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Original Papers

Romanian National Registry for Interstitial Lung Diseases and Sarcoidosis (REGIS): rationale and methods

Irina Strambu1, Diana Ionita1, Ionela Belaconi1, Irina Stoia2, Voicu Tudorache2 Contact: Irina Strambu,
1. Institutul de Pneumoftiziologie „Marius Nasta” Bucuresti; 2. Clinica de Pneumoftiziologie, Spitalul de Boli Infectioase „Victor Babes” Timisoara


Interstitial lung diseases (ILD) are a group of extremely heterogeneous conditions (over 200), with low prevalence, but in most cases with severe impact on the quality of life and survival of the patients. The ILD group comprises: idiopathic pulmonary fibrosis, sarcoidosis, hypersensitivity pneumonitis, colagen diseases, vasculitis, eosinophilic pneumonia etc. The prevalence of these diseases is unknown in Romania; the accurate diagnosis needs access to special investigations and expertise with this group of diseases. The authors propose the initiation of a National Registry for Interstitial Lung Diseases and Sarcoidosis (REGIS), based on the lessons learned from other national ILD registries, which should allow building-up an extended clinical expertise in ILD, evaluating epidemiological data, creating an educational platform for young physicians, better understanding of the outcome and prognosis of these diseases, shaping Romanian Guidelines for the diagnosis and management of ILD, using the data base for clinical research. The registry is started as a pilot in two Romanian centres: „Marius Nasta" Institute of Pneumology in Bucharest and Pneumology Clinic, „Victor Babes" Infectious Diseases Hospital Timisoara. After refining the inclusion criteria for the data base, editing guidelines for ILD diagnosis and launching the registry website, other Romanian centres with interest in ILD will also be able to feed information.

Keywords: interstitial lung diseases, sarcoidosis, national registry, database

Sleep quality in students

Alina Micu1, Cristian Cojocaru2, Gianina Luca3, Traian Mihaescu2 Contact: Cristian Cojocaru,
1. Spitalul Clinic Judetean de Urgente „Sfantul Spiridon” Iasi, Clinica I Oftalmologie; 2. Universitatea de Medicina si Farmacie „Grigore T. Popa” Iasi, Spitalul Clinic de Pneumoftiziologie Iasi; 3. University of Lausanne, Faculty of Biology and Medicine Center of Integrative Genomics


Sleep quality is an important factor involved in students' learning process. Using different methods, actual studies suggest that complaints about sleep problems are common in young medical students 1. The aim of this study was to evaluate if is any relation between factors like medium and lifestyle
among students of the University of Medicine and Pharmacy "Grigore T. Popa" from Iasi. The study group included 30 students (2 of them were excluded) who performed a polisomnography, self reported Epworth questionnaire and two weeks sleep diary. Coffee, energy drinks, green and black tea and alcohol intake were recorded. In our evaluation it was used sleep disturbance index (SDI), for sleep quality description. In those two weeks, the mean sleep hours was 7.8 (95% CI 7.6-8), greater in female than in male. The results suggest a significant correlation between psychical excitants and sleep fragmentation. More, excessive daytime somnolence declared is not in concordance with sleep quality observed in sleep recorded with polysomnography. It looks to be in correlation with bad sleep habits and psychical excitants intake.

Keywords: sleep, students, polysomnography

The determinants of high school students smoking habits with special focus on teachers smoking in Iran: a population based study

Emami Habib1,2, Amir Soha Rezai Shiraz3, Ghazal Naseri-Kouzehgarani4, Sharifi Hooman1, Masjedi Mohammad Reza5 Contact: Sharifi Hooman,
1. Tobacco Prevention and Control Research Center (TPCRC), Masih Daneshvari Hospital, Shaheed Beheshti Medical Science University, Tehran, Iran; 2. Department of Epidemiology and Biostatistics, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University, M.C., Tehran, Iran; 3. Tobacco Resident Medical Officer, Women’s and Children’s Hospital 72 King William Road, North Adelaide, 5006, Australia; 4. Division of Nutritional Sciences, Department of Food Science& Human Nutrition, University of Illinois at Urbana-Champaign, IL, USA; 5. Department of Pulmonary Medicine, (NRITLD), Shahid Beheshti University, M.C., Tehran, Iran


Introduction: Approval of smoking by friends and teachers is likely to increase the probability of smoking by the students. This study aims to determine whether adolescent smoking is associated with teachers or other students smoking, after controlling for confounders.

Materials&Methods: In across sectional study, a representative sample of 4599 students in the third grade were selected from high schools in Tehran. A 21 item questionnaire was administered consisting of demographic and tobacco smoking habit questions. Pattern of adolescent tobacco smoking was compared between twosexes. Association between smoking behavior and perceived exposure to teachers smoking were assessed using bivariate and multivariate analyses, adjusting for parental, best friends and sibling smoking and sex. A multivariate logistic regression model was constructed and adjusted Odds Ratios were estimated.

Results: In total, 4591 students, aged 17 to 19 years, consisting of 2092 (45.6%) boys and 2499 (54.4%) girls, with the overall mean age of 17.53±0.59 years, were recruited. Of the students studied, 250 (12.1%) of boys and 131 (5.3%) of girls reported being current smokers (p=0.001).The proportion of smoker and non-smoker students reporting to have been exposed to teachers smoking inside the school building was 209 (55.7%) and 1191 (29.3%), respectively (p=0.001). Of those reporting being exposed to teachers smoking outdoors on school premises, 220 (58.7%) were smokersand 1205 (29.2%) were non-smokers (p=0.001). After adjusting for sex, smoking habit of father, mother, brothers, sisters and best friends, adolescent perceived exposure to teachers smoking on school premises, but not inside school, was significantly associated with current smoking (OR=2.1, 95%CI:1.7-2.7). Adolescent exposure to best friend smoking was strongly associated with current smoking after adjusting for above variables (OR=6.7, 95% CI:5-9).

Conclusion: Teachers smoking during school hours and best friend smoking are the two important determinants to be considered in any projectaiming to establish tobacco-free schools.

Keywords: adolescent, teacher, smoking, school

Sensitivity of alpha-1 antitrypsin level for inherited deficiency detection in COPD patients

Danielius Serapinas1, 2, Raimundas Sakalauskas1 Contact: Danielius Serapinas,
1. Department of Pulmonology and Immunology, Medical Academy, Lithuanian University of Health Sciences; 2. Mykolas Romeris University


Background and objective. Alpha-1 antitrypsin deficiency is an underdiagnosed condition in patients with chronic obstructive pulmonary disease. Diagnosis of this genetic condition is confirmed by genetic verification of pathology, but for screening purposes quantitative methods can be useful. The aim of our study was to evaluate sensitivity and specificity of quantitative methods for alpha-1 antitrypsin deficiency detection.

Methods.Serum alpha-1 antitrypsin concentrations from patients (n=1167) with chronic obstructive pulmonary disease, defined according to the GOLD criteria, were analysed bynephelometry, alpha-1 antitrypsin genotype was determined by means of isoelectric-focusing.

Results. Eight severe alpha-1 antitrypsin deficiency genotypes in homozygous type (ZZ) and 40 in heterozygous genotype (-Z) were identified. Calculated sensitivity of quantitative alpha-1 antitrypsin measurement bynephelometry for heterozygous PI*Z allele is 45% and for homozygous ZZ genotype is 88%. Specificity of quantitative alpha-1 antitrypsin deficiency determining analysis is 99%.

Conclusions. A case detection program of alpha-1 antitrypsin deficiency in patients with chronic obstructive pulmonary diseaseusing quantitative methods is specific, but due to limited sensitivity should be used only in screening programs.

Keywords: Chronic obstructive pulmonary disease, alpha-1 antitrypsin, sensitivity

Efficiency of prognostic scores for the assessment of patients with severe influenza pneumonias

Dumitru Chesov, Doina Rusu, Oxana Munteanu, Victoria Brocovschii, Victor Botnaru Contact: Dumitru Chesov,
Universitatea de Stat de Medicina si Farmacie „Nicolae Testemitanu” Clinica Medicala nr. 2, Chisinau, Republica Moldova


Aim: To compare the efficiency of some prognostic scores in patients with severe influenza pneumonias.

Materials and Methods: The study was performed on a cohort of 75 cases of 2009 AH1N1 influenza associated pneumonias. Clinical and laboratory features at admission were used to calculate retrospectively the following prognostic scores: SCAP (Severe Community Acquired Pneumonia), CAP-PIRO (Community Acquired Pneumonia - Predisposition Infection Reaction, Organ failure), SMRT-CO (Systolic blood pressure, Multilobar infiltrates, Respiration rate, Tachycardia, Confusion, Oxygen), IDSA/ATS (Infectious Diseases Society of America/ American Thoracic Society). The scores were used to assess two different outcomes - death and need for invasive mechanical ventilation (IMV). The performance of the prognostic tools were assessed using the area under receiver operating characteristic (AUC), and the sensitivity and specificity for identifying high risk patients for severe course of pneumonia.

Results: IMV was applied in 29 (38.7%) of studied cases, in 15 (20%) the diseases had a fatal outcome. Despite the fact that all scores had a very good discriminatory power in predicting both outcomes (AUC > 0,8), some of them have a very low sensitivity, in classes corresponding to sever pneumonias, in predicting mortality (IDSA/ATS - 0%; 95%CI, 0-21.8%), as well as the need for IMV (IDSA/ATS - 0%; 95%CI, 0-11.9%); SCAP - 58.6% (95%CI, 38.9-76.5%); CAP-PIRO - 58,6% (95%CI, 38.9-76.5%).

Conclusions: The CAP-PIRO and SMRT-CO scores were found to have the best performances to predict death from influenza associated severe pneumonias and the last, also in predicting the need for IVM. Other analyzed scores underestimate the risk of occurrence of both assessed outcomes.

Keywords: pneumonia, 2009 AH1N1 influenza, prognostic scores