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Emergency department (ED) physicians frequently encounter patients presenting with angioedema. Most of these involve histamine-mediated angioedema; however, less common forms of angioedema (bradykinin-mediated) also occur. It is vital physicians correctly recognize and treat this; particularly since bradykinin-mediated angioedema does not respond to antihistamines, corticosteroids or epinephrine and hereditary angioedema (HAE) laryngeal attacks can be fatal. Here we present four case reports illustrating how failures in recognizing, managing, and treating laryngeal edema due to HAE led to asphyxiation and death of the patient. Recognition of the specific type of angioedema is critical for rapid and effective treatment of HAE attacks. Bradykinin-mediated angioedema should be efficiently differentiated from the most common histamine-mediated form. Improved awareness of HAE and the associated risk of life-threatening laryngeal edema among emergency physicians, patients, and relatives and clear ED treatment protocols are warranted. Moreover, appropriate treatments should be readily available to reduce fatalities associated with laryngeal edema.

Background and Aim: Gastric cancer is an important malignancy worldwide due to high lethality, and it accounted for 20% of all cancers in 2017. Because the internet is increasingly used for health information, it is necessary to have tools that establish the quality of medical-related sites. Much of the information found on the Internet is non-compliant, posing a danger to patients and putting their lives at risk. The study aimed to evaluate the quality of the information about the treatment of gastric, hepatic, pancreatic, and colorectal cancer using the Brief Discern instrument and to test if the Brief Discern scores correlated with the websites’ credibility, completeness, and accuracy. Materials and Methods: This study included the first 25 websites listed on Google for each cancer, employing the most common search terms. Web sources were assessed using the Brief Discern, a six-question tool derived from the DISCERN instrument, which was developed to help patients to assess the quality of written information concerning treatment. Brief DISCERN scores can range from 5 for the poorest websites to 30. Credibility, completeness, and accuracy of information were graded on a scale from 0 to 10. Results: The mean Brief DISCERN score of the study sample was 19.0 (SD=5.7). The subsamples had the following mean Brief DISCERN scores: gastric cancer 21.7 (SD=5.0); colorectal cancer 16.4 (SD=6.4); hepatic cancer 18.7 (SD=5.4), and pancreatic cancer 19.0 (SD=5.0). The Kruskal-Wallis test showed a statistically significant difference (p=0.0137). The Brief DISCERN scores were correlated with the credibility (rho=0.3059, p=0.002) and completeness scores (rho=0.3952, p

Background and Aim: AI-powered chatbots are expected to revolutionize patients’ access to health information but their ability to provide comprehensive and scientifically accurate answers is insufficiently known. The study aimed to assess the completeness and accuracy of information regarding two cardiovascular and two oncological diseases of high interest to health information seekers. Materials and Methods: The completeness and accuracy of the information about acute myocardial infarction, peripheral artery disease, colorectal and gastric cancer provided by three AI chatbots (ChatGPT–Open AI, Gemini–Google, Llama–Meta) were evaluated against an evidence-based information quality benchmark on a scale ranging from 0 to 10. Chatbot prompting followed two basic scenarios, plausible for most users: (A) a single broad-scoped question; (B) a series of focused questions covering basic information about disease definition, causes, risk factors, symptoms, treatment and prevention. Responses were rated against evidence-based, disease-specific quality benchmarks following a predefined procedure. Data were collected between October 2023 and May 2024. Overall and chatbot-specific mean completeness, and accuracy scores were calculated. Results: Scenario A yielded an overall completeness score of 5.4, while bot-specific scores were 6.3 for ChatGPT, 5.1 for Gemini, and 5.0 for Llama. The overall accuracy score was 6.6, and bot-specific scores were 7.0 for ChatGPT, 6.1 for Gemini, and 6.5 for Llama. Scenario B showed an overall accuracy score of 8.1 with the following bot-specific accuracy scores: ChatGPT 8.6, Gemini 8.2, and Llama 7.6. The completeness score was not applicable within the second scenario. Conclusions: The overall completeness of the information provided by the three studied AI-powered chatbots about the four investigated diseases was moderate. The overall accuracy scores were high in case of the first scenario and very high in the second one. ChatGPT performed slightly better than the other two bots on both quality measures.

Background: Health on the Net (HON) promotes access to reliable medical information. The study aimed to investigate the prevalence of HON certification and whether it is associated with the quality of informational content. Methods: The study included the results of 21 researches conducted between 2018-2021 about the quality of online medical information (1040 Romanian and English language webpages). HON certification was assessed using the HONcode toolbar application. Completeness and accuracy scores were extracted from previous research. The frequency of certification and compliance with individual HON principles was calculated. Associations between HON certification and information quality scores (completeness and accuracy) were tested using the student t-test. The threshold for statistical significance was set at 0.05. Results: Health on the Net certification was present on 1.1% and 21.6% of the Romanian and English websites, respectively. Compliance with the HON principles varied between 9.7% and 82.7% of Romanian-language websites and between 35.6% and 88.5% of English-language ones. The principle with the highest compliance was transparency regarding the texts' authors in both languages. The minimum compliance was with the principle of displaying the date of the last update in the case of Romanian-language websites and of attributing sources in the case of English-language websites. Association tests between HON certification and information quality showed the following results: HON certification vs. completeness p=0.201 for the Romanian subsample and p

Introduction The aim of this study was to evaluate the potential impact of the changes in the national legislation on tobacco consumption and the impact of the implementation of the National Tobacco Control Program on ninth-grade students in Chisinau, Moldova, during 2015 and 2018, as well as tobacco consumption behavior and exposure to pro- and anti-tobacco messages. Methods The study sample consisted of the ninth-grade students from 132 schools in Chisinau, Moldova. It included 20 randomly selected schools (3 gymnasiums and 17 high schools). Data were collected using a validated self-completed questionnaire, once in October–December 2015 (n=368) and repeated in February–April 2018 (n=819). The chi-squared test was applied to compare categorical variables between the 2015 and 2018 groups. Results The student participants had mean age of 14.8 ± 0.49 years (2015) and 14.9 ± 0.53 years (2018), and, by coincidence, both groups had 51.9% boys and 48.1% girls. However, despite the rather strict regulations on tobacco in Moldova, adolescents still report a significant increase in the prevalence of cigarette consumption in the last 30 days in the period from 2015 to 2018. In this period, anti-smoking messages increased significantly and were seen by students in shopping malls, supermarkets (35.1% in 2015 and 60.0% in 2018), cinemas (11.7% in 2015 and 36.5% in 2018), magazines and newspapers (19.3% in 2015 and 37.6% in 2018) (p

Introduction: Web-based smoking prevention programs can be delivered to large groups of adolescents under relatively private conditions at a convenient cost, but their effectiveness is highly dependent on the level of exposure to the educational content. The objective of the study was to identify the predictors of high program exposure among a group of adolescents participating in a web-based smoking prevention cluster randomized trial in Romania. Methods: The study sample included 675 adolescents from Târgu Mureş, Romania. The level of exposure to the ASPIRE web-based smoking prevention program was monitored using data automatically saved on the system server. High program exposure was defined as watching 75% to 100% of the educational content. Associations between adolescents’ sociodemographic, psychological, and behavioral variables collected online at the beginning of the intervention and high program exposure were tested using chi-square test and logistic regression. Results: In all, 68.3% of students were highly exposed to the program. There were 4 significant predictors of high program exposure in the multivariable logistic regression model: participant’s father’s lower level of education (odds ratio [OR]: 1.75; 95% confidence interval [CI]: 1.19-2.44), participant’s brother’s nonsmoking status (OR: 1.76; 95% CI: 1.13-2.72), never trying e-cigarettes (OR: 1.73; 95% CI: 1.22-2.45), and considering the health of others an important reason not to smoke (OR: 2.46; 95% CI: 1.54-3.93). Conclusions: The analysis identified sociodemographic, psychological, and behavioral factors that may be useful in project management of such intervention to improve program effectiveness.

The aim of this study is to present a software application that facilitates consistent data collection, questionnaire administration, noncommunicable disease risk scoring for the benefit of the participants to community health promotion campaigns. The application was developed using open source scripting language, database management system and server. The application calculates the risk scores based on demographic data (sex, age), anthropometric measurements (height, weight), blood pressure, blood tests (blood glucose, total cholesterol, HDL cholesterol, and triglycerides) and on a brief lifestyle questionnaire. A summary of data and risk scores grouped at individual level can be printed as a handout for personal use or lifestyle counseling. Also, the application can aggregate the data at group level after basic statistical analysis and display them as tables and charts. Finally, the database can be exported for advanced statistical analysis for research purposes.

BackgroundThe internet provides general users with wide access to medical information. However, regulating and controlling the quality and reliability of the considerable volume of available data is challenging, thus generating concerns about the consequences of inaccurate health care–related documentation. Several tools have been proposed to increase the transparency and overall trustworthiness of medical information present on the web. ObjectiveWe aimed to analyze and compare the quality and reliability of information about percutaneous coronary intervention on English, German, Hungarian, Romanian, and Russian language websites. MethodsFollowing a rigorous protocol, 125 websites were selected, 25 for each language sub-sample. The websites were assessed concerning their general characteristics, compliance with a set of eEurope 2002 credibility criteria, and quality of the informational content (namely completeness and accuracy), based on a topic-specific benchmark. Completeness and accuracy were graded independently by 2 evaluators. Scores were reported on a scale from 0 to 10. The 5 language subsamples were compared regarding credibility, completeness, and accuracy. Correlations between credibility scores on the one hand, and completeness and accuracy scores, on the other hand, were tested within each language subsample. ResultsThe websites’ compliance with credibility criteria was average at best with scores between 3.0 and 6.0. In terms of completeness and accuracy, the website subsets qualified as poor or average, with scores ranging from 2.4 to 4.6 and 3.6 to 5.3, respectively. English language websites scored significantly higher in all 3 aspects, followed by German and Hungarian language websites. Only German language websites showed a significant correlation between credibility and information quality. ConclusionsThe quality of websites in English, German, Hungarian, Romanian, and Russian languages about percutaneous coronary intervention was rather inadequate and may raise concerns regarding their impact on informed decision-making. Using credibility criteria as indicators of information quality may not be warranted, as credibility scores were only exceptionally correlated with content quality. The study brings valuable descriptive data on the quality of web-based information regarding percutaneous coronary intervention in multiple languages and raises awareness about the need for responsible use of health-related web resources.

Background: 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. Objective: To assess the status of Romanian HAE patients after the recent introduction of a new therapy through a nationwide program. Methods: This cross-sectional observational study included patients from the Romanian HAE Registry. Results: 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. Fortythree (51.19%) patients practiced home treatment with subcutaneous injection of the bradykinin B2-receptor antagonist for acute HAE attacks. Conclusion: 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.

Background and objectives: Obstructive sleep apnea syndrome (OSAS) and heart failure (HF) are increasing in prevalence with a greater impact on the health system. The aim of this study was to assess the particularities of patients with OSAS and HF, focusing on the new class of HF with mid-range ejection fraction (HFmrEF, EF = 40%−49%), and comparing it with reduced EF (HFrEF, EF < 40%) and preserved EF (HFpEF, EF ≥ 50%). Materials and Methods: A total of 143 patients with OSAS and HF were evaluated in three sleep labs of “Victor Babes” Hospital and Cardiovascular Institute, Timisoara, Western Romania. We collected socio-demographic data, anthropometric sleep-related measurements, symptoms through sleep questionnaires and comorbidity-related data. We performed blood tests, cardio-respiratory polygraphy and echocardiographic measurements. Patients were divided into three groups depending on ejection fraction. Results: Patients with HFmrEF were older (p = 0.0358), with higher values of the highest systolic blood pressure (mmHg) (p = 0.0016), higher serum creatinine (p = 0.0013), a lower glomerular filtration rate (p = 0.0003), higher glycemic levels (p = 0.008) and a larger left atrial diameter (p = 0.0002). Regarding comorbidities, data were presented as percentage, HFrEF vs. HFmrEF vs. HFpEF. Higher prevalence of diabetes mellitus (52.9 vs. 72.7 vs. 40.2, p = 0.006), chronic kidney disease (17.6 vs. 57.6 vs. 21.5, p < 0.001), tricuspid insufficiency (76.5 vs. 84.8 vs.59.1, p = 0.018) and aortic insufficiency (35.3 vs.42.4 vs. 20.4, p = 0.038) were observed in patients with HFmrEF, whereas chronic obstructive pulmonary disease(COPD) (52.9 vs. 24.2 vs.18.3, p = 0.009), coronary artery disease(CAD) (82.4 vs. 6.7 vs. 49.5, p = 0.026), myocardial infarction (35.3 vs. 24.2 vs. 5.4, p < 0.001) and impaired parietal heart kinetics (70.6 vs. 68.8 vs. 15.2, p < 0.001) were more prevalent in patients with HFrEF. Conclusions: Patients with OSAS and HF with mid-range EF may represent a new group with increased risk of developing life-long chronic kidney disease, diabetes mellitus, tricuspid and aortic insufficiency. COPD, myocardial infarction, impaired parietal kinetics and CAD are most prevalent comorbidities in HFrEF patients but they are closer in prevalence to HFmrEF than HFpEF.

Background: The Internet has become a major and affordable source of health-related information. The quality of information affects not only the users' knowledge, but also their attitudes, and decisions regarding treatment procedures. The goal of the study was to assess the completeness and accuracy of the information regarding childhood obesity on the Romanian and Hungarian websites. Methods: The cross-sectional study included 20 Romanian and 20 Hungarian websites listed on the Google search engine's results pages. The search was conducted using "obezitate copii" and "gyermekkori elhízás" ("childhood obesity") as query terms. Each website was rated for completeness and accuracy by two independent evaluators observing a common set of detailed instructions. Completeness and accuracy scores were computed on a scale ranging from 0 to 10 in order to facilitate comparison within the sample and for ease of interpretation. Results: The mean completeness score was 2.5 (SD 0.9) for the Romanian websites and 2.5 (SD 1.2) for the Hungarian websites. The mean accuracy score was 8.7 (SD 0.7) for the Romanian and 6.2 (SD 1.0) for the Hungarian websites. While there was no difference between the two languages regarding the completeness scores, the Romanian websites rated significantly higher on the accuracy scores (p<0.0001; 95%CI: 1.9-3.1). Conclusions: Both Romanian and Hungarian websites had a very poor coverage of the investigated topic. The accuracy of the information, as defined by the authors, was good on the Romanian and modest on the Hungarian websites, which rated significantly lower. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to assess the credibility, completeness and accuracy of the information regarding celiac disease on the Romanian, and English language websites. Material and methods: The cross-sectional study included 25 Romanian and 25 English language websites. Google searches were conducted using appropriate query terms. Each website was rated for credibility, completeness, and accuracy by two independent evaluators. Credibility, completeness and accuracy scores were computed on a scale ranging from 0 to 10. Results: The mean credibility score was 4.3 (SD 1.2) for the Romanian websites and 6.8 (SD 1.8) for the English websites. The mean completeness score was 4.8 (SD 1.5) for the Romanian websites and 5.3 (SD 2.1) for the English websites. The mean accuracy score was 6.6 (SD 0.7) for the Romanian and 6.6 (SD 1.6) for the English websites. While the English websites had significantly higher credibility scores (Mann-Whitney U=72.000, p<0.0001), completeness and accuracy scores did not differ significantly (completeness: Mann-Whitney U=248.00; p=0.2177, accuracy: Mann-Whitney U=271.00; p=0.4261). Conclusion: Although the English websites had a slightly better compliance to the credibility criteria, this superiority did not translate into higher content quality scores. Both Romanian and English language websites had moderate completeness and accuracy scores. Users should exercise caution when searching the internet for information on celiac disease, regardless of the websites' language. [ABSTRACT FROM AUTHOR]