OBJECTIVE: Hepatocellular carcinoma (HCC) is a significant public health issue, with an increasing incidence and prevalence and a high incidence-to-mortality ratio. The prognosis of HCC depends on two competing factors, tumor burden and underlying liver disease severity, encompassed in the Barcelona Clinic Liver Cancer (BCLC) classification. To assess HCC staging and the way staging affects eligibility for treatment at the time of the first diagnosis in Romania in the setting of opportunistic diagnosis, in the absence of a national HCC screening policy.
METHODS: Data regarding HCC staging, underlying liver disease, and eligibility for treatment at the time of diagnosis was analyzed using a prospectively maintained multicentric database, which included patients from the five largest tertiary care hepatology units in the country between June 2016 and February 2020.
RESULTS: A consecutive series of 477 patients was included. The distribution within BCLC classes was as follows: very early (0) 7.1%, early (A) 34.3%, intermediate (B) 19.4%, advanced (C) 14.2%, terminal (D) 24.7%. At the time of the diagnosis, 198 (41.5%) were eligible for a curative intent treatment, while 359 (75.2%) were eligible for a disease-modifying therapy. 228 patients (47.8%) had decompensated liver disease at the time of diagnosis, the most common decompensating event being ascites (78.1%).
CONCLUSIONS: A large proportion of HCC cases are diagnosed at the time of a decompensating event, severely restricting the therapeutic potential. Proactive diagnostic strategies should be implemented to improve the rate of actionable diagnosis.

OBJECTIVE: Helicobacter pylori (H. pylori) infection has an unknown prevalence in certain Romanian regions. We aimed to estimate it in communities from Southern regions of Romania with limited access to health services.
METHODS: We designed a cross-sectional study to include adult voluntary participants in the \"Health in the neighborhood\" medical assistance program. This was offered in villages with deprived healthcare availability from Southern regions of Romania. An immunochromatographic assay for the qualitative detection of H. pylori stool antigen was used for testing.
RESULTS: We included 708 adult voluntary participants in 10 villages, 6 from Muntenia and Oltenia Regions (Southern Romania), 2 from Dobrogea and 2 from Moldova (2.4% of all village inhabitants). H. pylori prevalence in Romanian Southern regions was 28.2%, (95%CI: 24-32.6%), and overall was 27.1%, (95%CI: 23.9-30.6%). There were no significant differences of H. pylori infection pertaining to regions distribution (p=0.711), gender ratio (p=0.779), age distribution (p=0.471) and hemoglobin value (p=0.503).
CONCLUSIONS: H. pylori prevalence in communities from Southern regions of Romania with limited access to health services was 28.2%, 95%CI: 24-32.6%.

BACKGROUND: African swine fever (ASF) is a highly contagious and severe haemorrhagic disease of Suidae, with mortalities that approach 100 percent. Several studies suggested the potential implication of non-biting dipterans in the spread of ASFV in pig farms due to the identification of the ASFV DNA. However, to our knowledge, no study has evaluated the viral DNA load in non-biting dipterans collected in outbreak farms and no risk factors have been analysed. In this context, our study aimed to analyse the risk factors associated with the presence of non-biting dipterans collected from ASF outbreaks in relation to the presence and load of viral DNA.
METHODS: Backyard farms (BF), type A farms (TAF), and commercial farms (CF), were targeted for sampling in 2020. In 2021, no BF were sampled. Each farm was sampled only once. The identification of the collected flies to family, genus, or species level was performed based on morphological characteristics using specific keys and descriptions. Pools were made prior to DNA extraction. All extracted DNA was tested for the presence of the ASFV using a real-time PCR protocol. For this study, we considered every sample with a CT value of 40 as positive. The statistical analysis was performed using Epi Info 7 software (CDC, USA).
RESULTS: All collected non-biting flies belonged to five families: Calliphoridae, Sarcophagidae, Fanniidae, Drosophilidae, and Muscidae. Of the 361 pools, 201 were positive for the presence of ASFV DNA. The obtained CT values of the positive samples ranged from 21.54 to 39.63, with a median value of 33.59 and a mean value of 33.56. Significantly lower CT values (corresponding to higher viral DNA load) were obtained in Sarcophagidae, with a mean value of 32.56; a significantly higher number of positive pools were noticed in August, mean value = 33.12.
CONCLUSIONS: Our study brings compelling evidence of the presence of the most common synanthropic flies near domestic pig farms carrying ASFV DNA, highlighting the importance of strengthening the biosecurity measures and protocols for prevention of the insect life cycle and distribution.

OBJECTIVE: Smoking-free policies protect non-smokers from the negative effects of smoking, but many young adults still use products containing nicotine. The aim of this article is to analyze the factors that influence young people\'s attitudes towards the ban on smoking in public places.
METHODS: Data were obtained from a representative sample of young adults aged 13-15 from the Global Youth Tobacco Survey (GYTS) conducted in the Czech Republic, Lithuania, Romania, Slovakia and Slovenia. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS: At least a quarter of the adolescents were exposed to cigarette smoking, about 40% have parents who smoke and over 50% declared that they have peers who smoke. A higher proportion of adolescents have knowledge about the harmful effects of second-hand smoking (62.6-71.9%), but at least one-fifth of young people are still exposed to the marketing of tobacco products. Compared with current smoking, those with never smoked were significantly associated with positive attitude toward to restricting smoking in all five analyzed countries, with an AOR= 4.74 (95% CI: 3.61-6.23), AOR=4.33 (95% CI: 2.32-8.07), AOR=2.85 (95% CI: 2.19-3.70) and AOR=2.45 (95% CI: 1.65-3.64), respectively. Gender, age, smoking, exposure to second-hand smoke, knowledge about the harmful effects of smoking, anti-smoking education, seeing people using tobacco and exposure to tobacco marketing, were significantly associated with the attitudes of young people towards restricting smoking in public places.
CONCLUSIONS: The study provides useful information on factors that should be taken into account when planning anti-smoking strategies so that young people are able to resist the pressure to use tobacco products.

UNASSIGNED: This review reveals the role of linear economy prevalence and mismanagement practices in plastic pollution of aquatic and terrestrial environments and related knowledge gaps in Romania while outlining downstream and upstream solutions to reduce plastic pollution and adopt circular economy strategies. Thus, the major aim of this study is the investigation of the stage of scientific knowledge concerning all these demands in the Romanian context.
UNASSIGNED: This work integrates two main approaches: (i) a bibliometric analysis fed by Web of Science and Scopus databases to reveal the current coverage of peer-reviewed literature related to plastic waste in Romania and (ii) a subject-based review to underline the main themes related to plastic waste management, plastic pollution, and mitigating options in Romania in line with circular economy principles.
UNASSIGNED: Reducing plastic pollution requires scientific knowledge, multi-sectoral cooperation, and societal awareness. Following this, the topics of plastic waste and plastic pollution appeared to be under-investigated in the literature considering Romania as a case study and concentrated around the 2020 year, emphasizing, in this way, the trendiness of plastic waste concerns and their management in the current research landscape. Our analysis points out that: (i) Romania is facing massive plastic pollution requiring solid improvements in waste management performances; (ii) few peer-reviewed research studies are performed in Romania for both macro and microplastic concerns with unknown pollution levels in most of its geographical regions; (iii) the plastic waste management is still understudied here, while waste statistics are poorly available at local levels; (iv) the perspectives of circular economy transition are still limited, feeding the plastic pollution in the coming years.
UNASSIGNED: Several knowledge gaps are identified and must be covered by future research such as (i) adjusting mismanaged plastic waste levels to regional waste management performances and determining littering rates in urban and rural areas to improve the plastic pollution modeling inputs; (ii) examining plastic pollution associated with landfill sites and waste imports; (iii) assessing the sectoral contributions to macro and microplastic pollution of aquatic environments related to municipalities, tourist destinations, agriculture, etc.; (iv) determining retention levels of plastic in river basins and role of riparian vegetation; (v) analyzing microplastics presence in all types of freshwater environments and interlinkage between macroplastic fragmentation and microplastic; (vi) assessing the plastic loads of transboundary rivers related to mismanagement practices; (vii) determining concentrations of microplastics in air, soil, and other land use ecosystems.

BACKGROUND: Mental health literacy is a promising avenue of intervention for addressing the development of psychopathology, as well as its associated consequences, such as a decrease in academic performance. The current study aims to test the effectiveness of such an intervention in high school students, focusing on two main formats of delivery: (1) automated and (2) blended.
METHODS: To achieve this aim, a randomized clinical trial with direct comparisons at three time points between three conditions (automated, blended, and waitlist) was designed. Power analyses yielded a necessary sample size of 264 high school students. The participants will be selected from Romanian high schools.
CONCLUSIONS: The current study aims to contribute to the mental health literacy literature by testing the effectiveness of an educational intervention concerning mental health in terms of its benefits for reducing psychopathology and increasing academic performance. The success of such an intervention bears important implications for addressing mental health in the educational system.
BACKGROUND: Clinicaltrials.gov Identifier: NCT06217744, version 1, 22 January 2024.

Academic stress and transitioning to young adulthood can lead medical students to develop inadequate eating habits, affecting both their physical and mental well-being and potentially compromising their ability to offer effective preventive counseling to future patients. The primary objective of this study is to analyze the levels of mindful eating and nutrition knowledge in Romanian medical students and their associations with various sociodemographic variables. Additionally, we explore the relationship between mindful eating and nutrition knowledge while accounting for sociodemographic factors and examine the impact of these factors on excess weight. Significant predictors of excess weight include high weight gain in the past year (OR = 15.8), the mindful eating questionnaire (MEQ) score (OR = 0.131), male gender (OR = 2.5), and being in the clinical years of medical school (OR = 2.2). While nutrition knowledge levels do not directly impact weight status, they share a 4% common variance with mindfulness in multivariate analysis. Notably, high weight gain is independent of the levels of mindful eating, but univariate testing links it to disinhibition and emotional response, components of mindfulness. Mindful eating stands out as independently associated with both nutrition knowledge and excess weight among medical students. Thus, interventions to address obesity should consider incorporating mindfulness training to enhance food intake awareness and improve weight management outcomes in Romanian medical students.

We conducted an epidemiological non-interventional cross-sectional and case-control study from 1 January 2023 until 26 May 2023 in Oltenia region, southwestern Romania. Throughout the research, 160 consecutive patients were included from two different clinical departments (1-Pneumology; 2-Diabetes and Nutritional Diseases). Subjects were voluntary adult individuals of any gender who expressed their written consent. The clinical data of the patients were correlated with the exposure to behavioral risk factors (diet, lifestyle, exposure to pollutants) to identify some negative implications that could be corrected to improve the quality of life of patients with simple chronic obstructive airway diseases of the lung or associated with metabolic syndrome (MS). In the first group of patients with respiratory diseases, there was a higher degree of exposure to toxic substances (43.75%) compared to the second group of patients with diabetes (18.75%); it is also noticeable that in the first group, there were noticeably fewer individuals who have never smoked (25%) compared to the second group (50%). Respiratory function impairment was observed to be more severe in overweight individuals. In the group of patients with known lung diseases, a positive correlation was noted between the presence of MS and respiratory dysfunctions of greater severity. Additionally, potential exacerbating factors affecting lung function, such as direct exposure to toxins and smoking, were considered. Potential secondary factors exacerbating respiratory dysfunction were considered by correlating biochemical parameters with dietary habits. These included reduced consumption of vegetables, inadequate hydration, and increased intake of sweets and products high in saturated or trans fats (commonly found in junk food), primarily due to their potential contribution to excess weight. Compared to patients without MS, the severity of the pulmonary function impairment correlated with the number of criteria met for MS and, independently, with an increase in weight.

Background and Objectives: Recurrent implantation failure (RIF) affects 10% of couples undergoing in vitro fertilization (IVF), spurring exploration into tailored treatments to enhance implantation rates. Maternal immune tolerance towards embryos, particularly killer-cell immunoglobulin-like receptors (KIRs) on natural killer (NK) cells, is a focal point in RIF research. Materials and Methods: This retrospective cohort study, conducted at fertility clinic in Oradea, Romania, involved 65 infertile couples undergoing IVF treatment between January 2022 and December 2023. Couples were divided into two groups: KIR AA (Group A) and KIR Bx (Group B). Results: Factors such as age, type of infertility, oocytes retrieved, embryos produced, pregnancy rates in Group A without and with immunomodulatory treatment were documented. Group A, receiving immunomodulatory treatment, achieved a pregnancy rate of 47.8%, significantly higher than the 23.73% rate without treatment (p = 0.008). Group B had a higher mean patient age than Group A. However, miscarriage rates did not significantly differ between Group A with treatment and Group B (p = 0.2457), suggesting comparable outcomes with immunomodulation. Conclusions: The impact of immunological factors on recurrent implantation failure is being more and more emphasized and warrants the attention of specialists in human reproduction. Uterine natural killers and their function though KIR receptors deserve particular attention as immunomodulatory treatment may improve pregnancy rates in patients with KIR AA haplotype.

Background and Objectives: Adult T-cell leukemia/lymphoma (ATLL) is a highly aggressive T-cell lymphoproliferative disease associated with the human T-cell lymphotropic virus type I (HTLV-1). ATLL is a rare disease, found more frequently in HTLV-1-endemic areas, Romania being one of them. Despite treatment advances, the prognosis remains dismal. We aimed to describe the clinical, biological, and survival outcome features of Romanian patients with aggressive-type ATLL. Materials and Methods: We report the data of a prospective, observational, and unicentric study of all 20 patients diagnosed with lymphoma and acute types of ATLL at our center over the past 12 years. Data were collected from the patients\' medical records. Results: Lymphoma-type ATLL (60%) was more common than acute-type ATLL (40%). Median age at diagnosis was 40.5 years, and most patients were female. Laboratory data revealed significant differences between acute and lymphoma-type ATLL, namely, higher leukocyte (p = 0.02) and lymphocyte counts (p = 0.02) and higher levels of corrected calcium (p = 0.001) in acute-type ATLL. All patients received chemotherapy, and only two underwent allogeneic stem cell transplantation. Only six patients obtained a complete or partial response to chemotherapy, mostly the lymphoma-type ones. The median survival for all patients was 6.37 months, with higher survival in the lymphoma-type ATLL (8.16 months) than in the acute-type (3.60 months). Normal calcium levels (p = 0.011), uric acid (p = 0.005), BUN score (p = 0.000), JCOG-PI moderate risk (p = 0.038), and obtaining complete or partial response (p = 0.037) were associated with higher survival. Conclusion: Aggressive-type ATLL among Romanian patients presents distinct characteristics, including younger age at diagnosis, female predominance, and higher incidence of lymphoma-type ATLL compared to currently reported data. Survival remains very low, with all subtypes experiencing a median survival of less than one year.