Traian Constantin Panciu

Background: Romania continues to experience one of the highest tuberculosis (TB) burdens in the European Union/European Economic Area. During the COVID-19 pandemic, reduced inpatient capacity accelerated the use of ambulatory care for patients with drug-susceptible tuberculosis (DS-TB). This study evaluated treatment outcomes, outcome ascertainment, hospitalization requirements, and factors associated with unfavorable outcomes among patients managed through ambulatory TB services. Methods: We conducted a retrospective observational cohort study of adults with pulmonary or extrapulmonary DS-TB managed through ambulatory tuberculosis dispensaries affiliated with the “Marius Nasta” Institute of Pneumophthisiology, Bucharest, Romania, between January 2020 and December 2022. Treatment outcomes were defined according to World Health Organization criteria. Factors associated with unfavorable outcome were assessed using Firth penalized-likelihood logistic regression. Hospitalization during treatment was analyzed as a secondary outcome. Results: The final cohort comprised 545 patients with DS-TB, with a mean age of 44.8 years and 56.1% being male. Overall, 281 of 545 patients achieved treatment success, corresponding to a WHO-defined treatment-success rate of 51.6%. Twenty-seven patients (5.0%) experienced an unfavorable outcome, while 237 (43.5%) were classified as not evaluated. Among the 308 patients for whom a determinate end-of-treatment outcome was available, 281 (91.2%) achieved treatment success; however, this conditional proportion does not represent the programmatic treatment-success rate for the entire cohort. Conclusions: Structured ambulatory DS-TB care was operationally feasible within this tertiary-care-linked dispensary network during the COVID-19 pandemic. However, the WHO-defined treatment-success rate for the entire cohort was 51.6%, largely reflecting the substantial proportion of patients without an evaluable final outcome. The high proportion of not-evaluated patients represents an important programmatic weakness and limits conclusions regarding the effectiveness of the ambulatory model. Improved outcome ascertainment and continuity of follow-up are essential components of decentralized TB care.

Background: Romania continues to experience one of the highest tuberculosis (TB) burdens in the European Union/European Economic Area. During the COVID-19 pandemic, reduced inpatient capacity accelerated the use of ambulatory care for patients with drug-susceptible tuberculosis (DS-TB). This study evaluated treatment outcomes, outcome ascertainment, hospitalization requirements, and factors associated with unfavorable outcomes among patients managed through ambulatory TB services. Methods: We conducted a retrospective observational cohort study of adults with pulmonary or extrapulmonary DS-TB managed through ambulatory tuberculosis dispensaries affiliated with the “Marius Nasta” Institute of Pneumophthisiology, Bucharest, Romania, between January 2020 and December 2022. Treatment outcomes were defined according to World Health Organization criteria. Treatment success was calculated among patients with a determinate outcome and complemented by best-case/worst-case sensitivity analyses for patients classified as not evaluated. Factors associated with unfavorable outcome were assessed using Firth penalized-likelihood logistic regression. Hospitalization during treatment was analyzed as a secondary outcome. Results: The final cohort comprised 545 patients with DS-TB, with a mean age of 44.8 years and 56.1% being male. Among 308 patients with a determinate end-of-treatment outcome, 281 achieved treatment success and 27 experienced an unfavorable outcome, corresponding to a treatment-success rate of 91.2% (95% CI 87.5–94.1). However, 237 patients (43.5%) were classified as not evaluated; sensitivity analyses yielded treatment-success estimates ranging from 51.6% to 95.0%. Male sex was associated with unfavorable outcome in univariable analysis (OR 2.43, 95% CI 1.03–6.54; p = 0.042), but the association was no longer statistically significant after adjustment (aOR 2.70, 95% CI 0.90–10.67; p = 0.079). No other baseline factor was significantly associated with unfavorable outcome. Documented non-compliance was markedly more frequent among patients with unfavorable outcomes and was interpreted as a treatment-process indicator rather than a baseline prognostic factor. Hospitalization was required in 24 of 483 patients (5.0%), and adverse drug reactions were strongly associated with hospitalization (OR 5.95, 95% CI 2.55–13.72; p < 0.001). Conclusions: Structured ambulatory DS-TB care was feasible during the COVID-19 pandemic within a tertiary-care-linked dispensary network, with high treatment success among patients with known outcomes and a low requirement for hospitalization. However, the substantial proportion of patients without an evaluable final outcome limits interpretation of the overall success estimate. The findings emphasize the importance of complete outcome ascertainment, adherence support, adverse-event surveillance, and clear referral pathways in ambulatory TB programs. Prospective multicenter studies with comparator groups are needed to establish the long-term effectiveness, safety, and scalability of this model.

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can cause persistent, multisystem complications collectively termed long COVID. Cardiovascular sequelae are among the most clinically significant yet remain incompletely characterized. This review aimed to synthesize current evidence on objective cardiovascular outcomes in long COVID and explore underlying mechanisms. Methods: A systematic review was conducted using PubMed, Scopus, and Web of Science for studies published between January 2020 and March 2024. Search terms included “COVID-19,” “long COVID,” “post-acute sequelae,” “cardiovascular,” “echocardiography,” “biomarkers,” and “imaging.” Only studies reporting at least one cardiovascular outcome, defined as either objectively measured parameters (e.g., echocardiography, cardiac biomarkers, ECG findings, or vascular function indices) or clinically relevant cardiovascular symptoms during follow-up, were included. From 412 identified records, ten recent, high-quality studies with a primary cardiovascular focus were selected. This systematic review was conducted in accordance with the PRISMA 2020 guidelines. Results: Long COVID is associated with subclinical myocardial dysfunction, arrhythmias, endothelial injury, vascular stiffness, and a prothrombotic state. Reported findings included reduced left ventricular ejection fraction, impaired global longitudinal strain, increased arterial stiffness, elevated cardiac biomarkers, new-onset hypertension, and persistent ECG changes, even in non-hospitalized patients without prior cardiovascular disease. Proposed mechanisms include myocardial inflammation, endothelial dysfunction, renin–angiotensin–aldosterone system dysregulation, autonomic imbalance, and chronic inflammation. Secondary bacterial and fungal infections were noted in critically ill survivors but did not fully explain the breadth or persistence of symptoms. Conclusions: Long COVID is a heterogeneous entity with substantial cardiovascular implications across all levels of acute disease severity. Early detection through longitudinal monitoring, standardized definitions, and multidisciplinary care is essential to reduce long-term cardiovascular risk.

The challenges to effective tuberculosis (TB) disease control are considerable, and the current global targets for reductions in disease burden seem unattainable. The combination of complex pathophysiology and technical limitations results in difficulties in achieving consistent, reliable diagnoses, and long treatment regimens imply serious physiological and socioeconomic consequences for patients. Artificial intelligence (AI) applications in healthcare have significantly improved patient care regarding diagnostics, treatment and basic research. However, their success relies on infrastructures prioritising comprehensive data generation and collaborative research environments to foster stakeholder engagement. This viewpoint article briefly outlines the current and potential applications of advanced AI models in global TB control and the considerations and implications of adopting these tools within the public health community.

Resistance to anti-tuberculosis drugs is an increasing challenge worldwide. Besides multi-drug-resistant tuberculosis (MDR TB) strains (resistant to at least Rifampicin and Isoniazid), additional resistances to new drugs have emerged worldwide: pre-extended-drug-resistant TB (preXDR TB - MDR TB plus resistance to a fluoroquinolone) and extended-drug-resistant TB (XDR TB - preXDR TB plus resistance to Bedaquiline or Linezolide). In this retrospective observational study, the MDR TB strains identified in our laboratory during 2023 were tested for resistance to Linezolid and Bedaquiline using liquid culture and drug susceptibility test (DST). We collected bacteriological assay data from the laboratory electronic registry, and demographic, clinical and treatment outcome data from the National TB Program database. A number of 164 patients were included: 126 had Rifampicin-resistant TB or MDR TB; 34 had pre-XDR TB, and 4 had XDR TB (3 with resistance to Linezolid and 1 to Linezolid and Bedaquiline) In the group, 81% of patients were male, median age was 48 years, and 60% had residence in rural area. As TB case category, 43% were new cases and 57% had at least one previous episode of TB treatment. There was a small percentage of HIV positive (8%) and intravenous drug users (4%). The mortality was high, 14% overall, and 23% in the cases with preXDR and XDR TB. Our data show that one in 10 patients with preXDR will also display resistance to Bedaquiline or Linezolide, enforcing the need for mandatory extended DST for every MDR TB patient. Our results could be used to add to the map of TB drug resistance in Eastern European region.

COVID-19 pandemic has brought unprecedented challenges to healthcare systems worldwide, limiting the addressability of tuberculosis (TB) patients to medical care, and thus delaying the diagnostic. This retrospective observational study aims to assess the severity of TB at admission in patients admitted in our clinic during the COVID-19 pandemic, as compared to TB cases hospitalized before the pandemic. Severity at admission was assessed by microbiological analysis (high intensity of positive baseline sputum smears: 3+ or 2+ in semi-quantitative smear reading), and radiologic severity evaluated by Ralph score (0 to 140 points) and Falk score (mild, moderate, severe). The study group included 112 patients admitted between 01.07.2020 and 31.12.2020 (during the pandemic), the control group included 232 patients admitted between 01.07.2019 and 31.12.2019 (pre-pandemic). In the study group, 69% (67/96) of patients had a severe Falk score, compared to just 46% (99/215) in the control group. Median Ralph score was 70 points in study group, while in the control group was 50 points. The difference between the two groups is statistically significant for both scores. Sputum smear results showed an increased bacillary load in the study group, 3+ or 2+ in 46% (43/94) of patients, and only 35% (81/232) in the control group (p<0.01). The study demonstrates a significantly higher proportion of severe TB cases in patients admitted during the COVID-19 pandemic, due to reduced accessibility to medical care and delayed presentation. Any kind of disruptions of the public healthcare system should not hinder early detection and treatment of TB cases.

Air pollution is a serious problem in Romania, with the country ranking 13th among the most polluted countries in Europe in the 2021 World Air Quality Report. Despite the recognized impact of pollutants on health, there has been a lack of large-scale studies conducted in Romania. This study investigated the impact of air pollutants on patients with chronic respiratory, cardiovascular, cerebrovascular, or metabolic diseases in Bucharest and its metropolitan area from 20 August 2018 to 1 June 2022. The daily limit values for particulate matter PM10 and PM2.5 were exceeded every month, especially during the cold season, with a decrease during the COVID-19 pandemic restrictions. A significant statistical correlation was found between the monthly average values of PM2.5 and PM10 and hospitalizations for respiratory and cardiovascular diseases. A 10 µg/m³ increase in monthly average values resulted in a 40–60% increase in admissions for each type of pathology, translating to more than 2000 admissions for each pathology for the study period. This study highlights the urgent need for national and local measures to ensure a cleaner environment and enhance public health in Romania according to international regulations.