Occupational chronic obstructive pulmonary disease (oCOPD) represents 15–20% of the global burden of this disease. Even if industrial bronchitis has long been known, new occupational hazards continue to emerge and enlarge the number of people exposed to risk. This review discusses the challenges related to the early detection of oCOPD, in the context of new exposures and of limited usage of methods for an efficient disease occupational screening. It underlines that a better translation into clinical practice of the new methods for lung function impairment measurements, imaging techniques, or the use of serum or exhaled breath inflammation biomarkers could add significant value in the early detection of oCOPD. Such an approach would increase the chance to stop exposure at an earlier moment and to prevent or at least slow down the further deterioration of the lung function as a result of exposure to occupational (inhaled) hazards.

Background and Objectives: Chronic obstructive pulmonary disease (COPD) represents a debilitating disease, with rising morbidity and mortality. Vascular endothelial growth factor (VEGF) plays a major role in angiogenesis, vascular permeability, and airway remodeling. The purpose of this study was to investigate the relationship between VEGF serum levels and VEGF +936 C/T gene polymorphism (rs3025039) with COPD, for the first time in a Romanian population. Materials and Methods: In total, 120 participants from Transylvania were included in this case-control study. Serum levels of VEGF were determined using an enzyme-linked immune-sorbent assay and rs3025039 was investigated by high molecular weight genomic deoxyribonucleic acid (DNA). Spirometric values, arterial blood gas analysis, and the Six Minute Walk Test (6MWT) outcome were also determined. Results: The serum level of VEGF was higher in the COPD group versus controls (p < 0.001), with a positive correlation with the 6MWT outcome. No significant difference was observed in the VEGF serum levels between VEGF +936C/T genotypes. There was no difference in the VEGF +936C/T genotype between COPD patients and healthy subjects (chi2 test p = 0.92, OR = 1.04, 95%CI = 0.41–2.62), but the presence of the T allele was significantly linked to the presence of COPD (chi2 test p = 0.02, OR = 2.36, 95%CI = 1.12–4.97). Conclusions: Higher VEGF serum levels were found in moderate and severe COPD and were positively correlated with the distance in the 6MWT. No significant difference was found between CC, CT, and TT genotypes of rs3025039 and the presence of COPD. The presence of the T allele was found to be linked to COPD and also to the degree of airway obstruction.

Background and Objectives: The role of adenosine deaminase (ADA) in pulmonary tuberculosis (PTB) remains insufficiently defined in advanced forms of disease. Likewise, the systemic immune inflammatory index (SII) has not been validated in severe PTB. This 6-year prospective observational study aims to evaluate biomarker signatures of serum ADA and SII. Materials and Methods: According to the PTB case definition, 232 adult patients were divided into group 1, with a positive bacteriologic exam (n = 168), and group 2, without bacteriological confirmation (n = 64). ADA serum levels were compared by age, gender, nutritional status, morphologic and bacteriological pattern of PTB lesions, survival status, along with serum levels of other inflammatory biomarkers. All patients with comorbidities, interfering with the level of ADA, were excluded to avoid bias. Results: A total cohort of 208 PTB adults, aged 54.37 ± 14.365 years, included 156 males. The overall mortality was 11.53%. Death occurred after a mean interval of 1.63 ± 3.228 months after PTB diagnosis. ADA serum mean levels were 32.94 ± 9.146 IU/L, significantly higher in G1 (p = 0.002), in patients with delayed diagnosis of PTB (p = 0.000), with lung cavitation (p = 0.003), and death as a poor outcome (p ˂ 0.02). SII had a mean value of 1752.226 ± 2704.150, significantly increased in bacteriologically confirmed PTB cases (p = 0.018), delayed diagnosis (p = 0.002), cavitary advanced pulmonary tuberculosis (APT) (p = 0.002), and deceased (p = 0.003). Both an ADA cut-off elevated risk value of over 30 IU/L and SII of over 902 were fulfilled by 73 patients, with 2.10 higher risk of advanced PTB (p = 0.006) and 4.49 higher risk of mortality (p = 0.000). Conclusions: Serum ADA and SII are recommended as predictors of advanced and severe pulmonary TB. These findings indicate that ADA and SII, when elevated together, delineate a high-risk PTB phenotype with greater disease severity and early mortality. The combination offers a pragmatic, biomarker-based approach to risk stratification in PTB.

Background: Since October 2013, molecular testing for Mycobacterium tuberculosis (MTB) detection has been available in the Microbiological Laboratory of Constanta Clinical Pulmonology Hospital, Romania. Aim: To assess the accessibility of patients to rapid molecular diagnosis of multidrugresistant (MDR) tuberculosis (TB) in a TB burden area of Romania, with increased TB morbidity in 2013 (91.5%000 inhabitants). Material and Methods: A prevalence study was performed among 1,148 TB patients hospitalized in Constanta Clinical Pulmonology Hospital, from January 2014 to December 2017, and all collected positive specimen of sputum were analyzed. Two commercial genetic tests (GeneXpert MTB/RIF and GenoType MTB-Drplus) were used for detecting resistant strains of MTB. Final diagnosis of MDR-TB was established by conventional phenotypic liquid and solid culture and drug sensitivity testing. Rifampicin (RIF, R) Resistance (RR), detected by GeneXpert MTB /RIF, is strongly associated with isoniazid (INH, H) resistance (85%). Line Probe Assay (LPA) MTB-DRplus by Hain method can detect both mutations in rpoB and katG genes, responsible for HR resistance. Results: 28 inpatients, mean aged 46.35 years old (limits from 25 to 83 years), were diagnosed with MDR-TB by phenotypic methods. The accessibility to GeneXpert testing was 53.57% (n= 15/28). MDR-TB was revealed in all 14 cases investigated by LPA, with KatG MUT profile detected in 85.71%. Conclusions: Until December 2017, almost of half of hospitalized MDR-TB cases had moderate accessibility to a molecular method of rapid diagnosis. LPA had a very good yielding of early detecting MTB strains with concomitant INH and RIF resistance.

After 143 years from the discovery of Koch bacillus, the natural history of tuberculosis (TB) is characterized by heterogeneity and gaps of staging defining. The aim of the study consists in assessing the prevalence and characteristics of TB stages, from infection to disease, from acute to chronic disease, among inpatients of Constanta Clinical Pneumophthisiology Hospital. A cross sectional 8-year study, performed, from January 2017 to March 2025, among 630 inpatients, mean aged 58.23 years+/-13.812 std dev, mostly men (n=436; 69.2%) and smokers (n=414; 65.71%), enrolled with a positive diagnosis of TB infection (75 cases, based on positive QuantiFERON TB Gold Plus, 4% progressive forms), or disease (424 infectious, 410 new cases and 178 relapses, 35 multi drug resistant, 17 with mono or poly drug resistance). Subclinical TB was significantly more infectiousness than clinical forms (p=0.000). Active TB disease is characterized by delayed diagnosis (58.57%) and advanced extensive cavitary lesions (73.17%). Post treated lung TB disease (PTLD) occurred in 74.91% of cases, after a mean interval of almost 17 years (205.68 months+/-214.00 std dev), calculating from the first episode of treated TB disease. TB mortality rate was 16.66%o. In conclusion, landscaping tuberculosis′ new stages is very complex and challenging. TB infection and subclinical TB are intricated through progressive forms of infection. PTLD must be considered a part of the basic triangle of TB spectrum, standing near infection and active disease, states in a continuous dynamic relation, overlapping through reinfections and relapses, causing PTLD and death.

The discovery of anti- tuberculosis (TB) drugs, in the middle of last century, did not resolve the goal of a better healing, and the most important cause is represented by delayed diagnosis of TB disease. We conducted a single-center case control study, from January, 1st, 2017 to December, 31st, 2024, including 400 adult symptomatic inpatients diagnosed with post TB lung disease (PTLD), after a previous episode of treated TB disease. There were excluded 168 patients without pulmonary function testing (PFT), those with significant occupational exposure, and/or diseases autoimmune, COVID-19 or HIV infection, which might interfere lung function assessment. All demographics, behavioral and baseline PTB characteristics (relapses, clinical, imagistic, endoscopic, microbiologic, PFT, evolution) were assessed in order to inventorying sequelae and lung damage, types of lung function impairment. Eligible patients (n=232), mean aged 60.94+/-11.895 years, males (55.17%), were divided into 129 cases with previous bacteriologically confirmed PTB (mean age 58.37+/-11.86 years; 55.81% males) and 103 controls with previous clinically diagnosed PTB (mean age 60.04+/-11.222; 54.37% males). Delayed diagnosis and relapses of PTB had greater impact on PTLD development in cases (p=0.000), as well as previous cavitary PTB (p=0.000). The risk of death, during hospitalization, was greater in cases (p=0.000). Spectrum of PTLD, in cases, was dominated by bronchiectasis (p=0.000), suppurative episodes (p=0.004), open healing cavitation (p=0.000), intracavitary aspergilloma (p=0.002), fibrothorax (p=0.000), lung function impairment (p=0.030). In conclusion, PTLD severity is related to delayed diagnosis of previous contagious PTB, permanent lung damage, impairment of lung function, having a higher risk of death.