The genus Troglostrongylus includes nematodes infecting domestic and wild felids. Troglostrongylus brevior was described six decades ago in Palestine and subsequently reported in some European countries (Italy, Spain, Greece, Bulgaria, and Bosnia and Herzegovina). As the diagnosis by the first-stage larvae (L1) may be challenging, there is a possibility of confusion with Aelurostrongylus abstrusus. Hence, the knowledge on the distribution of this neglected feline parasite is still scarce. The present paper reports the first case of T. brevior infection in Romania. In July 2017, a road-killed juvenile male Felis silvestris, was found in in Covasna County, Romania. A full necropsy was performed and the nematodes were collected from the trachea and bronchioles. Parasites were sexed and identified to species level, based on morphometrical features. A classical Baermann method was performed on the lungs and the faeces to collect the metastrongyloid larvae. Genomic DNA was extracted from an adult female nematode. Molecular identification was accomplished with a PCR assay targeting the ITS2 of the rRNA gene.

Parkinson's disease (PD) is a significant cause of disability, with a fast-growing prevalence. This review summarizes the epidemiological and clinical data, research on the diagnostic approaches and the interventions available in the Eastern European country of Romania. This scoping review follows the recommendations on the scoping review methodology by Joanna Briggs Institute. We searched four databases (up to 27 January 2021). The data of eligible studies were extracted in standardized forms. We identified 149 unique studies from 1133 records, with 11 epidemiological studies, 52 studies investigating clinical aspects of PD, 35 studies on diagnostic tools, and 51 intervention studies. A narrative synthesis is provided and placed in a historical context. Our review revealed a considerable increase in the Romanian research on PD in the latest 15 years, which largely follows international trends. However, we also identified several research gaps that provide useful information for policymakers, public health specialists, and clinicians.

Toxoplasmosis is a widespread zoonosis caused by the intracellular protozoan parasite Toxoplasma gondii. Limited epidemiological information is available about the prevalence of T. gondii in sheep in Romania, and a high incidence would have implications for both the economy and public health. To our knowledge, no studies are available about the T. gondii strains circulating in lambs. The objective of this study was to assess the prevalence of T. gondii in sheep (serology), lambs (serology, bioassay, PCR) and sheep abortions (PCR) in Romania. Moreover, the study aimed to perform the genetic characterization of T. gondii isolates from lambs.

Endometrial cancer represents the most frequent gynecological malignant affection in the developed countries, in which the incidence of cervical cancer has significantly decreased due to the rigorous application of screening methods and prophylaxis. According to its frequency, endometrial cancer is situated on the fourth place in the category of women's genital-mammary malignant diseases, after breast, cervical and ovarian cancer in Romania. The incidence and mortality rates due to endometrial cancer have registered an increasing trend worldwide and also in Romania, a significant decrease of the age of appearance for the entire endometrial pathology sphere being noticed. At the national level, the maximum incidence is situated between 60 and 64 years old, the mortality rate of the women under 65 years old being high in Romania. The study evaluates endometrial cancer, from an epidemiologic point of view, at the national level compared to the international statistic data.

Small mammals play an important role in the life-cycle of ticks and are reservoirs for several zoonotic pathogens. The aim of this study was to provide epidemiological data regarding the presence of Borrelia spp. in tissues of small mammals from Romania.

Background and objectives: Health systems all over the world are confronted with an alarming rise of cases in which individuals hesitate, delay, and even refuse vaccination, despite availability of quality vaccine services. In order to mitigate and combat this phenomenon, which are now defined by the World Health Organization (WHO) as vaccine hesitancy (VH), we must first understand the factors that lead to its occurrence in an era characterized by wide access to safe and effective vaccines. To achieve this, we conducted field testing of the Vaccine Hesitancy Scale (VHS), as it was developed by the Strategic Advisory Group of Experts Working Group (SAGE WG), in Cluj-Napoca city, Cluj County, Romania. The scale is designed to quantify VH prevalence in a population, establish which vaccines generate the highest percentage of hesitancy, and allow a qualitative assessment of the individual's reasons for hesitance. Materials and Methods: We conducted an observational cross-sectional survey, which was comprised of descriptive, analytical, and qualitative elements regarding VH. The necessary sample size was 452 individuals. The VHS and Matrix of Determinants (recommended by SAGE WG) for reasons people gave to justify their hesitance, was interpreted by qualitative thematic analysis (QTA) to ensure the validity and reliability in detecting hesitancy across various cultural settings and permit global comparisons. Results: We found a VH of 30.3% and 11.7% of parents reported refusing to vaccinate their child. Among the VH responders, the varicella vaccine generated 35% hesitancy, measles vaccine 27.7%, Human Papillomavirus (HPV) 24.1%, and mumps vaccine 23.4%, respectively. The QTA values for percent agreement ranged from 91% to 100%. Cohen's Kappa values ranged from 0.45 to 0.95. Contextual influences identified for VH were "media," "leaders and lobbies," and "perception of the pharmaceutical industry." Individual and group influences for VH were "beliefs," "knowledge," and "risk/benefits (perceived)." Vaccine and vaccination specific issues for VH were "risk/benefit (rational)" and "health care practitioners (trustworthiness, competence)." Conclusions: One-third of the investigated population had expressed VH, and a further one-third of these had refused a vaccine for their child. Chicken Pox, Measles, Mumps, Rubella (MMR), and HPV vaccines generated the most hesitation. Negative information from the media was the most frequently evoked reason for VH.

Parkinson's disease (PD) is a significant cause of disability, with a fast-growing prevalence. This review will summarize the epidemiological and clinical data in Romania and the interventions and diagnostic approaches used in this Eastern European country. This scoping review will primarily follow the recommendations on the scoping review methodology made by the Joanna Briggs Institute. In order to answer our research questions, we will search four databases using appropriate search terms. We will use pre-defined inclusion criteria and the data of eligible studies will be extracted in a standardized form. Results will be reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The proposed scoping review will map the evidence on PD in Romania through a literature review, focusing on epidemiology, clinical characteristics, interventions, and diagnosis, contributing to PD research advancement. We will provide information for policy-makers, public health specialists, and clinicians.

Apicomplexan haemoparasites are protozoans that infect a variety of domestic and wild animal species, as well as humans. Data regarding haemoprotozoans in domestic cats are limited; therefore, the aim of this study was to assess the occurrence of Babesia spp., Cytauxzoon spp., and Hepatozoon spp. in domestic cats in Romania using molecular tools.

We aimed to develop an EQ-5D-5L value set for Romania.

Transylvania is a historical region in the northwestern part of Romanian with a rather heterogeneous population. Our study is the first to determine human leukocyte antigen (HLA) profiles in a large population sample from this region and to compare them with other European population groups. HLA genes were examined in 2,794 individuals using the Single Specific Primer-Polymerase Chain Reaction (SSP-PCR) and Polymerase Chain Reaction Sequence-Specific Oligonucleotide (PCR-SSO) methods. All samples were tested for the HLA-A locus, 2,773 for HLA-B, 1,847 for HLA-C, and 2,719 for HLA-DRB1 loci. HLA gene frequency data from several European population groups (as presented in studies involving more than 1,000 individuals) served as reference in comparison with the local sample. The distribution of HLA genes in the studied population group was heterogeneous, as the Hardy-Weinberg equilibrium was statistically significant (P value < 0.01). The most common genes found in our sample group were A∗02 (0.27%), B∗35 (0.14%), C∗07 (0.25%), and DRB1∗11 (0.19%). The most common haplotype was A∗01~B∗08~C∗07~DRB1∗03 (1.26% in 1,770 individuals with complete data). This analysis confirmed the known heterogeneity of the Transylvanian population. The study indicates that the European population groups located in close vicinity (those from Serbia, Hungary, Wallachia, and Croatia) are genetically closest to the Transylvanian population.

Hypodermosis, or warble fly, is an endemic parasitic disease, common in countries from the northern hemisphere. The use of effective insecticides has decreased the frequency of this parasitic disease, with untreated cattle remaining to act as reservoirs. This study focused on assessing the status of hypodermosis in northwestern Romania by means of clinical examination (skin inspection and palpation performed in order to identify nodules) conducted on a number of 11.741 cattle. The study was carried out from March until June 2021. The identified larvae were subject to molecular assays for species identification and genotyping, followed by comparison with data available in the GenBank database. The average prevalence rate of parasitism caused by Hypoderma spp. was 0.31%, with values ranging from a minimum of 0.11% to a maximum of 1.32%. The dominant age group among positive animals was the 1-3 years old category and in terms of breed distribution, most positive cases were seen in cows belonging to an indigenous breed: Bruna de Maramures. April was the most prolific month in terms of nodule count/animal. The species identified in our study by means of molecular assays was H. bovis with two haplotypes: HB3 and HB8.

Tick-borne diseases are of substantial concern worldwide for animals as well as humans. Dogs have been a human companion for millennia, and their significant impact on human life renders disease in dogs to be of great concern. Tick-borne diseases in dogs represent a substantial diagnostic challenge for veterinarians in that clinical signs are often diffuse and overlapping. In addition, co-infections with two or more pathogens enhance this problem further. Molecular methods are useful to disentangle co-infections and to accurately describe prevalence and geographical distribution of tick-borne diseases. At this point, this information is lacking in many areas worldwide. Romania is one such area, where prevalence and distribution of several important pathogens need to be further investigated. To address this, we screened blood samples from 96 sick dogs with molecular methods for eight different pathogens including Babesia spp., Theileria spp., Hepatozoon spp., Anaplasma spp., Ehrlichia spp., "Candidatus Neoehrlichia mikurensis", Mycoplasma spp., and Borrelia spp.

Approximately every two hours, a Romanian woman is diagnosed with cervical cancer as the country ranks first in the EU in terms of its mortality rate. This paper aims to identify the main reasons that have led to this situation. First, a study based on secondary data was conducted in order to identify measures taken by the Romanian Ministry of Health for the prevention of this type of cancer. Second, a quantitative study was conducted to evaluate the impact that exposure to information and awareness campaigns has on women's behavior regarding cervical cancer prevention through screening. The results of the research show an increased percentage of the women understanding the importance of screening and the benefits of early diagnosis, but also shows that a high percentage of women postpone the routine checks due to lack of time and financial resources. The research results also indicate that the only free screening program implemented in Romania during 2012-2017 was a failure due to poor procedures, low number of women tested, underfunding and the lack of promotion. Our conclusion is that the Romanian Ministry of Health has to take immediate action by conducting major awareness campaigns and also by implementing functional screening programs.

Screening of 1,000-years old ice layers from the perennial ice block of Scărișoara Ice Cave (NW Romania) revealed the presence of fungal communities. Using culture-dependent methods and molecular techniques based on DGGE fingerprinting of 18S rRNA gene fragments and sequencing, we identified 50 cultured and 14 uncultured fungi in presently-forming, 400 and 900 years old ice layers, corresponding to 28 distinct operational taxonomic units (OTUs). The dominant ice-contained fungal OTUs were related to Ascomycota, Basidiomycota and Cryptomycota phyla. Representatives of Mucoromycota and Chytridiomycota were also isolated from recent and 400 years old ice samples. The cryophilic Mrakia stokesii was the most abundant fungal species found in the cave ice samples of all prospected ages, alongside other cryophilic fungi also identified in various glacial environments. Ice deposits formed during the Little Ice Age (dated between AD 1,250 and 1,850) appeared to have a higher fungal diversity than the ice layer formed during the Medieval Warm Period (prior to AD 1,250). A more complex fungal community adapted to low temperatures was obtained from all analyzed ice layers when cultivated at 4 °C as compared to 15 °C, suggesting the dominance of cold-adapted fungi in this glacial habitat. The fungal distribution in the analyzed cave ice layers revealed the presence of unique OTUs in different aged-formed ice deposits, as a first hint for putative further identification of fungal biomarkers for climate variations in this icy habitat. This is the first report on fungi from a rock-hosted cave ice block.

Romanian national level stroke mortality data is relatively scarce. The current study investigated stroke mortality rates and trends in Romania.

The aim of this study was to focus attention on episiotomy practice in Romanian maternity units in order to identify factors associated with the very high rate of the procedure in Romania and to consider strategies to reduce it.

The honey bee (Apis mellifera) is an ecologically and economically important species that provides pollination services to natural and agricultural systems. The biodiversity of the honey bee is being endangered by the mass import of non-native queens. In many locations, it is not clear how the local populations have been affected by hybridisation between native and non-native bees. There is especially little information about temporal changes in hybridisation. In Romania, A. m. carpatica naturally occurs, and earlier studies show that there are two subpopulations separated by the Carpathian Mountains. In this study, we investigated how the arrangement of veins in bees' wings (venation) has changed in Romanian honey bees in the last four decades. We found that in the contemporary population of Romanian bees, there are still clear differences between the intra- and extra-Carpathian subpopulations, which indicates that natural variation among honey bees is still being preserved. We also found significant differences between bees collected before and after 2000. The observed temporal changes in wing venation are most likely caused by hybridisation between native bees and non-native bees sporadically introduced by beekeepers. In order to facilitate conservation and the monitoring of native Romanian bees, we developed a method facilitating their identification.

Trichinellosis is a public health problem and an economic issue in porcine animal production and food safety. The aim of this retrospective study was to evaluate the current epidemiologic, laboratory, clinical and therapeutic aspects of human trichinellosis in Western Romania. We retrospectively investigated the medical records of patients hospitalized in infectious diseases hospitals from three counties in Western Romania, between January 1st, 2012 and December 31st, 2016. A total of 83 patients diagnosed with trichinellosis were included in the study. Pork meat was the food source of infection in 76 (91.6%) patients and wild boar meat in 4 (4.8%). Patients were aged between 2 and 78 years; 48 (57.8%) were males and 27 (32.5%) came from an urban area. The most frequent symptoms included myalgia in 66 (79.5%) patients, fever in 55 (66.3%), eyelid edema in 40 (48.2%) and asthenia in 35 (42.2%). Two patients died and the others had favorable outcome. Although the number of reported cases has decreased in the past years, trichinellosis remains an important public health problem in Western Romania. Educational programs for both swine breeders and consumers are imperative, and implementation of strict hygienic measures aimed to control infection transmission are strongly recommended.

Introduction: Stroke is the second leading cause of death worldwide and Romania is no exception. There is a high economic burden associated with the treatment of stroke patients, which puts pressure on the healthcare budget. This study aims to measure the inpatient treatment costs of stroke patients in Romania. Methods: Our retrospective analysis follows stroke patients in six Romanian hospitals at different progressivity level from different regions. Patients are identified from the official hospital databases, reported for reimbursement purposes. Mean inpatient costs incurred with the treatment of these stroke patient episodes are calculated using the gross costing method. The cost data are derived from the management control system of the study hospitals. Results: 3,155 patient episodes of stroke were identified in the study hospitals. The average cost per stroke inpatient care episode sums up to EUR 995.57 (95% CI: EUR 963.74-EUR 1 027.39) in 2017, while the overall yearly healthcare burden adds up to EUR 140 million, representing 2.18% of the total national health insurance budget and a cost of EUR 7.15 per capita. Conclusion: The hospital cost of stroke inpatient care episode in Romania is high and it represents a sizable part of the healthcare budget, but it is among the lowest in Europe, which can mainly be explained by the level of economic development of the country. As both the number of patients and the cost of acute care are expected to increase in the future, the economic burden of stroke is also expected to increase.

Midface fractures are common injuries that are the result of interpersonal violence, traffic accidents, falls, work-related accidents, sports-related accidents, or animal aggression. In the northeastern part of Romania, these injuries are a significant health concern that, if left untreated, may lead to functional and esthetic sequelae. Background and Objectives: This study aims to update the statistical data available to help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence. Materials and Methods: This research was conducted over five years and included 651 patients of both sexes, with ages between 3 and 95 years, that addressed our center for midface fracture treatment. Results: The authors of this study found that men are more predisposed to fractures of the middle third of the face, with anterior laterofacial fractures being the most common type of fracture. Interpersonal violence was the most incriminated etiology for all midface fractures. Conclusions: The present study regarding midfacial fractures shows similar results compared to the medical literature. These findings could help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence.