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Using a particular locally convex space and Schaefer's theorem, a generalization of Krasnoselskii's fixed point Theorem is proved. This result is further applied to certain nonlinear integral equation proving the existence of a solution on $\mathbb{R}_{+}=[0,+\infty).$

Using interesting techniques, an existence result for the problem $\ddot{x}+2f\left( t\right) \dot{x}+x+g\left( t,x\right) =0,$ $\lim\limits_{t\rightarrow +\infty }x\left( t\right) =\lim\limits_{t\rightarrow +\infty }\dot{x}\left( t\right) =0,$ is given in [2]. This note treates the same problem via Schauder-Tychonoff and Banach theorems.

The problem of existence of the solutions for ordinary differential equations vanishing at $\pm \infty $ is considered.

Background: Cardiovascular disease is the leading cause of death in European and global level, manifesting an increase in the context of socioeconomic conditions. The elderly population category have a higher risk of a cardiovascular disease and poor prognosis due to the influence of socio-economic factors, along with other risk factors. Material and methods: We conducted a retrospective study using the statistical reports validated by the National Institute of Statistics of Romania. The analysis we have included data for the first quarter of 2016. The study included retired persons in Romania in the first quarter of 2016 and they were 5.273 million number. Results: Most of the group (74.56%, n = 3.932 thousand) was represented by retired people at age limit, with an average monthly pension of 1071 lei, 0.45% accepting early retirement with average monthly pension of 1119 lei and the proportion of those partially retired early was 1.49%, with average pension 644 lei/month retirement of invalidiate causes of 12.36% with average pension 593 lei / month) and a survivor's pension beneficiaries were a share of 11.03% with average monthly pension 497 lei. Conclusions: In the context of low income in the studied population conditions for medical care related to cardiovascular disease, frequent in high values at this age can not be completed effectively by measures targeting modifiable risk factors, represented mainly by diet that includes proper food choices, behavior and proper nutritional diet assisted therapy clinic. [ABSTRACT FROM AUTHOR]

Background Pre-existing cardiovascular disease (CVD) or cardiovascular risk factors have been associated with an increased risk of complications following hospitalisation with COVID-19, but their impact on the rate of recovery following discharge is not known.Objectives To determine whether the rate of patient-perceived recovery following hospitalisation with COVID-19 was affected by the presence of CVD or cardiovascular risk factors.Methods In a multicentre prospective cohort study, patients were recruited following discharge from the hospital with COVID-19 undertaking two comprehensive assessments at 5 months and 12 months. Patients were stratified by the presence of either CVD or cardiovascular risk factors prior to hospitalisation with COVID-19 and compared with controls with neither. Full recovery was determined by the response to a patient-perceived evaluation of full recovery from COVID-19 in the context of physical, physiological and cognitive determinants of health.Results From a total population of 2545 patients (38.8% women), 472 (18.5%) and 1355 (53.2%) had CVD or cardiovascular risk factors, respectively. Compared with controls (n=718), patients with CVD and cardiovascular risk factors were older and more likely to have had severe COVID-19. Full recovery was significantly lower at 12 months in patients with CVD (adjusted OR (aOR) 0.62, 95% CI 0.43 to 0.89) and cardiovascular risk factors (aOR 0.66, 95% CI 0.50 to 0.86).Conclusion Patients with CVD or cardiovascular risk factors had a delayed recovery at 12 months following hospitalisation with COVID-19. Targeted interventions to reduce the impact of COVID-19 in patients with cardiovascular disease remain an unmet need.Trail registration number ISRCTN10980107.

Background: Temperature-controlled baths are widely used in medico-biological laboratories and there is a wide offer of these equipments on the market. The price can vary, depending mainly on the thermostat precision. Our aim was to build a high precision thermostat with hysteresis capability at a very low cost. Material and methods: The thermostat was developed using PIC16F84 8-bit microcontroller, produced by Microchip Inc., using an DS8B20 high precision temperature sensor produced by Dallas Semiconductors. The software was developed in C language and the device memory is 82% full. To control the heater, the device uses a 10 A relay, able to handle 2200W maximum. To display the parameters, a 4 digit LED device is used. Results: Our thermostat is compact (7X8 cm) and it has a low power consumption (3W). The resolution is 0.1° C for temperature reading and 1 °C for hysteresis settings. The range of the controller is between -30 and +100°C, depending mainly on the heater capabilities. Conclusions: The device has good precision and the price is very low, so it can be used in a wide range of laboratory temperature control devices (heaters, organ baths, culture incubators). The LED display ensures a good readability and low power consumption. This work was supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNCS - UEFISCDI, project number PN-II-RU-TE-2014-4-1544. [ABSTRACT FROM AUTHOR]

Background : Common mental disorders are an underdiagnosed comorbidity, which can significantly worsen the prognosis of the main disease and decrease the quality of life. We aimed to investigate the prevalence of depression and anxiety in a cohort of irritable bowel syndrome with diarrhea (IBS-D) and ulcerative colitis (UC) patients and to evaluate the risk factors for their occurrence. Materials and Methods: A total of 112 patients were evaluated. Multivariable analysis was used to determine associations between patient factors and common mental disorders, evaluated with PHQ-9 and GAD-7 questionnaires. Results: We found a significantly higher prevalence of moderate and severe anxiety among patients with IBS-D, when compared with the UC group ( p < 0.01). Linear regression analysis revealed an inverse association between anti-TNF-alpha monoclonal antibodies treatment and a higher PHQ-9 score ( p = 0.02). Multivariate analysis revealed that, in patients with UC, the presence of children has been associated with a higher GAD-7 score ( p = 0.01), both individually and in combination with a higher duration of the disease. ( p < 0.01). For IBS-D, a combination of active employment status and religious belief, active employment status and higher educational level, as well as religious belief and the presence of children correlated with higher GAD-7 scores ( p = 0.03, p = 0.03 and p = 0.02, respectively). Conclusions: Infliximab used in the treatment for UC improved the parameters of depression. Patients with UC who have university education and a longer duration of the disease are at increased risk of developing depression and anxiety, especially if they have children in care. Regarding IBS-D patients who have an active work status, religious beliefs and caregivers are at increased risk of developing anxiety.

Background and Objectives : The current study aimed to compare the effectiveness of the Lung Imaging Reporting and Data System (Lung-RADS) Version 2022 and the British Thoracic Society (BTS) guidelines in differentiating lung metastases from de novo primary lung cancer on CT scans in patients without prior cancer diagnosis. Materials and Methods : This retrospective study included 196 patients who underwent chest CT scans between 2015 and 2022 without a known history of cancer but with detected pulmonary nodules. CT images characterized nodules based on size, number, location, margins, attenuation, and growth patterns. Nodules were classified according to Lung-RADS Version 2022 and BTS guidelines. Statistical analyses compared the sensitivity and specificity of Lung-RADS and BTS guidelines in distinguishing metastases from primary lung cancer. Subgroup analyses were conducted based on nodule characteristics. Results : Of the 196 patients, 148 (75.5%) had de novo primary lung cancer, and 48 (24.5%) had lung metastases from occult primary tumors. Lung-RADS Version 2022 demonstrated higher specificity than BTS guidelines (87.2% vs. 72.3%, p < 0.001) while maintaining similar sensitivity (91.7% vs. 93.8%, p = 0.68) in differentiating lung metastases from primary lung cancer. Lung metastases were more likely to present with multiple nodules (81.3% vs. 18.2%, p < 0.001), lower lobe distribution (58.3% vs. 28.4%, p < 0.001), and smooth margins (70.8% vs. 20.3%, p < 0.001), whereas primary lung cancers were associated with solitary nodules, upper lobe location, and spiculated margins. Conclusions : Lung-RADS Version 2022 provides higher specificity than the BTS guidelines in differentiating lung metastases from primary lung cancer on CT scans in patients without prior cancer diagnosis. Recognizing characteristic imaging features can improve diagnostic accuracy and guide appropriate management.

Background and Objectives: Lung cancer screening is critical for early detection and management, particularly through the use of computed tomography (CT). This study aims to compare the Lung Imaging Reporting and Data System (Lung-RADS) Version 2022 with the British Thoracic Society (BTS) guidelines in classifying solid pulmonary nodules detected at lung cancer screening CT examinations., Materials and Methods: This retrospective study included 224 patients who underwent lung cancer screening CT between 2016 and 2022 and had a reported solid pulmonary nodule. A fellowship-trained thoracic radiologist reviewed the CT images, characterizing nodules by size, location, margins, attenuation, calcification, growth at follow-up, and final pathologic diagnosis if malignant. The sensitivity and specificity of Lung-RADS Version 2022 in detecting malignant nodules were compared with those of the BTS guidelines using the McNemar test., Results: Of the 224 patients, 198 (88%) had nodules deemed benign, while 26 (12%) had malignant nodules. The Lung-RADS Version 2022 resulted in higher specificity than the BTS guidelines (85% vs. 65%, p < 0.001), without sacrificing sensitivity (92% for both). Nodules larger than 8 mm, spiculated margins, upper lobe location, and interval growth were associated with higher malignancy risk ( p < 0.01)., Conclusions: Compared with the BTS guidelines, Lung-RADS Version 2022 reduces the number of false-positive screening CT examinations while maintaining high sensitivity for detecting malignant solid pulmonary nodules.

Introduction: A key element for a healthy lifestyle in the formative years of a young adult is a balanced, healthy, individualized diet., Aim: The aim of this study was to analyze the eating behavior and lifestyles of students at a university in Romania, as well as the extent to which the study program interferes with these factors., Methods: A retrospective study was performed, with the data being collected through an online questionnaire via the Google Forms platform; data collection for the current study was carried out in November 2024 during a student session., Results: Out of the total of 501 questionnaires collected, 416 were completed by women and 85 by men. It can be observed that 57.65% of men (49 participants) eat three meals a day compared to 53.13% of women (221 participants). The university program influenced the students' meal schedules for 59.88% ( n = 300) of participants, while 30.94% ( n = 155) declared that they never have an ordered meal schedule. For 39.92% of students, the exam period has an influence on the meal schedule, including an increase the intake of sweet foods (59.88%), and some declared that they forget to eat (33.93%)., Conclusions: The food and lifestyle behaviors in the studied group show health risk elements, especially an increase in tobacco consumption, a lack of regular meal schedules, and the consumption of an excess of unhealthy snacks. It was found that intensive study schedules may intensify this behavior.

Background : Heart transplant is the final therapeutic option for end-stage heart failure patients. It has been used with increasing success as a surgical procedure, greatly influenced by advances in diagnostic and prognostic tools. The aim of this paper was to study potential implications of C-reactive protein (CRP) in patients who underwent heart transplants. Methods : Our cohort included 43 adult patients from the Emergency Institute for Cardiovascular Diseases and Transplant of Târgu Mureș who underwent heart transplants in our center between 2011 and 2023. Correlations between CRP levels and different characteristics of the patients were investigated, and the optimal cut-off value for CRP levels in relation to the 6-month mortality rate was determined. The central tendencies of the baseline characteristics of patients who had a CRP value lower than the cut-off and those with a value higher than it were compared using parametric or nonparametric tests. Results : Significant correlations between the preoperative CRP levels and 6-month mortality rate (r = 0.35; 95%CI: 0.05-0.60; p = 0.02), as well as previous cardiac resynchronization therapy (CRT) and preoperative CRP levels (r = -0.37; 95%CI: -0.61--0.07, p = 0.01) were highlighted. A value for CRP > 1.66 mg/dL was found to be associated with 6-month mortality (OR = 18.00; 95%CI: 1.90-170.33, p < 0.01). Moreover, the patients who received CRT before transplantation had significantly lower levels of CRP when compared to those who did not receive CRT ( p = 0.01). Conclusions : Preoperative CRP levels could represent a valuable asset in the follow-up algorithm of heart transplant patients. The lower levels of CRP in patients who benefited from CRT before transplantation highlights the importance of understanding the complex mechanisms of inflammation and increasing focus on device therapy for future transplant recipients. Further prospective studies with larger cohorts are needed for validation.

Background and Objectives : Cardiac transplantation represents the option for patients with end-stage heart failure (HF), providing the best survival rate. However, the postoperative complications of transplant patients remain a challenge for clinicians. The objective of our study was to evaluate the effect of preoperative chronic HF treatment on the occurrence of in-hospital complications. Materials and Methods : We retrospectively included a total of 50 patients who underwent cardiac transplantation between January 2011 and December 2023 from the Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures. We correlated the preoperative chronic HF treatment with the postoperative complications by Spearmen's correlation coefficient, respectively. With logistic regression, the associations between the treatment and specific complications were determined. Results : Significant negative correlations were found between Carvedilol treatment with 2-month mortality (r = -0.30; 95% CI: -0.53--0.02; p = 0.03), Ramipril with hospital stay (r = -0.38; 95% CI: -0.60--0.12; p < 0.01) and intensive care unit (ICU) stay (r = -0.37; 95% CI: -0.59--0.11; p = 0.01), and Spironolactone usage with hospitalization duration (r = -0.28; 95% CI: -0.52--0.01; p = 0.04). Furthermore, Carvedilol treatment represented a protective factor against early acute kidney injury (AKI) (OR: 0.22; 95% CI: 0.05-0.91; p = 0.03). Spironolactone treatment was a protective factor against AGR (OR: 0.12; 95% CI: 0.02-0.66; p = 0.01) treatment, in contrast to angiotensin-converting enzyme inhibitor (ACEI) therapy (OR: 5.30; 95% CI: 1.03-27.17; p = 0.04). Conclusions : Pre-transplant Carvedilol treatment was negatively correlated with the 2-month mortality rate. Ramipril and Spironolactone therapy were negatively correlated with hospitalization duration, and Ramipril was additionally correlated with ICU stay. Moreover, Carvedilol therapy represented a protective factor against early AKI. Pre-transplant Spironolactone was associated with lower event rates of AGR, in contrast to ACEI treatment. Prospective studies with larger cohorts are needed in order to draw drastic conclusions.

Introduction: Given the potential overlap in risk factors associated with both irritable bowel syndrome (IBS) and lower urinary tract infections (LUTIs), we aimed to identify factors that may contribute to the development of both conditions, as well as recurrent lower urinary tract infections (RLUTIs). Our research also sought to explore overlapping symptoms and interactions between these two disorders., Materials and Methods: The study included young women with a history of urinary tract infections. Participants were divided into three groups: women with sporadic LUTIs (NRLUTIs), women with recurrent LUTIs (RLUTIs), and women with both a history of urinary infections (NRLUTI or RLUTI) and a diagnosis of IBS. The diagnosis of IBS is primarily clinical, relying on symptoms and the exclusion of other gastrointestinal disorders. Data from intestinal microbiota tests were combined with information on patients' symptom perception, dietary habits, lifestyle, and knowledge regarding their conditions., Results: Abdominal pain, constipation, insufficient knowledge about antibiotic and probiotic use, and nutritionally unbalanced diets were identified as common factors associated with both LUTI-IBS and RLUTI., Conclusions: Our research identified shared risk factors between LUTI, IBS, and RLUTI, suggesting a pathological interdependence between these conditions. Notably, women with RLUTIs often experience gastrointestinal symptoms such as abdominal pain and constipation after consuming foods known to trigger IBS. This highlights that gut dysbiosis is both a risk factor and a potential consequence of RLUTI. The presence of either condition appears to exacerbate the symptoms of the other, further underscoring the intricate connection between RLUTI and IBS in affected individuals.

Background: Histidine-tryptophan-ketoglutarate (HTK) cardioplegia induces cardiac arrest through membrane hyperpolarization. Aortic valve pathology leads to pathophysiological changes in left ventricular vascularization that may prevent adequate cardioplegic distribution. The objective of the study was to ascertain whether the use of Bretschneider cardioplegia in aortic valve surgery yields different outcomes for male and female patients., Methodology: Our study compares the perioperative data of 300 adult patients who underwent aortic valve replacement between June 2023 and June 2024 at the Emergency Cardiac Disease and Transplant Institute, Tîrgu Mures, Romania. Concomitant procedures, age under 18 years, retrograde or combined cardioplegia, and emergency surgery were excluded. The main outcome was operative mortality, and secondary outcomes were postoperative complications and paraclinical data such as ejection fraction and cardiac enzymes., Results: Male patients comprised 190 (62%) of the sample. The most common age group was 61-70 years in both groups. The mortality rate was 6 (5.4%) for women compared to 9 (4.7%) for men. Preoperative left ventricular ejection fraction was the primary covariate determining 30-day postoperative mortality. Left ventricular ejection fraction decreased by 2.2% in men and 1.1% in women 30 days after surgery., Conclusions: The myocardial adaptation to aortic valve pathology exhibits gender-specific differences. However, the utilization of HTK cardioplegia obviates this disparity., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Ethics Committee of Emergency Institute for Cardiovascular Disease and Transplantation, Tîrgu Mures issued approval 3240, 15.04.2024. The study was conducted in accordance with the Declaration of Helsinki. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ghiragosian et al.)

The role of cytomegalovirus (CMV) in the flare-up of ulcerative colitis (UC) is not clearly understood. CMV can cause similar symptoms in different clinical contexts, which may be attributed to the natural evolution of the viral infection, the patient's immune status, or its association with inflammatory bowel disease (IBD). This study aims to delineate the diverse manifestations of CMV-related lesions from clinical, endoscopic, and histopathological perspectives, alongside a brief narrative review of the literature. In managing IBD patients, it is crucial to be vigilant for signs of CMV reactivation, especially before the initiation of more intensive therapies.

Background and Objectives : Heart transplant is currently the final step in treating patients with heart failure. The success of this procedure is strongly connected to potential complications such as postoperative heart failure, infections, graft rejection, graft vasculopathy, and kidney failure. Thus, identifying potential prognostic factors for patients' outcome is of utmost importance. We investigated the prognostic role of the postoperative ratio between the tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP) in patients who underwent heart transplantation in our center. Materials and Methods : The study included 46 adult patients from the Emergency Institute for Cardiovascular Diseases and Transplant of Târgu Mureș, who underwent heart transplant between January 2011 and April 2023. By the use of receiver operating characteristic (ROC) analysis, we determined an optimal cut-off value for TAPSE/sPAP with regard to survival at 6 months. Differences in central tendencies of baseline characteristics in those who had a value lower than the cut-off value of TAPSE/sPAP and those who presented a value above it were investigated using the corresponding parametric or nonparametric tests. Results : A value for TAPSE/sPAP above 0.47 mm/mmHg was associated with 6-month survival (OR: 59.5, CI: 5.7-616.0). No significant differences in central tendencies for baseline characteristics were found between the patients who had a TAPSE/sPAP ratio below the cut-off and those who had a ratio above it. Conclusions : The TAPSE/sPAP ratio might prove to be valuable in the early identification of at-risk heart transplant patients. Further prospective studies with larger cohorts are required for validation.

(1) Elucidating the role of miRNAs (miRs) in ulcerative colitis may provide new insights into disease pathogenesis, diagnosis, treatment, and monitoring We aimed to investigate whether plasma levels of miR-21-5p and miR-155-5p may be used to differentiate between patients with organic disease such as ulcerative colitis (UC) and Clostridioides difficile infection (CDI), and patients with functional disease such as irritable bowel syndrome with diarrhea (IBS-D). (2) Serological samples were collected to quantify miR-155 and -21 expression, which was carried out through quantitative real-time polymerase chain reaction (qRT-PCR), from 84 patients: 34 with acute UC (group 1), 17 with CDI (group 2), and 33 with IBS-D (control group). (3) In this study, we found that the expression levels of miR-155-5p were almost the same for the two conditions and the control group (UC: 4.22 ± 1.61, CDI: 3.94 ± 1.62, IBS-D: 4.26 ± 1.26), with no significant differences either for ΔCt- or for ΔΔCt-derived parameters ( p = 0.74 and p = 0.73, respectively). For miR-21, ΔCt levels presented significantly higher values among the ulcerative colitis group ( p < 0.01), but the most important expression fold change was noticed in patients with CDI (UC:4.11 ± 8,46, CDI: 4.94 ± 9.68, IBS-D: 2.83 ± 5.41). (4) Circulating miR-155 and miR-21 were upregulated in UC, CDI, and IBS-D, but differentiation was not possible among them. But their involvement in the pathogenesis of the three diseases makes them suitable for improving the accuracy of diagnosis and facilitating the development of personalized treatment strategies.

(1) Background: Urinary tract infections (UTIs) are among otherwise healthy women represent a problem that requires additional understanding and approaches. Evidencing the link between dysbiosis and UTIs and the associated potential risk factors could lead to therapeutic approaches with increased efficiency under the conditions of reducing the risks associated with antibiotic treatments. The purpose of this study was to evaluate dysbiosis and other potential risk factors in women with a history of urinary tract infections; (2) Methods: Fecal dysbiosis tests were performed comparatively in two groups of women. The first group in-cluded women with recurrent urinary tract infections (rUTI) who had either two or more symp-tomatic episodes of UTI in the previous six months. The second group included women with spo-radic UTIs who did not have >1 UTI during a 12-month period and who did not have another UTI in the last 12 months; (3) Results: An association was shown between intestinal dysbiosis and recurrences of urinary tract infections. Increased body weight was associated with intestinal dysbiosis. Also, the lack of knowledge regarding the risk of using antibiotics and the benefits of probiotics was associated with both dysbiosis and recurrences of urinary tract infections; (4) Conclusions: Dysbiosis can have an impact on the recurrence of urinary tract infections. The risk factors for rUTI and dysbiosis in the sphere of lifestyle are potentially controllable, broadening the perspective for new approaches and changing the paradigm in the treatment of urinary tract infections., Competing Interests: The authors declare no conflicts of interest.

Background: Within modern health systems, the possibility of accessing a large amount and a variety of data related to patients' health has increased significantly over the years. The source of this data could be mobile and wearable electronic systems used in everyday life, and specialized medical devices. In this study we aim to investigate the use of modern Machine Learning (ML) techniques for preclinical health assessment based on data collected from questionnaires filled out by patients., Method: To identify the health conditions of pregnant women, we developed a questionnaire that was distributed in three maternity hospitals in the Mureș County, Romania. In this work we proposed and developed an ML model for pattern detection in common risk assessment based on data extracted from questionnaires., Results: Out of the 1278 women who answered the questionnaire, 381 smoked before pregnancy and only 216 quit smoking during the period in which they became pregnant. The performance of the model indicates the feasibility of the solution, with an accuracy of 98 % confirmed for the considered case study., Conclusion: The proposed solution offers a simple and efficient way to digitize questionnaire data and to analyze the data through a reduced computational effort, both in terms of memory and computing power used., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Background : In infants presenting with motor development impairment, early kinesiotherapeutic interventions aim to normalise the pattern of movements and improve recovery. By applying Bobath and Vojta methods, we aimed to identify a combined approach regarding motor deficit in infants with neurological disabilities. Methods : We designed a prospective interventional study on 108 infants with motor developmental delay and applied Bobath, Vojta, or combined Bobath and Vojta therapy in three equal groups. Results : In the combined Bobath and Vojta group, complete motor recovery was achieved for 50% of the participants, with full recovery after six months, whereas in Bobath- or Vojta-only therapy groups, the total recovery for all participants was achieved at seven months. Regarding infants with muscular hypertonia, Bobath therapy initiation demonstrated complete recovery in 5 months in more than 50% of the cases, while for Vojta this was achieved in only 33.57% of the cases. Conclusions : The comparative evaluation conducted by analysing the data regarding the application of the Bobath and Vojta methods showed that combining these two therapies results in a shorter motor deficit recovery time than if a single therapy is applied. These findings have important implications for the selection of rehabilitation therapies in infants with neurological motor development issues.

Background: Hyperuricemia is classically defined as serum uric acid (SUA) value higher than 6.8 mg∕dL; between hyperuricemic patients, only 15-20% will develop gout. Our first goal was to find if there is a specificity of the "snowstorm" feature on ultrasound (US) for hyperuricemia. Moreover, we aimed to determine if there is a level of SUA from which the urates tend to appear in the synovial fluid, without generating a typical clinical gouty flare., Patients, Materials and Methods: We conducted a cross-sectional, transverse study, including 108 consecutive patients that displayed a set of clinical and imaging features, such as swollen knee and US proof for knee joint effusion., Results: Performing binary logistic regression, the relation between the explanatory variable (hyperechogenic spots) and the response variable (SUA) was demonstrated to be a significant one (p=0.005). The value of 0.397 for the statistical phi coefficient suggests a medium intensity association between the diagnosis of gout or asymptomatic hyperuricemia and whether the patients have hyperechogenic spots or not. We found the cut-off value for SUA equal to 4.815 mg∕dL, regardless of gender, from which, the urate starts to precipitate. Values for men tend to be higher in comparison to the ones found for women (4.95 mg∕dL vs. 3.9 mg∕dL)., Conclusions: The "snowstorm" aspect of the fluid might be the result of an increased level of SUA and more than this, the cut-off level for SUA to precipitate might be lower than the fore used values.

Background/aim: A real challenge for patients with rheumatoid arthritis (RA) and rheumatologists is primary nonresponse status (PNRS) or secondary nonresponse status (SNRS) to various therapies. Despite their detrimental influence on patient life quality, PNRS and SNRS have no accurate definition and no early predictive criteria for their development exist. Patients with RA under 40 years of age are rare, hence PNRS and SNRS data for this age group are scarce. This study examined the PNRS and SNRS according to sex, age, BMI, therapy type, and duration., Patients and Methods: Retrospectively, 115 patients with RA having PNRS and/or SNRS were stratified by age (22-39, 40-59, and 60-81). The association between body mass index (BMI), proinflammatory cytokines inhibitors, JAK inhibitors, and TNF-alpha inhibitors, sex, age, and PNRS and SNRS was examined., Results: All three proinflammatory cytokine inhibitors (rituximab, tocilizumab, and abatacept) were associated with PNRS and SNRS in women with a high BMI aged 40-59 years. Abatacept-related PNRS and SNRS was significant in women with normal BMI aged 60-81 years. Adalimumab, infliximab, and golimumab affected SNRS differently in women with normal BMI aged 22-39 years and women with high BMI aged 60-81 years. Etanercept and infliximab were associated with SNRS status in men with high-BMI aged 40-59 years., Conclusion: PNRS and SNRS development in patients with RA is significantly influenced by age, sex, and BMI, but most importantly is closely and differentially related to therapy type and duration., (Copyright © 2023, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

BACKGROUND: There are no approved therapies for cough in patients with idiopathic pulmonary fibrosis (IPF). In this small crossover trial we administered nalbuphine extended-release tablets (NAL ER) as a potential cough therapy for such patients. METHODS: This randomized, double-blind, placebo-controlled, crossover trial involved two 22-day treatment periods (NAL ER→placebo and placebo→NAL ER) separated by a 2-week washout period. NAL ER was started at a dose of 27 mg once daily and was titrated up to 162 mg twice daily at day 16. The primary end point was percent change from baseline in hourly daytime objective cough frequency as measured by an electronic cough monitor. The daytime period was defined as the patient-reported time of awakening and bedtime. Secondary end points included change in objective 24-hour cough frequency, changes in cough frequency, cough severity, and breathlessness, per patient-reported outcomes. RESULTS: A total of 41 patients were randomly assigned and received one or more doses of study medication. There was a 75.1% reduction in daytime objective cough frequency during the NAL ER treatment period versus the placebo treatment period of 22.6%, a 52.5 percentage point placebo-adjusted decrease from baseline (P<0.001) at day 21. There was a 76.1% (95% confidence interval, 83.1 to 69.1) decrease in the 24-hour objective cough frequency with NAL ER, versus a 25.3% (43.9 to 6.7) decrease with placebo, a 50.8 percentage point placebo-adjusted change. Nausea, fatigue, constipation, and dizziness were more common with NAL ER than with placebo. CONCLUSIONS: In this short-term crossover trial, NAL ER reduced cough in individuals with IPF. Larger and longer trials are needed to assess the impact on cough versus drug adverse effects. (Funded by Trevi Therapeutics; ClinicalTrials.gov number, NCT04030026.)

The application of artificial intelligence (AI) in diagnostic imaging has gained significant interest in recent years, particularly in lung cancer detection. This systematic review aims to assess the accuracy of machine learning (ML) AI algorithms in lung cancer detection, identify the ML architectures currently in use, and evaluate the clinical relevance of these diagnostic imaging methods. A systematic search of PubMed, Web of Science, Cochrane, and Scopus databases was conducted in February 2023, encompassing the literature published up until December 2022. The review included nine studies, comprising five case-control studies, three retrospective cohort studies, and one prospective cohort study. Various ML architectures were analyzed, including artificial neural network (ANN), entropy degradation method (EDM), probabilistic neural network (PNN), support vector machine (SVM), partially observable Markov decision process (POMDP), and random forest neural network (RFNN). The ML architectures demonstrated promising results in detecting and classifying lung cancer across different lesion types. The sensitivity of the ML algorithms ranged from 0.81 to 0.99, while the specificity varied from 0.46 to 1.00. The accuracy of the ML algorithms ranged from 77.8% to 100%. The AI architectures were successful in differentiating between malignant and benign lesions and detecting small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC). This systematic review highlights the potential of ML AI architectures in the detection and classification of lung cancer, with varying levels of diagnostic accuracy. Further studies are needed to optimize and validate these AI algorithms, as well as to determine their clinical relevance and applicability in routine practice., Competing Interests: The authors declare no conflict of interest.

Background: The platelet-to-albumin ratio (PAR), leucocyte-to-albumin ratio (LAR), neutrophil percentage-to-albumin ratio (NPAR), and monocyte-to-albumin ratio (MAR) represent easily reproducible markers, which may predict the outcomes in various diseases. Early postoperative complications might appear after heart transplantation, such as infections, diabetes mellitus type 2 (DM2), acute graft rejection, and atrial fibrillation (AFib)., Objective: The aim of our study was to investigate the PAR, LAR, NPAR, and MAR values before and after heart transplantation, and the associations of the preoperative levels of these markers with the presence of postoperative complications in first two months after surgery., Methods: Our retrospective research was directed from May 2014 to January 2021, with a total number of 38 patients being included. We used cut-off values for the ratios from previously published studies, as well as our own determination of these levels by using a receiver operating characteristic (ROC) curve., Results: By ROC analysis, the optimal preoperative PAR cut-off value was 38.84 (AUC: 0.771, p = 0.0039), with 83.3% sensitivity, and 75.0% specificity. Applying a Chi square (χ 2 ) test, PAR > 38.84 represented an independent risk factor for complications, regardless of cause, and postoperative infections., Conclusions: Preoperative PAR > 38.84 was a risk factor of developing complications of any cause, and postoperative infections in the first two months after heart transplantation.

Background: Statin therapy has been proven to reduce the risk of cardiovascular events. The objective of our retrospective study was to investigate the relationship between preoperative chronic administration of statins to postoperative 2-month heart transplantation complications., Methods: A total number of 38 heart transplantation recipients from the Cardiovascular and Transplant Emergency Institute of Târgu Mureș between May 2014 and January 2021 were included in our study., Results: In logistic regression, we found a statistical significance between statin treatment and the presence of postoperative complications of any cause (OR: 0.06, 95% CI: 0.008-0.56; p = 0.0128), simultaneously presenting an elevated risk for early-postoperative acute kidney injury (AKI). From the statin group, atorvastatin therapy had a higher risk of type 2 diabetes mellitus (T2DM) development (OR: 29.73, 95% CI: 1.19-741.76; p = 0.0387) and AKI (OR: 29.73, 95% CI: 1.19-741.76; p = 0.0387). C-reactive protein (CRP), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-c) represented risk factors, atorvastatin administration being independently associated with lower CRP values., Conclusions: Chronic previous administration of statins represented a protective factor to the development of 2-month postoperative complications of any cause in heart transplant receipts.

Background: Heart transplantation represents the treatment for patients with end-stage heart failure (HF) being symptomatic despite optimal medical therapy. We investigated the role of NMR (neutrophil-to-monocyte ratio), NLR (neutrophil-to-lymphocyte ratio), NPR (neutrophil-to-platelet ratio), NWR (neutrophil-to-white cells ratio), MLR (monocyte-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio), MWR (neutrophil-to-white cells ratio), and LWR (lymphocyte-to-white cells ratio) at the same cut-off values previously studied, to predict complications after heart transplant within 2 months after surgery., Methods: From May 2014 to January 2021, was included 38 patients in our study from the Cardiovascular and Transplant Emergency Institute of Târgu Mureș., Results: Preoperative NMR > 8.9 (OR: 70.71, 95% CI: 3.39-1473.64; p = 0.006) was a risk factor for the apparition of post-operative paroxysmal atrial fibrillation (Afib). In contrast, preoperative MWR > 0.09 (OR: 0.04, 95% CI: 0.003-0.58; p = 0.0182) represented a protective factor against AFib, but being the risk of complications of any cause (OR: 14.74, 95% CI: 1.05-206.59, p = 0.0458)., Conclusion: Preoperative elevated levels of NMR were associated with the apparition of documented AFib, with high levels of MWR as a protective factor. High MWR was a risk factor in developing complications of any cause in the first 2 months after heart transplantation.

Background:  Prolonged computer use and poor ergonomics among IT professionals are considered risk factors for musculoskeletal disorders. This research aims to analyze the degree of forward head posture and workplace ergonomics in young IT professionals to assess the risk for a neck disability. Methods: A prospective study was carried out by assessing the sitting posture at work, neck disability in the cervical region, quality of life, physical activity, and ergonomics of the workspace in 73 young IT professionals (32.56±5.46 years). Results: The score for the cervical functional disability index (NDI) showed a mild neck disability (8.19±7.51). The craniovertebral angle has an average value of 32.01±11.46, corresponding to a light forward head posture, and it positively correlated with age and work experience and negatively correlated with ROSA (r=0.24, p<0.05). The NDI positively correlated with physical activity (r =00.32 p<0.05) and with ROSA (r= 0.24, p<0.05). Conclusions: In IT professionals, neck disability is associated with the lack of workspace ergonomics and the amount of physical activity. Forward head posture correlated with age, work experience, and poor workspace ergonomics. According to our findings, there are real concerns about the influence of head posture and workplace ergonomics on health among IT professionals. We consider that it is necessary to adopt preventive measures to address neck disability and improve workspace ergonomics.

This study proposes a simple and effective method to obtain ultra-thin membranes based on κ-carrageenan. Two types of membranes were obtained, one based on κ-carrageenan and the second type based on κ-carrageenan, hydroxyethyl cellulose and the plasticizer (glycerol). Three non-steroidal anti-inflammatory drugs (Dexketoprofen trometamol, Meloxicam, Diclofenac sodium) and a glucocorticoid (Dexamethasone) were introduced, looking for the best option for incorporation. The obtained membranes were characterized by FTIR, TG/DTG and UV-VIS methods and the data collected following these methods indicated success in terms of the incorporation of the active substance, as well as the high thermal stability in the temperature range 37-100 °C of both the matrices of membrane types, as well as the membranes with the drug incorporated. All the studies carried out led to the conclusion that within all the membranes the anti-inflammatory substances were intact and, thus we can say that these membranes can be used for transdermal administration of the studied anti-inflammatory substances.

Introduction: The aim of the study was to identify the consumption of vitamin and folic acid supplements before and during pregnancy in a group of post-partum women (Romanian, Hungarian, and Roma) from Mureș County, Romania, and the influence of socio-economic and behavioral factors on the consumption of vitamins. Materials and Methods: This cross-sectional questionnaire-based study included 1278 post-partum women (during the three days of hospitalization for birth), average age 29.5, registered for giving birth in the three hospitals in Mureș County, 2015−2016. Results: In our sample, 69.58% of the interviewed women did not use any vitamin and folic acid supplements before pregnancy, while 30.70% did not use vitamin supplements during pregnancy. The lack of vitamin supplementation during pregnancy was associated with the low birth weight (<2500 g) of newborns (OR = 2.4, 95% CI [1.6−3.8]) and birth at under 36 weeks of gestation (OR = 0.5, 95% CI [0.2−0.8]). Conclusion: The use of vitamin supplements, including folic acid, continues to be deficient among Romanian women before getting pregnant, as well as during their pregnancy. We observed a lack of vitamin supplementation for pregnant women even if they were influenced by risk factors. This highlights the importance of promoting the benefits of vitamin supplementation equally among all subjects.

The Pap test plays a significant role worldwide in the early diagnosis of and high curability rates for cervical cancer. However, the coronavirus disease 2019 (COVID-19) pandemic necessitated the use of multiple drastic measures to stop the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, limiting women's access to essential invasive and non-invasive investigations for cervical cancer diagnosis. Therefore, we aimed to determine the impact the COVID-19 pandemic had on cancer diagnosis and management in western Romania. A retrospective study design allowed us to compare the last 24 months of the pre-pandemic period with the first 24 months of the COVID-19 pandemic to determine the change in volume of cervical screening tests, the number of newly diagnosed cases and their severity, and the access to cancer care. A drastic 75.5% decrease in the volume of tests was observed in April 2020 during the first lockdown, after which the volume of cases decreased by up to 36.1% in December 2021. The total volume loss of tests during the first 24 months of the pandemic was 49.9%. The percentage of late-stage cervical cancers (III-IV) rose by 17%, while the number of newly diagnosed cancers in our outpatient clinic was significantly lower than the baseline, with a 45% drop. The access to cancer care was negatively influenced, with 9.2% more patients waiting longer to receive test results over four weeks, while taking longer to seek cancer care after diagnosis (6.4 months vs. 4.1 months pre-pandemic) and missing significantly more appointments. The COVID-19 pandemic had a significantly negative impact on cervical cancer diagnosis and management during the first 24 months compared with the same period before the pandemic. Although the numbers are now recovering, there is still a big gap, meaning that many cervical cancer cases were potentially missed. We recommend further interventions to reduce the gap between the pre-pandemic and pandemic period.

Objective: To identify a spectrum of perspectives on functioning and health of patients with primary Sjögren's syndrome (pSS) from the five European countries in order to reveal commonalities and insights in their experiences. Methods: A multicenter focus group study on the patients with pSS about their perspectives of functioning and health was performed. Focus groups were chaired by trained moderators based on an interview guide, audiotaped, and transcribed. After conducting a meaning condensation analysis of each focus group, we subsequently combined the extracted concepts from each country and mapped them to the International Classification of Functioning, Disability and Health (ICF). Results: Fifty-one patients with pSS participated in 12 focus groups. We identified a total of 82 concepts meaningful to people with pSS. Of these, 55 (67%) were mentioned by the patients with pSS in at least four of five countries and 36 (44%) emerged in all the five countries. Most concepts were assigned to the ICF components activities and participation ( n = 25, 30%), followed by 22 concepts (27%) that were considered to be not definable or not covered by the ICF; 15 concepts (18%) linked to body structures and functions . Participants reported several limitations in the daily life due to a mismatch between the capabilities of the person, the demands of the environment and the requirements of the activities. Conclusion: Concepts that emerged in all the five non-English speaking countries may be used to guide the development and adaption of the patient-reported outcome measures and to enhance the provision of treatment options based on the aspects meaningful to patients with pSS in clinical routine., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Unger, Mattsson, Drăgoi, Avram, Boström, Buttgereit, Lackner, Witte, Raffeiner, Peichl, Durechova, Hermann, Stamm and Dejaco.)

Romanian rural villages are struggling to survive present times when youngsters leave for a better life in the city while elders work the land like a hundred years ago. Our paper integrates human environments research with public health preparedness, presenting the Țigani (Gypsy/Roma) ethnic group from rural Romania as an example to the world. The future security of mankind will require a new understanding of the human place in its environment. That will lead to a new society, not the most powerful or intelligent, but the one that is more adaptable to changes, with sensitive and interconnected community members. Therefore, the Țigani ethnic group that fought for its rights and flourished despite unfavorable odds, including the recent COVID-19 pandemic, represents the best example for a new world that prioritizes humans, promotes health and wellbeing, facilitating innovation and transformative networks environmental integration. This research attempts to quantify the Țigani 's unique attributes that helped their communities survive and made them more adaptive to change. Always marginalized, they identified the other ethnic groups' weaknesses to penetrate the villages and learned to use the smartphone apps to communicate, for their trades, coppersmith, metal roof tiles and drainage systems. Our research was based on Geographical Information System, Microsoft Power Bi analytics data visualization tools and statistical analysis with SPSS V20 to demonstrate what enables their flourishing and what resistance they face locally. We argue that the Țigani 's intense social cooperation, strong sense of family, community and mutual assistance helped them to fight COVID-19, generating their significant adaptability to the societal changes and their power to keep intact their cultural identity. The results show how the constant growing Țigani population changed and may change Romania's rural environments in the future.

Background/aim: Chloride intracellular channel protein 1 (CLIC1) activates inflammasomes in rheumatoid (RA) and psoriatic (PsA) arthritis. We studied CLIC1 expression in RA and PsA patients' skin with vasculitis and its variability depending on the therapy used., Materials and Methods: CLIC1 immunoexpression was evaluated in the vascular (CLIC1-V) and stromal (CLIC1-S) compartments of the RA and PsA skin biopsies of patients treated with methotrexate (MTX), leflunomid (LFN), corticotherapy (CT), or biological therapies., Results: MTX significantly reduced CLIC1-S expression (p=0.016), whereas LFN decreased CLIC1-V (p<0.001). LFN therapy duration also correlated with CLIC1-V (p<0.001). CT decreased CLIC1-S expression (p=0.006). CLIC1-S expression persisted in skin biopsies despite of erythrocyte sedimentation rate (ESR, p=0.018) and C reactive protein (CRP, p=0.0026) normalisation. For PsA, CLIC1-S expression significantly related to MTX (p<0.022). Both CLIC1-S (p<0.001) and CLIC1-V (p=0.007) decreased by biological therapies in RA., Conclusion: CLIC1 expression is strongly influenced by the therapy used. Our data strongly support the extensive evaluation of CLIC1 in RA as a potential marker of inflammation and tool to predict therapy response., (Copyright © 2021 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Introduction: At the end of the first year of the COVID-19 pandemic, more than 78 million known survivors were recorded. The long-term pulmonary sequelae of COVID-19 remain unknown., Methods: We performed a retrospective analysis of a post-COVID follow-up service to estimate the burden of persistent pulmonary morbidity in hospitalised COVID survivors., Results: A total of 221 patients were followed-up: 44 intensive care unit (ICU) and 177 ward patients. Further investigations were planned as per British Thoracic Society Guidelines: For all ICU patients (n = 44) and for 38 of 177 (21%) ward-based patients who had persistent symptoms and/or persistent radiographic changes on CXR at their initial 8-week follow-up visit. In the ward-based cohort, statistically significant associations with persistent symptoms were being an ex- or current smoker, having pre-existing diabetes, and having a longer length of stay. In patients requiring further investigations, pulmonary function tests (PFTs; n = 67) at an average of 15 weeks post-discharge showed abnormalities in at least one PFT parameter in 79% (equating to 24% of the entire cohort). The most common abnormality was an abnormal diffusion capacity of carbon monoxide (TLCO), highest in the ICU cohort (64% ICU vs. 38% non-ICU). TLCO correlated negatively with length of stay and with maximum inspired FiO 2 in the patient group as a whole. In ICU patients, TLCO correlated negatively with maximum inspired positive airway pressure. Computed tomography scans (n = 72) at an average of 18 weeks post-discharge showed evidence of persistent ground glass opacities in 44% and fibrosis in 21% (equating to 7% of the entire cohort)., Conclusion: Our data add to the growing evidence that there will be pulmonary sequelae in a proportion of COVID survivors, providing some insight into what may become a significant chronic global health problem., (© 2021. The Author(s).)

The aim of this study is to obtain and characterize of alginate-based membranes, as well as to choose the most suitable membrane type for the transdermal release of methotrexate. The paper presents the synthesis of four types of membranes based on alginate to which are added other copolymers (Carbopol, Tween, and Polyvinylpyrrolidone) as well as other components with different roles. Membranes and binary mixtures made between the components used in membrane synthesis and methotrexate are analyzed by thermogravimetric techniques, FTIR and UV spectroscopic techniques as well as SEM. The analyses aim to establish the type of membrane most indicated in the use of the controlled release of methotrexate, namely those membranes in which there are no interactions that could inactivate the active substance. Following these studies, it was concluded that membranes obtained from alginate/alginate and Tw can be used for methotrexate release. The membrane obtained from alginate and carbopol was excluded from the beginning because it is not homogeneous. Regarding the AGP-MTX membrane, it presents interactions with the active substance, carboxylate group interactions argued by TGA and FTIR studies, and interactions that occur in aqueous medium.

Introduction: The approval of two antifibrotic treatment agents for delaying disease progression in idiopathic pulmonary fibrosis (IPF), has prompted researchers to look at expanding the role of antifibrotic therapy to other fibrosing interstitial lung disease (ILD). Similarities in the pathological mechanisms that lead to the development of IPF have been implicated in other progressive fibrosing ILD (PF-ILD) such as chronic hypersensitivity pneumonitis, connective tissues disease associated ILD, sarcoidosis, occupational ILD and idiopathic non-specific interstitial pneumonia (iNSIP). This has prompted the rationale to use antifibrotic therapy to target similar molecular pathways in these diseases., Areas Covered: This review will summarise the available evidence from randomised controlled trials that have evaluated the use of antifibrotic therapy in PF-ILD outside the realm of IPF., Expert Opinion: There is promising data for antifibrotic therapy as a therapeutic option for non IPF PF-ILD. The new therapy option does provide some challenges that need to be addressed such as timing of initiation of therapy, clarifying the strategy for overlap or combination with existing immunosuppressive therapies and potential drug interactions. There is an unmet need to determine accurate predictors of disease progression to allow early intervention for the preservation of lung function and mortality reduction.

Changes in confidence in implementing smoking cessation support for pregnant women was assessed among Romanian General Practitioners (GPs) before and after a training program of evidence-based clinical practices to promote quitting. The total number of physicians participating in the study was 69. Before training, 51% of GPs felt somewhat/very confident asking pregnant women about tobacco use, 39% assisted smokers with a quit plan, 38% arranged follow-up for patients. After training, 85-90% found the training informative/very informative on: how to ask patients if they smoke (89%), advising patients to quit (88%), talking about the benefits of quitting (85%), assessing patients readiness to quit (87%), assisting patients in setting a quit date (87%).

Introduction: Respiratory trainees in the UK face challenges in meeting current Royal College of Radiologists (RCR) Level 1 training requirements for thoracic ultrasound (TUS) competence, specified as attending 'at least one session per week over a period of no less than 3 months, with approximately five scans per session performed by the trainee (under supervision of an experienced practitioner)'. We aimed to clarify where TUS training opportunities currently exist for respiratory registrars., Methods: Data were collected (over a 4-week period) to clarify the number of scans (and therefore volume of training opportunities) within radiology departments and respiratory services in hospitals in the South West, North West deaneries and Oxford., Results: 14 hospitals (including three tertiary pleural centres) provided data. Of 964 scans, 793 (82.3%) were conducted by respiratory teams who performed a mean of 17.7 scans per week, versus 3.1 TUS/week in radiology departments. There was no radiology session in any hospital with ≥5 TUS performed, whereas 8/14 (86%) of respiratory departments conducted such sessions. Almost half (6/14) of radiology departments conducted no TUS scans in the period surveyed., Conclusions: The currently recommended exposure of regularly attending a list or session to undertake five TUS is not achievable in radiology departments. The greatest volume of training opportunities exists within respiratory departments in a variety of scheduled and unscheduled settings. Revision of the competency framework in TUS, and where this is delivered, is required., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Aim: Smoking before, during and after pregnancy leads to detrimental outcomes on maternal and foetal health and represents an important public health issue. This study aims to evaluate the prevalence and correlates of smoking before and during pregnancy in a sample of Romanian women., Methods: A cross-sectional survey was conducted among mothers (N=1,278) in three maternity hospitals in Tirgu-Mures, Romania, immediately after childbirth, in 2014. We evaluated the prevalence of smoking before and during pregnancy and used binary logistic regression to assess the influence of socio-demographics and other health behaviour factors in three groups of women: non-smoking pregnant women, women who continued smoking during pregnancy, and smokers who quit during pregnancy., Results: 30% of the interviewed mothers were smokers prior to pregnancy, of whom 43.3% continued smoking during pregnancy. Women with a family income of less than 100 Euro/month (OR=3.01, 95% CI: 1.02-8.83) and those who were unemployed (OR=13.2, 95% CI: 3.90-44.79) had increased odds of continued smoking versus quitting during pregancy in multivariable analyses. Women who continued smoking during pregnancy were also more likley to be of lower socioeconomic status than never smokers (OR=14.1, 95% CI: 4.97-39.6)., Conclusions: A high percentage of women of reproductive age smoke and continue to smoke despite their knowledge about risks of smoking during pregnancy. Smoking prior to and during pregnancy is predominantly associated with lower socioeconomic status. Women with limited economic means should be a high priority target group for smoking cessation interventions., (Copyright© by the National Institute of Public Health, Prague 2016)

Cardiovascular risk is an important factor for increased morbidity and mortality in patients with ankylosing spondylitis. The aim of this study is to assess arterial stiffness in relation to the disease activity and functional limitation in patients with ankylosing spondylitis. Twenty-four patients (mean age 45.8 ± 11.7 years) suffering of ankylosing spondylitis (disease duration 11.1 ± 5.1 years) and 24 gender and age-matched healthy controls were included in the study. Clinical, biological, and functional status of ankylosing spondylitis patients was recorded. Arterial stiffness was assessed by measuring pulse wave velocity (PWV) and pulse wave analysis (PWA) was performed using applanation tonometry. We found significant differences between ankylosing spondylitis patients and healthy controls in regard to PWV (p = 0.047), aortic augmentation pressure-AP (p = 0.028), augmentation index-AIx (p = 0.038) and aortic augmentation index adjusted for heart rate-AIx75 (p = 0.011). PWV and AIx75 were significantly associated with the disease functioning score-BASFI (p = 0.012, r = 0.504; p = 0.041, r = 0.421). Aortic AP and augmentation indexes (AIx and AIx75) were all associated to ASDAS score (p = 0.028, r = 0.448; p = 0.005, r = 0.549; p = 0.025, r = 0.455). Our study showed that ankylosing spondylitis patients have a higher arterial stiffness than the age-matched controls, leading to an increased cardiovascular risk. We found that arterial stiffness is positively associated with disease activity and functional impairment. Chronic spondiloarthropaties should be screened for arterial stiffness, even in the absence of traditional cardiovascular risk factors, in order to benefit from primary prevention measures.

Aim: To evaluate the impact of physical training on central hemodynamic parameters and elasticity of large arteries in hypertensive patients., Patients and Methods: A total of 129 hypertensive patients were divided into two groups: group A followed lifestyle changes and physical training; and group B acted as a control group; seven parameters were recorded: Pulse wave velocity (PWVao), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), central aortic systolic blood pressure (SBPao), aortic diastolic blood pressure (DBPao), and central aortic pulse pressure (PPao)., Results: The difference between values at 4 months and baseline (Δ) were as follows: ΔPWVao was -1.02 m/s (p<0.001) versus 0.17 m/s (p=0.035), ΔSBPao was -9.6 mmHg (p=0.009) versus 1.6 mmHg (p=0.064), and ΔPPao was -6.8 mmHg (p<0.001) versus 3.2 mmHg, (p=0.029) in group A versus B, respectively., Conclusion: Exercise training improves SBP, PP, SBPao, PPao and may delay arterial ageing., (Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Objective: To evaluate the impact of inspiratory muscle training on aerobic capacity and pulmonary function in patients with ankylosing spondylitis., Design: Randomized controlled study., Setting: Rheumatic Rehabilitation Centre., Subjects: A total of 54 ankylosing spondylitis patients, all males, were randomized to a conventional exercise training associated with an inspiratory muscle training group, or to a conventional exercise training group., Interventions: Group 1 (27 patients) performed eight weeks of conventional exercise training (supervised weekly group sessions followed by a home-based exercise programme) associated with inspiratory muscle training sessions. Group 2 (27 patients) received eight weeks of conventional exercise training only., Main Measures: Resting pulmonary function (forced vital capacity - FVC, forced expiratory volume in one second - FEV1); effort ventilatory efficiency (lowest ventilatory equivalent ratio for oxygen and carbon dioxide - VE/VO2 and VE/VCO2) and aerobic capacity (peak oxygen uptake - VO2peak) were assessed at baseline and after eight weeks of exercise-based intervention., Results: After eight weeks follow-up, patients in Group 1 had a significant increased chest expansion and VO2peak compared with Group 2 (3.6 ±0.8 cm vs. 3.2 ±0.5 cm, P = 0.032; 2.0 ±0.5 l/min vs. 1.8 ±0.3 l/min, P = 0.033). There were no significant differences of spirometric measurements, except FVC which significantly improved in patients who performed inspiratory muscle training (82.7 ±5.1% vs. 79.5 ±3.5%, P = 0.014). VE/VCO2 also improved significantly in Group 1 (26.6 ±3.6 vs. 29.2 ±4.7, P = 0.040)., Conclusions: Ankylosing spondylitis patients who performed eight weeks of inspiratory muscle training associated to conventional exercise training had an increased chest expansion, a better aerobic capacity, resting pulmonary function and ventilatory efficiency than those who performed conventional exercise training only., (© The Author(s) 2015.)

Background/purpose: Chronic obstructive pulmonary disease (COPD), especially in severe forms, is commonly associated with systemic inflammation and balance impairment. The aim of our study was to evaluate the impact on equilibrium of stable and exacerbation (acute exacerbation of COPD [AECOPD]) phases of COPD and to investigate if there is a connection between lower extremity muscle weakness and systemic inflammation., Methods: We enrolled 41 patients with COPD (22 stable and 19 in AECOPD) and 20 healthy subjects (control group), having no significant differences regarding the anthropometric data. We analyzed the differences in balance tests scores: Falls Efficacy Scale-International (FES-I) questionnaire, Berg Balance Scale (BBS), Timed Up and Go (TUG) test, Single Leg Stance (SLS), 6-minute walking distance (6MWD), isometric knee extension (IKE) between these groups, and also the correlation between these scores and inflammatory biomarkers., Results: The presence and severity of COPD was associated with significantly decreased score in IKE (P<0.001), 6MWD (P<0.001), SLS (P<0.001), and BBS (P<0.001), at the same time noting a significant increase in median TUG score across the studied groups (P<0.001). The AECOPD group vs stable group presented a significant increase in high-sensitive C-reactive protein (hs-CRP) levels (10.60 vs 4.01; P=0.003) and decrease in PaO2 (70.1 vs 59.1; P<0.001). We observed that both IKE scores were significantly and positive correlated with all the respiratory volumes. In both COPD groups, we observed that fibrinogen reversely and significantly correlated with the 6MWD, and FES-I questionnaire is correlated positively with TUG test. Hs-CRP correlated reversely with the walking test and SLS test, while correlating positively with TUG test and FES-I questionnaire., Conclusion: According to this study, COPD in advanced and acute stages is associated with an increased history of falls, systemic inflammation, balance impairment, and lower extremity muscle weakness.

Purpose: Pedometry is an objective method to analyse part of physical activity. The aims of this study were to evaluate physical activity (by quantifying walking steps/day) in Romanian chronic obstructive pulmonary disease (COPD) patients and healthy subjects., Methods: A total of 58 COPD patients (GOLD stages III and IV) and 273 healthy subjects, divided by decades of age, wore pedometers for 2 weeks., Results: Significant decrease of physical activity level was observed in COPD patients vs. control group (3,414 ± 1,105 vs. 7,200 ± 2,452 steps/day). Walking performance of patients with COPD stage III was better than that of patients with COPD stage IV. For both groups, the lowest activity level was recorded during the weekend. Patients with COPD could not perform any aerobic movement., Conclusions: This study revealed a difference of physical activity in both healthy individuals and COPD patients, in the latter group the decrease being worse and in accordance with the disease severity.

The objective of the study was to assess the effectiveness of using electromyographic biofeedback in the early stages of rehabilitation after meniscal repair. In this randomised, controlled, parallel group study, the evolution of patients with meniscal lesions treated by meniscal suture who received (study group, n = 33) or did not receive (control group, n = 31) electromyographic biofeedback as part of their early rehabilitation programme has been compared. A total of 64 patients with previous meniscal repair participated in the study. The patients received a baseline assessment (after 1 postoperative week) and a follow-up (after 8 postoperative weeks) consisting of surface electromyography, dynamometry of thigh muscles and the assessment of the Knee injury and Osteoarthritis Outcome Score (KOOS). The electrical potential in contraction and the speed for contraction and relaxation for all monitored muscles increased significantly in the study group (p < 0.05). The difference between groups in the assessed score was significant for sport and recreational function (p < 0.05). The strength of the thigh muscles was not significantly influenced by the introduction of electromyographic biofeedback (EMG- BFB) in the rehabilitation programme. Electromyographic biofeedback helped patients to control their muscles after meniscal repair to accomplish physical activities that require better neuromuscular coordination and control. For these reasons, one may consider electromyographic biofeedback as an important component of rehabilitation after meniscal repair. Key PointsExercises during the early phases of rehabilitation after meniscal repair are difficult to perform because of pain, oedema, and possibly a disruption in normal joint receptor activity.Electromyographic biofeedback is a painless, non-invasive method that can be used in muscle recovery after meniscal repair and enhances the rehabilitation process, especially related to muscular function.The rehabilitation programme that includes electromyographic biofeedback after meniscal repair increased the speed of muscle response to acoustic stimulation in both the initiation of contraction (onset time) and relaxation (offset time) and, also, the capacity of performing some specific physical acti-vities after 8 weeks of rehabilitation (according to KOOS values).Electromyographic biofeedback is not responsible for the decrease in pain, swelling or other postoperative symptoms but it is important in order to help the patient to conduct the activities which require neuromuscular coordination and muscle control.

Background: Cardiovascular disease (CVD) is the main cause of morbidity and mortality worldwide, but it also is highly preventable. The prevention rate mainly depends on the patients' readiness to follow recommendations and the state's capacity to support patients. Our study aims to show that proper primary care can decrease the CVD-related morbidity rate and increase the economic efficiency of the healthcare system. Since their admission to the European Union (EU), the Eastern European countries have been in a quest to achieve the Western European standards of living. As a representative Eastern European country, Romania implemented the same strategies as the rest of Eastern Europe, reflected in the health status and lifestyle of its inhabitants. Thus, a valid health policy implemented in Romania should be valid for the rest of the Eastern European countries., Methods: Based on the data collected during the EUROASPIRE III Romania Follow Up study, the potential costs of healthcare were estimated for various cases over a 10-year time period. The total costs were split into patient-supported costs and state-supported costs. The state-supported costs were used to deduce the rate of patients with severe CVD that can be treated yearly. A statistical model for the evolution of this rate was computed based on the readiness of the patients to comply with proper primary care treatment., Results: We demonstrate that for patients ignoring the risks, a severe CVD has disadvantageous economic consequences, leading to increased healthcare expenses and even poverty. In contrast, performing appropriate prevention activities result in a decrease of the expenses allocated to a (eventual) CVD. In the long-term, the number of patients with severe CVD that can be treated increases as the number of patients receiving proper primary care increases., Conclusions: Proper primary care can not only decrease the risk of major CVD but also decrease the healthcare costs and increase the number of patients that can be treated. Most importantly, the health standards of the EU can be achieved more rapidly when primary care is delivered appropriately. JEL: I18, H51.

Background: End-stage renal disease patients can be considered as 'cardiovascular time bombs' due to their tremendous cardiovascular risk. Our study has determined the impact of 3 months of exercise training during dialysis on some of the cardiovascular risk factors (arterial stiffness, body composition and physical performance) in a chronic hemodialyzed population., Methods: The study group (n = 19) and control group (n = 16) of chronic hemodialysis patients from Timisoara, Romania, were enrolled in a prospective cohort study. The intervention--40 min of exercise training (with non-fistula hand and both lower limbs) during each hemodialysis session for 3 months--was applied only to the study group. The measurements made before and after intervention were aortic pulse wave velocity (PWV), aortic augmentation index, return time and both central and peripheral blood pressure for arterial stiffness evaluation, using the Arteriograph Tensiomed system, body composition by multifrequency bioimpedance and physical performance (Myotest PRO system and hand dynamometer)., Results: We found a significant 1-m/s reduction in PWV, a 12-second increase in return time and a 10-mm Hg reduction in both central and systolic blood pressure driven only by the exercise training. Exercise training significantly increased the skeletal muscle mass and the soft lean mass of the study group patients. Physical performance significantly improved in the study group jumping height by 1 cm, lower limbs explosive power by 3 W/kg and non-fistula hand strength prehension by 0.06 bar., Conclusions: Exercise training during dialysis has a positive effect on arterial stiffness, body composition and physical performance of chronic hemodialyzed patients., (© 2013 S. Karger AG, Basel.)

We present a case report of a 27 years old pacient with central retinal vein occlussion and macular edema. The pacient has a significant reduction of the macular aedema with complete recovery of vision after the treatment.

It is a clinical, observational, retrospective, randomised study, performed on 46 eyes. We have evaluated the effects of some of the drugs used to treat glaucoma (prostaglandine analogues, beta blockers, carbonic anhydrase inhibitors) on the central corneal thickness.