CHARACTERISTICS OF RESPIRATORY MECHANICS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE.

UNLABELLED: In chronic obstructive pulmonary disease (COPD) the changes in respiratory thoracoabdominal mechanics result from both hyperinflation and functional and structural skeletal muscle alterations. AIM: Evaluation of the particularities of respiratory movement in COPD and identification of inter-relations between respiratory thoraco-abdominal mechanics and clinical and functional respiratory status. MATERIALS AND METHODS: This study comparatively analyzed the respiratory thoracoabdominal mechanics recorded by polygraphy, using piezoelectric film belts, in 34 COPD patients and 30 healthy subjects, during rest, and during 6-minute walk test. RESULTS: In COPD patients, phase angle between direction of thoracic and abdominal respiratory movements presented significantly higher values compared to the control group, for supine (p = 0.023) and sitting position (p = 0.001), revealing the presence of paradoxical respiratory movements. Furthermore, phase angle dynamics increased significantly during walking test compared to sitting position (p = 0.001). Quantitative difference of end-expiratory pulmonary volume (qDEEL) correlated with pack-years (r = 0.372, p = 0.03) in supine position, and with body mass (r = 0.338, p = 0.05) and St. George activity score (r = 0.353, p = 0.041) during walking test. Rib cage inspiratory contribution to tidal volume ratio (%RCi) inversely correlated with pack-years (r = -0.417, p = 0.014) and body mass index (r = - 0.344, p = 0.047) in supine position, and with St. George activity score (r = 0.345, p = 0.046) in sitting position. CONCLUSIONS: In COPD patient thoracoabdominal mechanics is characterized by paradoxical respiratory movements, more prominent during exercise. The alteration of thoracoabdominal mechanics correlated with St. George activity score, pack-years and body mass.

Respiratory rehabilitation in healing depression and anxiety in COPD patients.

UNLABELLED: Chronic Obstructive Pulmonary Disease (COPD) is an inflammatory affection of the whole lung, characterized by an accelerated loss of the pulmonary functions, that reduces the patients' independence and stops them from having a normal, active life. The medical rehabilitation is considered "Third class rehabilitation", after preventive medicine and pharmaceutical medicine, and the respiratory rehabilitation recovery represents a complex structure of service addressing to patients with chronic pulmonary illnesses whose aim is to optimize the physical performances, psycho-social and autonomy. AIM AND OBJECTIVES: The main objective of this study is to show the importance of respiratory rehabilitation that is correctly and timely made, based on the gravity and stage of the illness, the COPD patient's associated illnesses and their importance in improving the patient's mental and physical quality of life. Patients from the study were assigned a complex pulmonary rehabilitation regimen consisting of 10 physical exercise sessions and 10 educational sessions, for two weeks, followed by 3 physical education sessions and medical education per week, for six weeks. MATERIAL AND METHOD; The research included 35 COPD patients from the 5th medical Geriatric and Gerontology. Clinic during 1.03.2014-30.11.2014. Patients from the study were assigned a complex pulmonary rehabilitation regimen consisting of 10 physical exercise sessions and 10 educational session for two weeks, followed by 3 sessions a week for 6 weeks. The dyspnea evaluation was made by BORG and MRC dyspnea scales, the quality of life was measured by St. George and CAT questionnaires, and anxiety and anxiety and depression were quantified by Hamilton Anxiety Rating Scale (HARS) and Hamilton Depression Rating Scale (HDRS). RESULTS: The gradation of dyspnea on BORG scale was correlated with the variation of the expiratory capacity that varied at COPD patients, suggesting that hyperinflation has a major role in producing the dyspnea. The average score measurement was about 75.25 ± 5.9. the positive effects of rehab were validated by decreasing the St. George score by 16% to the initial value. Respiratory rehab was an important way of treatment due to effort tolerance increasing and the patient's independence. Depression was significantly more pronounced in women (Z = -1.876: p = 0.039). The little value of maximum respiratory volume per second (VEMS) was correlated to a bigger HARS and HDRS score. CONCLUSIONS: The prevalence and importance of symptoms of anxiety and depression in COPD patients requires a specific questionnaire as routine screening procedure, for detecting early symptoms and preventing their progress.

A CASE OF POLYMYOSITIS WITH INTERSTITIAL LUNG DISEASE ONSET.

Polymyositis is an idiopathic inflammatory myopathy of unknown aetiology that affect skeletal muscles causing symmetrical, proximal muscle weakness, and also other internal organs. The investigations reveal elevated skeletal muscle enzyme levels and characteristic electromyography (EMG) and muscle biopsy findings. Pulmonary involvement in polymyositis includes respiratory muscle weakness, aspiration pneumonia, interstitial lung disease, infection and drug-induced pneumonia. We expose the case of a young woman (47 years old) who presented to the Pulmonology Clinic with fever, cough, purulent sputum, discrete myalgia, being diagnosed at that moment with interstitial lung disease and treated with antibiotics, low dose of corticosteroids and symptomatic drugs. The evolution was slowly favorable for the respiratory impairment, but the patient developed exacerbated myalgia, muscle weakness, reaching even the impossibility of maintaining orthostatism, and also joint pain. Biological investigations revealed an important hepatocytolysis syndrome and also increased levels of muscle enzyme. The hypothetical diagnosis was polymyositis and to sustain this theory it was performed a muscle biopsy. The patient was transferred afterwards to the Rheumatology Clinic, in order to perform other specific investigations. In our clinic the patient maintained elevated levels of skeletal muscle enzymes and the muscle biopsy revealed polymyositis findings. Also immunological investigations objectified the presence of Jo1 antibodies. Therefore we pleaded for the diagnosis of idiopathic polymyositis, acute form. A multidisciplinary approach is needed in order to establish an accurate diagnosis and to institute a proper treatment.

Body composition alterations in chronic obstructive pulmonary disease.

UNLABELLED: Metabolic disorders are involved in the pathogenesis of some comorbid conditions such as atherosclerosis and cardiovascular diseases, which frequently occur in COPD patient. These disorders may also associate alterations in body composition. AIM: To determine the particularities of body composition, assessing its relationship with respiratory function and clinical status in COPD patients. MATERIAL AND METHODS: A prospective case-control study including 31 patients with COPD admitted to the Clinic of Pulmonary Diseases lasi from April 2011 to September 2012, and 29 subjects without lung diseases which served as controls. Body composition (body fat, lean body mass, body water) and basal metabolic rate were measured using bioelectrical impedance analysis. Other assessments included anthropometric parameters, spirometry, 6-minute walk test. In COPD patients, dyspnea scale and health impairment assessment by St George's Respiratory Questionnaire (SGRQ) were used. RESULTS: In COPD group, 67% of the patients were normal weight, 10% underweight, 10% overweight and 13% obese. The results showed that lean body mass (p < 0.001), dry lean mass (p < 0.001), total body water (p < 0.001) and basal metabolic rate (p < 0.001) were lower in the COPD patients as compared to the controls. These findings significantly correlate with age, dyspnea, severity of airway obstruction and exercise capacity in patients with COPD. No significant differences between study groups were observed in body fat mass. CONCLUSIONS: Lean body mass, dry lean mass, and total body water are altered in COPD patients and significantly correlate with age, clinical and functional severity of COPD.

Serum testosterone and depressive symptoms in severe OSA patients.

Obstructive sleep apnoea (OSA), also characterised by hypoxia-related sleep- fragmentation, has been studied in relation to depression and serum testosterone deficit. In middle-aged men, it has been reported the association between depressive mood and low serum testosterone level; however, no data are available about this association in OSA patients. Therefore, the aim of this study was to investigate in adult obese males, affected by severe OSA, the relationship between serum testosterone concentration and depressive symptoms, in order to identify among all measured parameters (serum testosterone morning concentration, polysomnography parameters, body mass index, Epworth Sleepiness Scale) those predictors for OSA-related depression. Forty patients diagnosed with severe OSA and forty subjects for the control-matched group were enroled in the study. The results indicated that the serum testosterone in OSA group was significantly lower than in controls. In addition, the OSA group presented a level of depression although moderate, yet significantly higher than controls. Furthermore, a statistically significant inverse correlation has been found between serum testosterone level and depressive symptoms. Among all variables, serum testosterone level was shown to be the only independent variable significantly predictor for depression in OSA patients.

Heart rate variations in chronic obstructive pulmonary disease.

UNLABELLED: Autonomic nervous system dysfunction proved in chronic obstructive pulmonary disease (COPD) patients might determine an elevated cardiovascular risk by heart rate alteration. AIM: To assess the particularities of heart rate as a possible cardiovascular risk factor in COPD patients. MATERIALS AND METHODS: This prospective, case-control study comparatively analyzed the pulse rate continuously recorded with a polygraph in 32 COPD patients and 29 healthy subjects during rest (supine and sitting position) and during submaximal exercise (6-minute walk test). The relation between pulse rate and respiratory, functional or clinical alterations was analyzed in COPD patients. RESULTS: The mean pulse rate was significantly higher during rest and exercise in COPD patients compared with the controls. However, the chronotropic response determined by exercise was similar in COPD and control groups: 55.19 beats/minute and 57.21 beats/minute, respectively (p=0.686). The mean pulse rate during exercise correlated with hypoxemia (r=-0.354, p=0.47) and with resting pulse rate (r=0.871, p<0.001 for supine position). CONCLUSIONS: COPD associates elevated pulse rates during both rest and exercise. Hypoxemia and resting pulse rate are determinatives of chronotropic response during submaximal exercise in COPD patients.

Body composition alterations in chronic obstructive pulmonary disease.

UNLABELLED: Metabolic disorders are involved in the pathogenesis of some co morbid conditions such as atherosclerosis and cardiovascular diseases, which frequently occur in COPD patient. These disorders may also associate alterations in body composition. AIM: To determine the particularities of body composition, assessing its relationship with respiratory function and clinical status in COPD patients. MATERIAL AND METHODS: A prospective case-control study including 31 patients with COPD admitted to the Clinic of Pulmonary Diseases lasi from April 2011 to September 2012, and 29 subjects without lung diseases which served as controls. Body composition (body fat, lean body mass, body water) and basal metabolic rate were measured using bioelectrical impedance analysis. Other assessments included anthropometric parameters, spirometry, 6-minute walk test. In COPD patients, dyspnea scale and health impairment assessment by St George's Respiratory Questionnaire (SGRQ) were used. RESULTS: In COPD group, 67% of the patients were normal weight, 10% underweight, 10% overweight and 13% obese. The results showed that lean body mass (p < 0.001), dry lean mass (p < 0.001), total body water (p < 0.001) and basal metabolic rate (p < 0.001) were lower in the COPD patients as compared to the controls. These findings significantly correlate with age, dyspnea, severity of airway obstruction and exercise capacity in patients with COPD. No significant differences between study groups were observed in body fat mass. CONCLUSIONS: Lean body mass, dry lean mass, and total body water are altered in COPD patients and significantly correlate with age, clinical and functional severity of COPD.

[Therapeutic approach in a case of allergic reaction to antituberculosis drugs -- a case report]. / Atitudine terapeutica in caz de reactie alergica la medicatia antituberculoasa. Prezentare de caz.

UNLABELLED: Medicaton used to treat tuberculosis is responsible for numerous side effects that have a major impact on patient's health, with a negative influence on the quality of life. Patients of all ages must be trained in order to recognize all the adverse effects and the undesirable reactions produced by antituberculosis medication. We report the case of a 24-year-old woman with generalized psoriasis and psoriatic arthropathy who was treated against tuberculosis. After 7 days of treatment with isoniazid, rifampicin, ethambutol and pyrazinamid she had severe allergic reaction with generalized pruritus and rash which were difficult to control with antiallergic treatment. CONCLUSIONS: Particular to this case is the absence in patient's history of the allergic reactions to medication. The re-establishment of treatment of tuberculosis was done by clinical trials and the patient had responded to only three drugs: isoniazid, rifampicin and ofloxacin, so the patient received an individual treatment due to adverse reactions to tuberculosis medications.

Relationship between immunohistochemical assessment of bronchial mucosa microvascularization and clinical stage in asthma.

Although hardly ever used in current practice, fibrobronchoscopy may provide interesting histopathological-clinical correlations in patients diagnosed with different stages of evolutive asthma. The aim of the study was to evaluate the correlation between semi-quantitative microvascularization features and the asthma severity assessed according to the GINA classification 2006. Our study group consisted in 21 patients diagnosed with asthma of different stages of severity and two-control patients investigated by fibrobronchoscopy with associated biopsy. The tissue fragments underwent standard processing procedures for the immunohistochemical exam, using CD34 as microvascularization marker. The semi-quantitative analysis was based on the "hot spot" method and on a score system that corresponds to the microvessels density. The statistical analysis of the correspondence between CD34 score and clinical parameters was performed using the SPSS 17 software, applying non-parametric correlation tests. The CD34 evaluation showed an increase in blood vessels count in all asthmatic patients in comparison to the control group and a close correlation with the asthma severity, reflected by the FEV1 values. The statistical analysis showed an inverse correlation between FEV1 [%] values and CD34 expression (r=-0.93, p<<0.01). Our data concur to other research reports, supporting the hypothesis that angiogenesis initially facilitates the edema development and later on appears to be involved in the bronchial wall thickening, as a component of the chronic inflammatory response, with concomitant distensibility reduction. The bronchial mucosa microvascularization evaluation opens new perspectives for advanced therapies, with beneficial effects for asthmatic patients' life quality.

Lung cancer - a comorbidity in chronic obstructive pulmonary disease.

Chronic Obstructive Pulmonary Disease (COPD) is an important public health challenge, representing the fourth leading cause of death in the world. A very important characteristic of COPD is represented by the coexistence of comorbidities. Lung cancer, a major cause of morbidity and mortality throughout the world, is also a frequent comorbidity in COPD. Cigarette smoking represents the best-known risk factor in both COPD and lung cancer, causing common pathogenic mechanisms like oxidative stress and inflammation. However, the etiopathogenic link between COPD and lung cancer implies a common underlying genetic susceptibility, acting in addition to environmental risk factors. These trigger more complex cellular and molecular mechanisms, represented by immune dysfunction, abnormal activation of transcription factors, altered signaling pathways, epithelial to mesenchymal transition. A better understanding of the etiopathogenic link between COPD and lung cancer at the molecular level will allow the discovery of more sensitive diagnostic methods and also new molecular targets for an efficient treatment.

[Writing and publication of a clinical case report]. / Scrierea si publicarea unei prezentari de caz clinic.

A case report represents a collection of detailed information about an individual patient, written with the purpose to disseminate clinical outcomes, not previously reported. Case reports provide a rich resource for teaching and research in medicine. Despite the limitation of case reports, these are useful to generate new hypothesis for future large scale clinical trials. A clinical case report should be well structured and convey a clear message. Elements of a case report are similar to all forms of medical scientific articles: title, structured abstract, introduction, case report, discussion, conclusion and references. A well written case report with literature support and a detailed description of management of the case has the greatest chances to be published. "Uniform Requirements for Manuscripts to Biomedical Journals" form the basis for most journal instructions regarding content and formatting and should be consulted when journal's instructions don't answer to author's questions. In this paper we present a case report check sheet to use as a form of self-evaluation, prior to submitting the articles.

[Clinical features and course of patients with tuberculosis requiring intensive care]. / Particularitatile clinico-evolutive ale pacientilor cu tuberculoza care au necesitat terapie intensiva.

BACKGROUND: To describe the characteristics of patients with tuberculosis (TB) requiring intensive care and to identify the risk factors for mortality. METHODS: We conducted a retrospective, cohort study, between January 2006 and December 2009. The patients with TB, admitted in Pneumology Clinic Hospital, Iasi, requiring advanced life support in intensive care unit (ICU), were included. We assessed different clinical parameters to identify the factors that predict in-hospital mortality. The primary outcome was the in-hospital mortality. RESULTS: During the study period, 27 patients with TB required intensive care. Of them, 16 (59.3%) had acute respiratory failure and 6 (22.2%) required mechanical ventilation. Eighteen (66.7%) patients died. Acute respiratory failure, acute hepatic failure and mechanical ventilation significantly correlate with a high in-hospital mortality rate. CONCLUSIONS: In this study we found a high mortality rate in TB patients requiring intensive care, identifying some risk factors.

Serum trace metal and ceruloplasmin variability in individuals treated for pulmonary tuberculosis.

SETTING: Investigation of trace metal behaviour during the treatment of active pulmonary tuberculosis (PTB) patients residing in Romania. OBJECTIVE: To assess, follow and identify serum iron (Fe), copper (Cu) and zinc (Zn) levels in patients diagnosed and treated for active PTB. DESIGN: Chemical and statistical analysis of various biochemical parameters in 47 subjects diagnosed with active PTB and 170 healthy Romanian residents. RESULTS: Copper and ceruloplasmin levels were increased in patients with active PTB compared to the control group (P < 0.01), while the serum Zn level was significantly lower than in healthy subjects (P < 0.01) or within the normal range. The present study shows that there is a significant correlation between serum Cu concentrations and ceruloplasmin. CONCLUSIONS: This study provides preliminary evidence that Zn and Fe redistribution is operating as a primary host defence mechanism to reduce the availability of metals for microbial metabolism during infection. The study also calls attention to the fact that anti-tuberculosis treatment is sufficient to enhance the concentration of the antioxidant species (Cu and ceruloplasmin). The data obtained suggest that serum Cu, Zn and Cu/Zn levels may serve as indirect pointers in the diagnosis of a disease but they cannot be considered as specific markers for TB.

[Macroscopic and microscopic lesions in bronchial asthma]. / Aspecte lezionale macroscopice si microscopice în astmul bronsic.

Bronchial asthma is a chronic inflammatory disease characterized by reversible airways obstruction, inflammation, and increased bronchial hyperresponsivennes. The aim of this study was to evaluate the macroscopic and microscopic airways lesions, using bronhoscopy followed by biopsy in 38 cases of Outpatient Department from Clinic of Pulmonary Diseases Iasi, investigated between January 2005 - June 2008. Patients distribution according to the degree of severity was performed, using the international recommendations for asthma management of the Global Initiative for Asthma (GINA): intermittent (n=7 patients), mild persistent (n=10 patients), moderate persistent (n=16 patients), and severe persistent (n=5 patients). 23,68% of patients had a chronic disease of more than 15 years. The endoscopic changes of the peripheral airways were represented by edema, congestion, bronchial stenosis and mucus hypersecretion. Microscopic routine exam showed epithelial lesions (epithelial desquamation, goblet cell hyperplasia, squamous metaplasia), basement membrane thickening, edema, increased vascularisation, glandular and muscular hypertrophy and bronchial inflammatory infiltrate. Although bronhoscopy exam offers important information regarding changes of the airway mucosa in bronchial asthma, it concomitantly provide bioptic control, as microscopic examination still represents the "gold standard" assessment of bronchial wall remodeling process.

[Variability of cardiac rate in patients with obstructive sleep apnea/hypopnea]. / Variabilitatea frecventei cardiace la pacientii cu sindrom de apnee/hipopnee obstructiva în somn.

BACKGROUND: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by repeated breathing pauses caused by upper airway collapse during sleep, leading to intermittent hypoxemia, sleep fragmentation and autonomic dysfunction. The gold standard for the treatment of OSAHS is ventilation with continuous positive airway pressure (CPAP). AIM: To study the effect of CPAP on autonomic dysfunction in patients OSAHS, by assessing the heart rate variability (HRV) parameters before the initiation of CPAP and under CPAP during the first week and at 3 months. MATERIAL, METHODS: We have assessed HRV parametrs by 24 hours ECG Holter monitoring in 42 patients with moderate and severe OSAHS (apnea-hypopnea index AHI > or = 15/h) without other causes of autonomic neuropathy. The assessment was made at diagnosis, during the first week of CPAP use and at 3 months of CPAP use. RESULTS. Both time domain and frequency domain HRV parameters decreased significantly during the first week of CPAP use and increased back to normal values at 3 months. Initially and during the first week of treatment, HRV parameters correlated negatively with the severity of OSAHS expressed by AHI. CONCLUSIONS: Patients with OSAHS present an alteration of HRV, proportionally with disease severity. The decrease in HRV is revealed by the absence of apneas during the initiation of CPAP. After 3 months of CPAP treatment, the HRV parmeters are normalized independently of the disease severity.

[Pathophysiology and treatment of bronchectasis]. / Aspecte fiziopatologice si tratamentul in bronsiectazii.

Bronchiectasis is a complex pathology which consists of some important morphopathological changes in the lumen of the bronchi that consecutively determines recurrent pulmonary infections with a diversity of germs. The repeated episodes of infection are associated with chronic colonization of the respiratory system with certain pathogen microorganisms and play an important role in the maintenance of the chronic inflammatory syndrome, as well as the decline of the pulmonary function. This chronic inflammation is represented by a series of fisiopathological changes (the raised number of neutrophiles, macrophages, alteration in the expression of pro-inflammatory cytokine and adhesion molecules). The first hand treatment of patients with infected bronchiectas is the antibiotic treatment, followed by anti-inflammatory treatment and adjuvant therapy. The use of macrolides in the long-term treatment schemes has confirmed their role in the reduction of the chronic inflammatory syndrome associated with this disease, moreover its association with the anti-inflammatory medication has significantly improve the patient's health status.

Obstructive sleep apnea patients voice analysis.

UNLABELLED: It is generally considered that obstructive sleep apnea may associate larynx abnormalities--either anatomic or functional in nature; considering the vocal tract as a series of uniform loss cylindrical pipes the idea of non-invasively exploring this by means of spectral analysis emerged. The aim of our study is to evaluate potential changes in acoustic features of voice in sleep apnea patients as compared to matched controls in order to develop a potential screening test. MATERIAL AND METHOD: Sleep apnea subjects and controls were asked to produce sustained vowels such as "a" and "i" which were recorded and analyzed. Some parameters were estimated--average of fundamental frequency, peak amplitude variation and compared and others are still to be developed.

[Obstructive sleep apnea (OSA) syndrome and traffic accidents]. / Sindromul de apnee obstructiva în somn (SAOS) si accidentele rutiere.

UNLABELLED: For many years traffic accidents represent an important concern in the world and was proven that excessive sleepiness, decreased vigilance of falling asleep in traffic are involved in many car accidents. AIM: To asses the correlation between obstructive sleep apnea (OSA) syndrome severity, the length of nocturnal arterial oxygen desaturation period and the patients' answers to the Epworth Sleepiness Scale Questionnaire (ESS) and Berlin Questionnaire (BQ). MATERIAL AND METHOD: We used the records of patients admitted in Iasi Pneumology Clinical Hospital with obstructive sleep apnea syndrome between 2007-2008, including only those patients which drive the car daily and excluding those patients with comorbidities which could increase the nocturnal arterial oxygen desaturation. The study group (33 patients) have been assessed through polysomnography and some specific questions from ESS and BQ. We identified those patients involved in traffic accidents due to sleepiness. The correlation between obstructive sleep apnea syndrome severity (reflected by Apnea-Hipopnea Index--AHI), the length of the nocturnal arterial oxygen desaturation period (< 90%) and the answers the answers to ESS and BQ were assessed. RESULTS: Two patients presented mild severity sleep apnea syndrome, 15 presented moderate severity and 16 high severity sleep apnea syndrome. The correlation of AHI with ESS (r = 0.59, p < 0.001) and BQ (r = 0.47, p < 0.05) were significant while the correlation with nocturnal arterial oxygen desaturation period had no significance (r = 0.29, p < 0.05). CONCLUSION: Patients with moderate or severe OSA present a high degree of diurnal sleepiness which could affect the driving capacity.

Comparative study using tuberculin from Cantacuzino Institute versus Statens Serum Institute.

SETTING: Iasi County, Romania. OBJECTIVE: To evaluate the efficiency of the tuberculin produced by Cantacuzino Institute (ICB) compared to Statens Serum Institute (SSI) tuberculin in a group of high school students. DESIGN: 36 subjects were tested simultaneously with two tuberculin tipes. For each student, the left arm was tested with ICB tuberculin, while the right arm was tested with SSI tuberculin. All tests were single blind, and the subjects did not know which tuberculin type was used for each arm. The tuberculin administration sequence was random. RESULTS: No significant discrepancies were observed in results of both tuberculin reactions. The correlation coefficient was significant (0.95) between both tests (p<0.0001, CI 0.9111-0.9765). Positive results for the tuberculin test were found in 11.1% of the subjects when we used SSI tuberculin. The pain was almost absent at ICB tuberculin injection, comparatively at SSI tuberculin. CONCLUSION: Tuberculin 2u PPD made by Cantacuzino Institute has the same efficiency as tuberculin PPD RT 23 SSI. The findings of present study recommend, in absence of SSI tuberculin, to use Cantacuzino Institute tuberculin for identification of infections with Mycobacterium tuberculosis complex.

Completeness of notification of adult tuberculosis in Iasi County, Romania: a capture-recapture analysis.

SETTING: Iasi County, Romania. OBJECTIVE: To assess the completeness of notification of adult tuberculosis (TB; age > or=15 years) in 2004. DESIGN: Record-linkage and capture-recapture analysis of three TB-related registers: a notification register, a laboratory register and a prescriptions register. RESULTS: After record linkage, the observed completeness of the notification register was 86.4%, giving an observed adult TB incidence rate of 202 per 100,000 population. After capture-recapture analysis, internal validity analysis and application of alternative truncated population estimation models, the estimated completeness of the notification register was 82-85%, giving an estimated adult TB incidence rate of between 204 and 212/100,000. CONCLUSION: This study shows that the severity of the TB problem in Iasi County is under-reported. The results are in agreement with a previous estimate of the undernotification of TB in Romania by the the World Health Organization.