consumption of sweets (OR 3.36[95% CI 1.6,7]), processed and high-fat meat (OR 2.5[95% CI1.4, 4.7], fried food (OR 9.5[3.8, 23.6]), salt (OR 2.8[1.5, 5.3]), ice cream (OR 3.25[1.1, 9.8]), mayonnaise (OR 3.49[1.1, 10.3]), margarine (OR 5.63[1.64, 19.33]), chips/nachos/other snacks (OR 2.3[0.97, 5.73]), compared with the healthy control group. The intake of seeds, nuts (OR 0.26[0.14,0.52]) and the yoghurt consumption (OR 0.44[0.23, 0.83]) was lower in the IBD group compared with the control group. Conclusion In Romanian and Belgian IBD patients, a westernised diet with increased consumption of sweets, processed food, high-fat meat, fried food, salt, margarine, snacks, ice cream and mayonnaise seems to be a risk factor for IBD. Food intake of seeds, nuts and yogurt may be a protective factor.

Moorrees-like mesh diagram for Romanian patients - a pilot study.

Background and aimsIn 1976, Coenraad F.A. Moorrees completed a series of facial mesh diagrams to ease the orthodontic diagnosis and treatment of North-American patients. Subsequently, the system was adapted by different authors to other races and populations. The objective of this study is to provide a system of Moorrees-like mesh diagrams for the Romanian population, Caucasian race, which would help orthodontists, surgeons and prosthetists.Methods40 patients were introduced in the study, 20 males and 20 females, with ages between 12–33 years, permanent dentition and slight dental-maxillary abnormalities, class I and II Angle. For each patient, a lateral cephalometric radiograph was taken, with CRANEX 3D, head straight, maximum intercuspation. On tracing paper were drawn 35 anthropometric points and 3 planes, Frankfurt plane, as the horizontal landmark, a perpendicular line through nasion as the vertical landmark and the occlusal plane. From each point we measured the distance in millimeters to the horizontal landmark and to the vertical landmark, respectively. The obtained values were introduced into 40 tables, using Microsoft Office Excel 2007 and 3 arithmetic means were calculated, for males, for females and a general one, for children under 12 years old. The arithmetic means were transferred on millimetric paper and tracing paper, joining the obtained points and completing the templates.ResultsThree different Moorrees-like mesh diagrams were obtained, one for male, one for female and a mixt one for children under 12 years, Romanian patients, Caucasian race, respectively.ConclusionsMesh diagram comes in the support of a better perspective of the anatomical elements of the face and the facial growth, being a useful tool in predicting treatment. Computer based programs with Moorrees-like diagrams adapted to Romanian patients may be the object of further studies.