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.

Introduction: Tuberculosis (TB) remains a global health challenge, requiring enhanced active case finding (ACF) through screening strategies. This study assesses the effectiveness of such an approach in locating TB cases among vulnerable groups, such as homeless persons, injecting drug users, those detained in prison, and people living in rural areas. Methods: The study focuses on socio-economic characteristics and TB detection rates across Romanian counties using modern techniques including computer-aided detection of lesions on chest X-ray and GeneXpert tests. Results: The results highlight the disproportionate burden of TB in vulnerable groups, by revealing significant differences in TB detection rates between regions. Notably, the TB detection rates among these vulnerable groups (250.85 per 100,000 population) are five times higher than the national incidence rate (46.1). Discussion: These findings underscore the imperative integration of ACF into National TB Program to provide customized and efficient solutions for diverse vulnerable groups, thereby informing crucial public health initiatives and interventions.

The study proposes a dynamic spatio‐temporal profile of the distribution of tuberculosis incidence and air pollution in Romania, where this infectious disease induces more than 8,000 new cases annually. The descriptive analysis for the years 2012–2021 assumes an identification of the structuring patterns of mycobacterium tuberculosis risk in the Romanian population, according to gender and age, exploiting spatial modeling techniques of time series data. Through spatial autocorrelation, the degree of similarity between the analyzed territorial systems was highlighted and the relationships that are built between the analysis units in spatial proximity were investigated. By modeling the geographical distribution of tuberculosis, the spatial correlation with particulate matter (PM_2.5) pollution was revealed. The identification of clusters of infected persons is an indispensable step in the construction of efficient tuberculosis management systems. The results highlight the link between the distribution of tuberculosis, air pollution and socio‐economic development, which requires a detailed analysis of the epidemiological data obtained in the national tuberculosis surveillance and control program from the perspective of geographical distribution.

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.

Background: Central nervous system (CNS) tuberculosis (TB) accounts for 1% of all cases of TB and is a major cause of mortality and morbidity. Cerebral tuberculomas represent 30% of CNS TB and is a diagnostic challenge. Case presentation: A 42-year-old male patient, known with alcoholic cirrhosis, performs a cerebral computer tomography (CT) after a lipothymic episode accompanied by right hemiparesis, which showed multiple parenchymal ring-lesions (inflammatory-infectious substrate/secondary tumours). Subsequently, the thoracic-abdominal-pelvic-CT-scan reveals micronodular diffuse pulmonary infiltrate and right pleural effusion. Cerebral Magnetic resonance imaging (MRI) describes bilateral infra/supratentorial lesions, raising the suspicion of tuberculomas. HIV serology was negative, cerebrospinal fluid showed no pleocytosis, but high protein level, pleural lymphocytosis in the pleural effusion and positive GeneXpert test in bronchial aspirate. The diagnosis of military TB with cerebral tuberculomas was established. The outcome was favourable under antituberculous treatment initially associated with corticosteroids. At two months the patient had a significant improvement in pulmonary lesions, but while some cerebral lesions decreased in size other lesions increased (paradoxical reaction). At the 14-month end-of-treatment re-evaluation there was an important regression in number and size of the brain lesions. Conclusions: The diagnosis of cerebral tuberculoma remains a challenge for the clinician due to non-specific clinical and radiological findings. The survival rate is over 80% with early diagnosis and correct treatment.

Background: Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) patients are likely to suffer from TB-related morbidity, social and economic consequences during and beyond anti-TB treatment. The aim of this study is to describe clinical and socio-economic outcomes of TB patients in Bucharest, Romania. Methods: We have established a prospective cohort of patients with MDR/XDR TB followed for more than 2 years from TB diagnosis. We have collected TB-related, laboratory and clinical data, including chest X-ray, lung function measured by spirometry, St. George's Respiratory Questionnaire (SGRQ), and socio-economic information. Results: From 50 enrolled participants, 31 remained in the study till month 6. 71% were male with mean age 46.7 (SD 15.4). 41.9% had a previous TB infection and median BMI of 20.3 kg/m2. Baseline CXR showed that on average 47.3% of the lung was affected, with 32.7% at month 6. The majority (71%) of participants had lung impairment at baseline, which remained stable till month 6. The total SGRQ score improved between baseline and month 6 (30 vs 22.8), but remained significantly worse compared to healthy individuals. 52% of participants stated that TB affected their social or private life as well as their household financially at treatment start. Conclusions: From the start of anti-TB treatment patients are suffering from lung impairment and experiencing socio-economic impact of TB. This cohort demonstrates a slow and slight longitudinal improvement of these outcomes and brings awareness to the need of employing social and rehabilitation programs to target TB impact. Key messages: • MDR/XDR TB patients suffer from a significant morbidity and socio-economic burden in Romania. • Targeted measures are needed to address this burden during and after TB treatment.