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Background: Hepatitis B Virus (HBV) remains a major global health challenge, with significant morbidity and mortality associated with chronic infections. Methods: This study examines the epidemiology, screening, and risk factors associated with HBV in Romania, focusing on a comprehensive national screening program, LIVE(RO)2, involving 320,000 individuals (majority of them considered vulnerable population). A questionnaire was used to collect information on the potential risk factors for HBV transmission. Results: The overall prevalence rate of HBV chronic infection among all the participants tested was 1.67% (confidence interval: 1.63–1.72%), with significant differences (p = 0.0001) between participants from the main geographical regions of residence (North-East 1.89%, South 1.38%, South-East 2.06%, and South-West 1.54%). Male persons aged 30–49 or 60–69 years old, from the rural and Eastern parts of Romania and non-Romanian ethnia, with a low level of education, unvaccinated, not married, unemployed, with family members with hepatitis, with personal histories of blood or blood product transfusion, surgical interventions, tattooing, hospitalizations, imprisonment, haemodialysis, unsafe sexual contacts, or with sexual transmitted infectious diseases were risk factors associated with HBsAg seropositivity. Conclusions: Our findings highlight significant demographic and epidemiological patterns of reduced HBV prevalence even in vulnerable persons, as well as modified risk factors and the impact of socio-economic factors. [ABSTRACT FROM AUTHOR]

(1) Background: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a tool designed to measure disability in accordance with the International Classification of Functioning, Disability and Health. Measuring disability is becoming increasingly important due to its high prevalence, which continues to rise. Rehabilitation interventions can reduce disability and enhance functioning. (2) Objective: The present study aims to assess the impact of rehabilitation interventions on reducing disability, as measured by the WHODAS 2.0 questionnaire. It also seeks to identify which specific rehabilitation interventions are more effective and to explore other disability assessment questionnaires. (3) Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a systematic review, with the protocol registered with the identifier CRD42023495309, focused on "WHODAS" and "rehabilitation" using PubMed and Web of Science electronic databases. (4) Results: We identified 18 articles from various regions encompassing patients with various health conditions, related to stroke, the cardiovascular system (cardiovascular disease, chronic heart failure), the pulmonary system (chronic obstructive pulmonary disease), the neurologic system (Parkinson's disease, cerebral palsy, neurodegenerative disease), the musculoskeletal system (orthopaedic surgery), cancer, and chronic pain, and among frail elderly. These patients have received a wide range of rehabilitation interventions: from conventional therapy to virtual reality, robot-assisted arm training, exergaming, and telerehabilitation. (5) Discussion and Conclusions: A wide range of rehabilitation techniques can effectively improve disability with various comorbidities, offering numerous benefits. The WHODAS 2.0 questionnaire proves to be an efficient and reliable tool for measuring disability, and scores have a tendency to decrease after rehabilitation. [ABSTRACT FROM AUTHOR]

The negative consequences of microgravity for the human body are central aspects of space travel that raise health problems. Altered functions of the same systems and treatment options are common points of spaceflight physiology, age-related diseases, and oral medicine. This work emphasizes the convergence of knowledge between pathophysiological changes brought on by aging, physiological reactions to microgravity exposure, and non-pharmacological and non-invasive treatment methods that can be used in spaceflight. Sarcopenia, peripheral nerves alterations, neuromotor plaque in the masticatory muscles, lingual, labial, and buccal weakness, nociplastic pain in oral mucosal diseases, and microgravity, as well as soft tissue changes and pathologies related to chewing and swallowing, corticomotor neuroplasticity of tongue, and swallowing biomechanics, are of particular interest to us. Neurologic disease and other pathologies such as recovery from post-stroke dysphagia, nociplastic pain in glossodynia, sleep bruxism, and obstructive sleep apnea have been studied and, in some cases, successfully treated with non-invasive direct and transcranial magnetic stimulation (TMS) methods in recent decades. An interdisciplinary team from medical specialties, engineering, and biophysics propose an exploratory study based on the parallelism of ageing and space physiology, along with experiment scenarios considering TMS and non-invasive direct methods. [ABSTRACT FROM AUTHOR]

Background and Objectives: Despite being largely preventable, cervical cancer mortality still remains an important public health problem globally, in Europe, and in Romania. The European Union member states are urged to implement systematic, population-based screenings for cervical cancer, but the programs developed by the countries remain very heterogeneous. This study aimed to investigate the differences in cervix cancer mortality between Romania and EU and within Romania over the last two decades and to reveal the major sources of inequalities and the policy implications. Materials and Methods: We analyzed the number of deaths and the mortality rates by cervical cancer, standardized using the direct method, over two decades (2001–2016 for the EU, and 2001–2019 for the national and sub-national analyses). Trends, mortality reduction over the years, and mortality differences at the beginning and end of the time interval have been calculated for the EU and Romania, at national and sub-national levels (rural–urban and regions). Results: Our results revealed differences in cervical cancer mortality between Romania and EU and within Romania (among regions and rural–urban areas). These differences used to be very high in the past and are still persisting. Conclusions: The country should revisit its national cervical cancer screening program, which has been implemented for many years, but with a very limited participation rate. Due to the similar problems existing in Central-Eastern Europe, targeted support from the EU for the members from this geographical area could contribute to the minimization of differences in cervical cancer mortality among the EU members. [ABSTRACT FROM AUTHOR]

Background. The treatment of stage II colon cancer has been a subject of debate for a long time. In the last years, a few risk factors have been proposed in order to guide any treatment decision more accurately. One of these risk factors is the number of resected lymph nodes, and according to the latest guidelines, it is recommended that at least 12 lymph nodes should be resected for optimal staging. The aim of this study is to evaluate the role of lymph node resection, in stage II colon cancer and the implication of suboptimal lymph node resection on disease free survival and overall survival. Patients and methods. This was a prospective study that included 130 patients with stage II colon cancer who were monitored between October 2014 and October 2016. The relation between patients' tumour characteristics that include number of lymph node resection and the use of adjuvant chemotherapy using Chi test and multiple logistic regression was analyzed. The disease-free survival and overall survival were estimated with the Kaplan-Meier method and compared with the log-rank test. Results. 130 patients with stage II colon cancer were recruited. 56 patients were treated with surgery alone and 74 patients received fluorouracil- based chemotherapy after surgery. Patients' age varied from 37 years to 81 years. According to the number of resected lymph nodes, patients were divided into two groups - with less than 12 lymph nodes resected and at least 12 lymph nodes resected. The number of resected lymph nodes varied from 2 to 32 lymph nodes. Median follow up was 36 months. Suboptimal resections of lymph nodes confirmed to be a negative prognostic factor for survival without disease recurrence. Conclusion. Data results confirmed the importance of lymph node resection as a prognostic factor for stage II colon cancer and the role of chemotherapy for patients with suboptimal lymph node resection. [ABSTRACT FROM AUTHOR]

Background. Biological therapy has reduced the number of cases requiring surgical interventions, but at least half of the patients are operated during their lifetime. Choosing the optimal surgical moment is based on a series of factors related to the patient, preoperative medication, long term complications of the disease. Aim. Stratification of risk factors for postoperative morbidity, based on clinical guidelines for surgical therapy in Crohn's disease. Methods. The analysis of our own series of cases, superimposed on the statistical data from the ECCO surgical treatment guide, highlighted a series of risk factors, which were stratified according to the possibilities of preoperative correction. Results. The most frequent postoperative complications were identified as: anastomotic and enterocutaneous fistulas, intraperitoneal abscesses, wound dehiscences, general complications (pneumonia, urinary infections). The following factors were taken into account: Preoperative nutritional status, especially in patients with long periods of disease evolution, preoperative corticosteroid medication, control of sepsis sources (including clostridium difficile infection), cessation or not of immunological therapy. The nutritional status of patients with malabsorption syndrome or long-standing stenoses can be improved preoperatively by parenteral nutrition, minimally invasive treatment of the sources of intraperitoneal sepsis, correction of stenosis (percutaneous drainage of abscesses, balloon dilatations for short stenoses), antibiotic therapy and discontinuation of cortisone medication, can reduce the risk of postoperative complications. Conclusion. The surgical moment is not clearly coded and it is difficult to choose. The decision must be multidisciplinary and take into account the patients' quality of life and the operative risk. Delaying the intervention can lead to nutritional degradation and increased postoperative morbidity as a result of prolonged corticotherapy or the installation of malabsorption syndrome. There are often situations in which surgery represents a new beginning for the gastroenterologist in re-initiating drug therapy, such as situations in which the timing of the intervention until the non-invasive therapeutic resources are exhausted can lead to the failure of a surgical solution that, applied early, would have been beneficial. [ABSTRACT FROM AUTHOR]

Background. Lynch syndrome (LS former known as HNPCC) is a subject of interest for gastroenterologists and other specialties. The design of a multidisciplinary center for Lynch syndrome requires not only equipment but also the existence of a complex team of specialists who are trained to possess expertise in this field. Aim. In order to design the project, we started a colorectal cancer prevalence study among patients who present themselves in a university emergency hospital. The purpose of the study was to characterize epidemiologically and clinically the cases of colorectal cancer diagnosed and treated in our hospital and to highlight among them the potential cases of LS. This study represents only one part of the prevalence study of digestive or gynecological tumors that may present the defining elements of LS. Methods. We performed an observational, retrospective study in a single tertiary center were the complete diagnosis and treatment is recommended by the tumor board team. The board's goal is to determine the best possible cancer treatment and care plan for an individual patient. The complete medical files of the patients discharged with CCR diagnosis confirmed by biopsies were collected and analyzed, on a period of one year before (2019), during (2020-2021) and a year after (2022) pandemic time. From the total number of patients discharged with CCR, we chose those younger than 50 years old, for whom we searched the medical records if they fulfill the Amsterdam criteria. All patients underwent pathological examination and IHC. Those who presented microsatellite instability MSI, were registered to undergo genetic tests to identify the possible presence of LS. Results. from 1850 CCRs discharged patients who performed histological examination and IHC (2019-2022), 165 (8.91%) were under 50 year old at diagnosis and 24 of them (14,4%) had MSI high on IHC. Of these, only 3 patients fulfill the family history for LS. For all 24 patients we recommend genetic testing in order to confirm the specific mutations. From 165 patients, we lost for follow-up 18 (10.9%) Conclusions. The design of a multidisciplinary center for LS is feasible, under the premise that the data collection methodology is homogenous and the patients go through the diagnostic and follow-up protocol under the coordination of a team of specialists in genetic syndromes. The high percentage of patients with MSI on IHC offers the opportunity to diagnose those with genetic LS by complete family history anamnesis and genetic testing. [ABSTRACT FROM AUTHOR]

Background and Aims. Elimination of viral hepatitis represents a WHO objective that Romania undertook to fulfill it through the National Framework Plan for the control of viral hepatitis. Microelimination programs are recommended by WHO in order to reach the targets. Prisoners represent a population at risk for viral infection, considering multiple vulnerabilities: PWID, high-risk sexual behaviours and violence and the absence of screening upon incarceration. There are no standard protocols for HCV/HBV testing in Romanian prisons. A pilot study of HCV/HBV screening and linkage to care in prison setting was conducted using mobile medical teams in different prison facilities in three regions of Romania. Method. Multidisciplinary mobile teams were set up, coordinated by three University Hepatology Centers. A point-of-care anti-HCV and HBs-Ag tests and medical history were performed to prisoners and to staff. Only those positive for HBV/HCV rapid tests had blood collected for viremia and non-invasive tests and were selected for the hospital visit, for liver disease staging and treatment initiation. Results. For two years, multidisciplinary teams visited 18 detention centers in three regions of Romania - S-M, S-E, and N-E. Local awareness campaigns preceded every test visit. A number of 9950 persons deprived of liberty (PDL) and a number of 427 penitentiary staff were tested. The global prevalence of hepatitis B infection was 2.48 % and of hepatitis C infection was 9.9% with important diferences between centres and regions - 11,49% HCV infection vs 2,08% in the detention centres from the south part of the country and the N-E region, respectively. The greater part of tested were men (94%), with secondary education (51.7%) from urban areas (54.2%). 85.3% did not know they had hepatitis and had not been treated previously. Were highlighted 18.4% former PWID. 3.7% of PDL declared blood transfusions in the past, and a percentage of 28,2% declared previous surgical interventions. We specify these are interim data, the project being ongoing. Patients' medical records were processed and the eligible subjects started antiviral treatment after the hospital visit for complet diagnosis and staging. Conclusion. The prevalence of HCV and HBV in prisoners is significantly higher than in the general population. This ongoing project is a proof of concept that detection of incarcerated HCV/HBV positive patients and their linkage to care, in the prison environment in Romania, is feasible, prisons providing a rare opportunity for viral hepatitis microelimination. [ABSTRACT FROM AUTHOR]

Sarcopenia, first introduced as a concept by I. Rosenberg in 1989, has since been extensively studied, particularly in its correlation with chronic diseases. In recent years, sarcopenia has been increasingly associated with advanced chronic liver disease, leading to a lower quality of life and poor outcomes for these patients. Studies have shown that sarcopenia has a prevalence of 33% in individuals with advanced chronic liver disease, impacting not only the patient's health but also contributing to increased healthcare costs. The prevalence of frailty in patients with advanced chronic liver disease is 27%. Given the high prevalence of sarcopenia and frailty in this population, early diagnosis and treatment are crucial to improving patient quality of life outcomes and reducing the strain on healthcare systems globally., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s).)