Epidemiology of hospitalized burns in Romania: A 10-year study on 92,333 patients.

BACKGROUND: No epidemiological information is available of the number of burns treated in the past 30 years in Romania. The aim of the present study is to investigate the extent of burn injuries in Romania, as well as to detect and analyze the essential epidemiological characteristics. METHODS: A comprehensive retrospective study was conducted over a period of 10 years (1.01.2006 to 31.12.2015). Patient-related data were obtained from the Diagnosis-related group (DRG) Center of National School of Public Health, Management and Professional Development, which is the only official national structure that collects and manages data concerning all the hospitalized patients in Romania. RESULTS: Included in this study were all 92,333 patients with burn injury as the main International Classification of Diseases (ICD-10) code of discharge from Romanian hospitals. The data was analyzed using SPSS V.24, IBM Statistics Package. The annual number of burns decreased gradually from 10,547 in 2006 to 7313 in 2015, reaching statistical significance (p = 0.001). The incidence decreased from 47 cases per 100,000 in 2006 to 36.93 per 100,000 in 2015. The seasonal evolution showed that the number of burns increases in July-August (8.8% and 9.1% of annual burns). The mean length of stay (LoS) was 10.59 days, with the highest value in 2012 (11.00) and the lowest in 2014 (10.30). The median LoS and the mean LoS values during the 10 years period have a plateau-type evolution, with no tendency for improvement. We found a significant correlation (r = 0.708, p = 0.0118) between increased mortality and the year of study. CONCLUSIONS: This is the first nationwide epidemiological study concerning hospitalized burns in Romania. It provides insight in demographical characteristics but also uncovers a worrying trend of increasing mortality rates, which requires further investigation. This study cannot make any reference to the severity of burns (surface and depth) or towards major burns events which unfolded during the studied period, due to lack of data. Consequently, it should raise awareness towards policymakers and caregivers that for a durable burns management strategy in Romania, it would be extremely useful to implement a national burn registry.

Novel amikacin inhaled formulation for the treatment of lower respiratory tract infections.

Lower respiratory tract infections are usually treated with systemic antibiotics, but sometimes in certain conditions inhaled antibiotics may also be used. In cystic fibrosis (CF) for example, inhaled tobramycin is used to treat chronic airways infection due to Pseudomonas aeruginosa, and in other conditions such as ventilator-associated pneumonia, inhaled colistin is used as add-on therapy to reduce the risk of side effects of prolonged systemic exposure. Other inhaled antibiotics are currently under development, and inhaled amikacin is one such example. The two formulations of inhaled amikacin currently under clinical development may have two different therapeutic trajectories: the nebulized liposomal formulation is the first once-daily aminoglycoside for CF patients, whereas the free nebulized amikacin may be used in addition to systemic therapy in ventilator-associated pneumonia patients exploiting reduced systemic exposure to amikacin as a therapeutic advantage, especially in patients with renal impairment.

The prevalence of the owner of serologic markers for the hepatitis C virus, in a north-eastern territory of Romania.

The paper describes aspects in the natural evolution of hepatitis C virus (HCV) infection with severe outcomes induced by the typical or atypical clinical manifestations or chronic carrier state. In the interval 1995-1999 in the Iasi district morbidity from all types of viral hepatitis ranged from 153.4 cases per 100,000 inhabitants in 1995 to 66.6 in 1999. The features of A viral hepatitis epidemiological process was the multiannual cyclic pattern. From estimating the circulation of HCV in the population of Iasi district, several population categories have been screened for the presence of HCV antibodies (anti-HCV). Testing 87,894 blood samples assessed the prevalence of anti-HCV in blood donors. Different annual values resulted: 1.5% in 1997 and as a result of routine screening, only 0.3% in 1999. The cases of posttransfusion hepatitis (PTH) admitted to the Clinic of Infectious Diseases of Iasi, the diagnosis of which was supported by epidemiological history and confirmed serologically by the presence of anti-HCV were of 12 in 1995 (36.4% of all PTH), 20 in the interval 1996-1999, with an average for the 4 study years of 7.5%. Anti-HCV was found in 24.4% of series of 4,594 patients with viral hepatitis, in 32.1% of 582 individuals with various disorders or at risk, of which those with liver cirrhosis accounted for 37%, and in 9.6% of 94 patients with neurological disorders. Of the 1083 tested physicians and nurses working in health care settings at risk 6.6% were anti-HCV-positive.

[National statistical parameters of cervical cancer in Romania: 1992-1997]. / Indicatori statistici ai cancerului de col în România în perioada 1992-1997.

UNLABELLED: Cervical cancer is an important health issue in Romania, as the 1990-1992 statistics of IARC mentioned it to be first in Europe as mortality through this neoplasia. We bring to 1997 the national statistical data regarding the cervical cancer. MATERIAL AND METHODS: Our data provided by the Romanian Health Ministry statistical Office allowed estimations over the following parameters: incidence (crude and age-related), prevalence and number of deaths, and relationships between these parameters and age group, clinical stage, geographical distribution, etc. Usual statistical methods of interpretation are used, as well as prognosis using the parabola methods, and world-standardized incidence rates. RESULTS: Between 1992-1997, there were 14743 new cases of cervical cancer diagnosed in Romania. The crude incidence per 100,000 was 21.27, and age-related incidence ranged between 0.27 per 100,000 for the under 20 to 46.73 in the 40-49 group. World standardized incidence rate indexed by age groups gave an incidence of 16.84. The mortality was 2.37, with world standardized age related deaths of 2.81. The clinical stage distribution showed stages 0 (15.02%), I (14.04%), II (34.91%), III (27.81%) and IV (8.19. The incidence and mortality data shows a better evolution for younger age groups, but a steady increase in 30-39 group for incidence and mortality. CONCLUSIONS: The data above place Romania on a stable but high incidence of cervical cancer, with a high mortality due to late diagnostic and socio-economical conditions.

[Occupational stress--risk factor in essential arterial hypertension]. / Stresul ocupational--factor de risc în hipertensiunea arteriala esentiala.

The stress was recorded taking into consideration the epidemiological interview, using a standard methodology by filling in the type card the occupational stress (OS) and the family stress (FS). The constitutional factors (behaviour type A, body weight index > 25 Kg/m2) as well as the consumption in excess of salt, have significantly correlated themselves, both in individuals with OS and FS, and in those with the exclusively OS. The modification of biochemical constants (total cholesterol, triglycerides, total lipids, HDL-cholesterol, LDL-cholesterol) significantly associate themselves in persons to which the presence of OS and FS, of the occupational one, respectively was put into evidence (chi 2 = 94.10 for 5 freedom degrees and p < 0.001, chi 2 = 118.94 and p < 0.001, respectively). The prevalence of persons with pathologic values of total lipids was 58.7%, of triglycerides 35.7%, of total cholesterol 12.7%, of LDL cholesterol 27%, and of HDL-cholesterol 44.4%. Measuring the values of systolic and diastolic arterial hypertension an increase above the normal values of limit systolic arterial hypertension at 23.8% and at 12.3% for illness systolic arterial hypertension was found. The evaluation of association of certain cardiovascular risking factors in individuals with occupational stress has permitted a global understanding, useful for the elaboration of some preventive programmes.

[The concordance and discordance of cardiovascular risk factors in a group of twin children]. / Concordanta si discordanta unor factori de risc cardiovascular, la un grup de copii gemeni.

The cross-sectional study of epidemiological screening type has permitted to evaluate some cardiovascular risk factors in two groups of monozygotic (MZ) and dizygotic (DZ) twins born between 1975-1990, in the town of Iasi. In the 89 MZ pairs and 112 DZ pairs, certain constitutional and behavioural cardiovascular risk factors have presented values of prevalence with statistical signification (p < 0.05) in terms of their age, sex, the urbanisation time and the educational level of their parents. In risk factors existence or absence to both of the twins have put into evidence, to the MZ, most enhanced values of concordance as regards: overweight (66.6%), excessive consumption of salt (56.9%), food with atherogenic risk (50.9%). The concordance values have been less in DZ compared to MZ concerning all the risk factors excepting compartmental type A (77.7%). By analysing the concordance variants, an preponderant influence of the environment has been noted in the studied MZ and heredity and environment influence in DZ. By measuring the arterial blood pressure values at the twins and the twins parents, a prevalence of the essential arterial hypertension is noticed to both of the twins, 6.2% in MZ pairs and 6.9% in DZ ones.

[Epidemiological observations on the physical activities of patients with arterial hypertension]. / Unele observatii epidemiologice privind activitatea fizica a bolnavilor cu hipertensiune arteriala.

The authors point out the results of some multidisciplinary epidemiological researches concerning the relation between the multifactorial etiology of arterial hypertension (AHT) in employers working in two factories and the nature of physical activity. The results show that the highest percentage of AHT cases is in the persons which do not have physical activity (occupational, housing or leisure). The women with AHT, which are frequently supra-ponderously, make a low level of physical activity. They have effort respiratory modifications in 40% of cases. The decreasing interest for control and prevention of health risks of the level of occupational health services has medical and social negative effects on long term.

[The epidemiological aspects and prevalence of markers in those with viral hepatitis C in some population categories in 1994-1997 in Iasi County]. / Contributii la cunoasterea unor aspecte epidemiologice si a prevalentei posesorilor de markeri pentru virusul hepatitei C, în unele categorii populationale, în perioada 1994-1997, în judetul Iasi.

The results of the epidemiological, clinical and laboratory investigations, carried out in the 1994-1997 interval in the Iasi district, on various populational groups, to indicate the prevalence of the antibodies anti-HVC possessors are presented. In 3611 patients with clinical-epidemiological HCV diagnosis, it was recorded a prevalence of the anti-HCV antibodies (AcHCV) presence of 22.7%. Posttransfusional hepatitis, epidemiologically diagnosed in 205 hospitalised patients was attributed to HCV in 11.6% of the cases, and in 94 patients with neurological diseases, AcHCV were identified in 9.6%. The presence of AcHCV at 825 persons in medico-sanitary staff, from risk domains, has recorded a prevalence of 8.0%. In the January 1997-September 1997 interval, the investigation by IIIrd generation ELISA of 51,149 blood samples of donors from various areas indicated the presence of AcHCV with an interval average of 2.6%.

[Epidemiological considerations of the arbo- and arenaviruses]. / Unele consideratii epidemiologice asupra arbo si arenavirozelor.

The complex epidemiological process of arboviral and arenaviral diseases, their dependence on a multitudine of etiologic agents, the risk of severe manifestations, absence of a specific treatment and difficulties in preparing the vaccines, place these diseases among those of high concern at national and international level. The multidisciplinary investigations carried out in Moldavia by M. Duca, Eugenia Duca, Gr. Teodorovici, Alla Vâta, St. Dumitriu, V. Luca, D. Buiuc, A. Ivan and others have elucidated numerous aspects regarding the epidemiology and prevention of arboviral diseases. The increased morbidity by meningitis and meningoencephalitis recorded in Romania the interval summer--early fall 1996 was attributed based on serologic diagnosis, to West Nile virus. The etiological investigations were done both in our country (Cantacuzino Institute, Institute of Virology, Laboratory of the Ministry of National Defence) and abroad (Pasteur Institute at Paris, Colindale Institute London, CDC, Atlanta, USA). For the Romanian population the risk for a periodical re-emergence of some arbovirus diseases is due to favorable local conditions with the relationships with geographical areas were these diseases have and endemic-epidemic evolution are added.

[The importance of the use of selenium in the role of an antioxidant in preventing cardiovascular diseases]. / Importanta utilizarii seleniului cu rol antioxidant în preventia bolilor cardiovasculare.

The evaluation of the results of the oxygen free radicals (RLO2) formation is a current subject in biology and medicine. The oxidative stress, which is the altering of the balance between the higher activity of oxygen and the enzymatic or nonenzymatic protection systems, may be one of the causes that starts and aggravates a disease. In this context, the supplementation of the diet with selenium, superoxide dismutase, vitamins A, C, E, is considered a primary prevention measure (for the apparently healthy persons) and a secondary one (for those with advancing forms of disease) that is both efficient and modern by utilization of some "drug-food" products. The transversal study realized on a group of 39 blood donors presence of the cardiovascular risk determined by the raising of the prevalence of some atherogenic factors (active smoking, hypercholesterolemia) which is also expressed by the lowering of the level of some oxidative stress indicators (glutathione peroxidase--GSH-Px < 0.139 moli/ml and catalase < 2.20 U/ml). The simultaneous low intake of selenium from the central drinking water supplies in the city of Iasi (0.1-1 g/l) has permitted us to consider necessary the diet supplementation both with foods rich in vitamins with an antioxidant role and with specific medication with selenium, as a protective micro-element.

[The specific serological profile in hepatitis B virus infection in children]. / Profil serologic particular în infectia cu virusul hepatitei B la copii.

UNLABELLED: Hepatitis B virus infection (HBV) has a very well known specific serologic profile. In the last years the molecular biology methods reveal some "particular serological profiles" by genomic mutation. One particular profile consists in the absence of anti-HBc total antibodies simultaneously with the presence of HBsAg. Our tested group consists of 372 children aged 0.1 to 15 years. The presence of HBsAg was determined by ELISA "sandwich" and confirmed by neutralisation test. For HIV infection we used two ELISA tests (competitive and indirect) and the Western Blot test for confirmation. Of the total, there were 13 children HBsAg positive and without anti-HBc antibody (3.49% respectively), 7 of the 13 children (53.8%) were dystrophic and 4 were HIV positive (30.76%). From 372 cases, 104 were HBsAg positive (27.9%) and 53 (14.2%) of them had chronic hepatitis. CONCLUSIONS: 1. The particular serologic profile requires the testing of all serological markers specific for HBV. 2. This particular serologic profile is correlated with HIV positive status and dystrophy.

[Epidemiological evaluations of the incidence of posttransfusion hepatitis in Iasi County in 1985-1995]. / Unele evaluari epidemiologice asupra incidentei hepatitei posttransfuzionale în judetul Iasi, în perioada 1985-1995.

In the interval 1985-1995 the morbidity rate of viral hepatitis of various causes showed yearly variations, an average of 181 cases being recorded. The performed investigations revealed markers for viral hepatitis B in an yearly average of 154 cases for the 11 years under study. Posttransfusion hepatitis had an average incidence of 43 cases per year, in 59.1% the markers for viral hepatitis B being absent. 93.3% of the cases with posttransfusion hepatitis belonged to the age groups over 20 years and workers presented a mean yearly incidence of 28.3% of all cases. In 1995 the blood donors with viral hepatitis C antibodies represented 4.05% and 75% of them belonged to the age groups 21-60 years, 50% of them being industrial workers and 40% having the A II blood group. Of the 321 admitted cases, 26.7% presented AgHBs, 8.4% AcVHC, in 2.3% markers for both viruses were evidenced and in 62.8% of the cases the diagnosis was made on epidemiological criteria and serologic exclusion (non A, B, C) without excluding the possible intervention of other hepatitic viruses.

[The prevalence of HBsAg in hospitalized children as a marker of hepatitis B virus infection]. / Prevalenta AgHBs la copii spitalizati, ca marker al infectiei cu virusul hepatitei B.

UNLABELLED: The aim of this study was to determine the prevalence of hepatitis B surface antigen (HBsAg) in hospitalised children, as specific marker for hepatitis B virus (HBV) infection. Our study group consists of 517 children, 68 of them diagnosed with chronic hepatitis. For HBsAg determination we used an ELISA test (Labsystems); for some children we also tested by ELISA the following markers: the antibodies and anti-hepatitis C virus (HCV) antibodies. From 517 children 24.28% were HBSAg positive and 75% of children with chronic hepatitis were positive for the same marker. Almost 100% of chronic active hepatitis (CAH) patients was positive for HBSAg. CONCLUSIONS: 1. The prevalence of HBsAg was much higher as compared with the healthy population prevalence; it is a clear prove that HBV infection has an important role in chronic hepatitis appearance. 2. For all HBsAg positive patients, it is necessary to determine other markers like HBeAg-anti-HBe antibodies system as well as markers for other viral hepatitis (HDV, HCV). 3. The anti-HBV infection vaccine will reduce significantly the prevalence of HBV and HDV infections; 4. Biological molecular technique, like PCR will be necessary in our country, in the future, even the price is so high, to monitoring the IFN treatment for chronic infection as unique solution for these patients.

[The clinico-epidemiological premises for antioxidant prevention and treatment in chronic myocardial infarct]. / Premisele clinico-epidemiologice pentru preventia si tratamentul antioxidant în infarctul miocardic cronic.

The improvement of therapeutic and recoverable proceeding to chronic myocardial infarction (IMC) imposes a complex epidemiological estimation of the global cardiovascular risk, of their clinical and biological status. The retrospective evaluation of the risk factors (RF) by epidemiological methods, in 38 hospitalized prevalence of both constitutional and behavioral factors, and the quantification of the risk state, according to graph Euro 194, has pointed on the fact that 50% of IMC cases have presented a global risk of 10-20%. That justified the application of a preventive conduct in order to continually neutralize the associates FR. The biochemical determinations have allowed to frame the dyslipidemic patients, according to the ARCOL classification in the classes D (29.2%), E (25.0%) and B (20.8%) with direct implication in the adopted therapy. The colorimetric dozing with thyo-barbituric acid of the malonly dialdehyde (MAD) each is a product of the lipidic peroxidation, as well as the interpreting or correlation of the registered values with an evolutive clinic stage, and with the existence of some existing diseases (diabetes, chronic hepatitis etc.) along with signification of other dismethabolical parameters (cholesterol, triglycerides, LDLc, apoB) have confirmed the necessity of a complex therapy, including an antioxidative treatment, having the role to directly inhibit or exclude the free radicals resulted after the oxidative stress of the infarct.

[Multidisciplinary epidemiological observations on the role of mineral elements and other environmental factors in inducing essential arterial hypertension]. / Observatii epidemiologice multidisciplinare asupra rolului unor elemente minerale si altor factori ambientali în inducerea hipertensiunii arteriale esentiale.

The results of a pluridisciplinary epidemiological study carried out on a series of 225 adults from rural areas, in whom the prevalence of arterial hypertension disease (AHTD) and borderline (AHTB) was of 19.0% and 14.4%, respectively, are presented. In 19.0% of the carriers of over five associated risk factors for cardiovascular disease, the classical lipid constants (triglycerides-TG. total lipids-TL. total cholesterol-TC. HDL-cholesterol-HDL-c), plasma (PML) and erythrocyte magnesium level (EML), as compared to the degree of drinking water mineralization were determined. The environmental conditions, also expressed in water hardness (21.650 G) or magnesium water intake (85.13 mg/l) correlate in 41.0% of the subjects with a decrease in PML (1.8 mg/l) and in 70.48 with a decrease in EML (4.8 mg/l) through the association of some behavioral or metabolic risk factors: stress, consumption of atherogenic foods, excess alcohol and lipid dysmetabolism (TG: 130-140 mg/l = 59.5%; TL: 8 g%-30.9%; TC: 220 mg/l = 19%; HDL-c: 35 mg/l + 1.9%).

[An epidemiological assessment of acute diarrheal diseases in Iasi city and County (1985-1994)]. / Evaluari epidemiologice asupra bolii diareice acute în municipiul si judetul Iasi (1985-1994).

Acute diarrhoea, with a remarkable etiologic, clinic and epidemiologic polymorphism represents, for various reasons, an important concern for health preservation both in industrialised countries and, mainly, in the developing ones. It is that, at world level, 1.2-1.5 milliards of diarrhoea episodes, of which 750-950 millions in children, causing death in over 4 millions aged 0-5 years, are recorded. In Romania, although the real data of morbidity by acute diarrhoea are not known, the reports show a significant decrease in the past 10 years. In 1993, 420.2 cases at 100,000 inhabitants were reported, the most commonly affected being the children age 0-4 years. In Moldavia (Romania), numerous extensive studies on the epidemiology of acute diarrhoea have been carried out. This paper present and aims rendering evident some epidemiological aspects of acute diarrhoea cases reported in the interval 1985-1994 in Iasi County and town.