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Introduction: Adherence to direct-acting antivirals (DAAs) could be a predictor of chronic viral hepatitis C (HCV) therapeutic failure. We examined the perceptions of patients receiving DAAs to determine how cognitive factors influence their decision to maintain adherence. Also, we explored the threshold of DAAs adherence for obtaining sustained virologic response (SVR) among patients with HCV, in order to better implement a strategy that improves the DAAs adherence in the future clinical practice. Methods: A single-arm prospective study was performed. Patients with HCV that started and completed DAAs treatment in the County Hospital of Craiova, Dolj, Romania, were enrolled. Patients' medication adherence was assessed using the HCV-AD10 questionnaire, and the cognitive emotion regulation was measured with CERQ questionnaire (five positive/adaptive cognitive emotion-regulation domains and four negative/maladaptive domains). Spearman correlation analysis was conducted to explore the relationships between adherence and different factors. ROC-curves were used to evaluate the adherence threshold to achieve SVR. A linear regression model was performed to analyze the primary outcome (DAAs adherence) to be the target variable based on given independent variables (age, treatment duration, severity of HCV, the nine adaptive and maladaptive strategies). Results: 368 patients (mean age: 61 years) with HCV diagnosed 4.05 ± 6.38 (average) years ago were enrolled. Mean (±SD) adherence via HCV-AD10 was 91.51 ± 8.34, and the proportion of the participants achieving SVR was 96%. Patients with an adherence less than 84% (5 patients, 1.36%) was considered nonadherent and they have a high probability of not achieving response (sensitivity and specificity of 83% and 80%, respectively). We obtained significantly higher values of three adaptive strategies between adherent and nonadherent patients following DAAs treatment: in positive refocusing (p -value = 0.044), refocus on planning (p -value = 0.037), and positive reappraisal (p -value = 0.047). Discussion: The interplay between the three adaptive strategies of the cognitive emotion regulation and the enhancement of DAAs adherence contributes to a more holistic comprehension of patient behavior in the context of HCV treatment. Increasing refocusing and planning using goal setting and assisting patients in establishing specific, achievable goals can be crucial strategies for clinicians aiming to improve adherence among their patients. [ABSTRACT FROM AUTHOR]

Osteopenic bone disease occurs frequently in patients with chronic liver cirrhosis, which most frequently presents with hepatic osteodystrophy. Thus, the relationship between nutritional status and bone mineral density has been poorly measured in liver cirrhosis. This single-center study consisted of a group of 70 patients diagnosed with liver cirrhosis. The nutritional status was evaluated with the Controlling Nutritional Status index, and volumetric vertebral bone mineral density was measured with quantitative computed tomography. Among the 70 patients included, osteopenia and osteoporosis were found in 71% and 24.3%, respectively. Malnutrition assessed with the Controlling Nutritional Status index was observed in 56 (80%) patients and was more frequent in alcoholic cirrhosis patients than viral cirrhosis patients (87.24% vs. 65.22%). Significant positive correlation with Controlling Nutritional Status score was found with Model for End-Stage Liver Disease (rho = 0.576, p-value < 0.0001), Child–Pugh score (rho = 0.670, p-value < 0.0001), International Normalized Ratio (rho = 0.517, p-value = 0.001), aspartate aminotransferase (rho = 0.293, p-value = 0.045), and bilirubin (rho =0.395, p-value = 0.02). Among the liver cirrhosis patients, 15 had osteoporosis and 49 had osteopenia at the lumbar spine (L1-L4 vertebrae), as determined by bone mass density via quantitative computed tomography. A non-significant relationship between Controlling Nutritional Status index-assessed nutritional status and bone mass density was documented. Regarding osteoporosis, no differences were found between the viral and alcohol types of liver cirrhosis patients (p-value = 0.870). Age, obesity, grade of varices, Child–Pugh score, and Model for End-Stage Liver Disease score were associated with osteoporosis in patients with liver cirrhosis. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is the leading infectious cause of mortality worldwide. In the last years, resistant strains of the etiological agent, Mycobacterium tuberculosis, have emerged, thus demanding more triage tests to identify active pulmonary TB (PTB) patients and to evaluate their disease severity. Therefore, acute-phase reaction serum tests are required for monitoring TB patients, among WHO symptom screening recommendations. C-reactive protein (CRP) is a non-specific inflammatory biomarker that has been recently proposed for TB screening and can be quantitatively analyzed through cost-effective point-of-care assays. A previous meta-analysis found CRP to be highly sensitive and moderately specific for active PTB with confirmed HIV infection. Methods: We performed a meta-analysis update of diagnostic tests, pooling sensitivities, and specificities in order to assess the accuracy of CRP as a potential test for the screening of HIV-associated PTB in outpatients. We searched MEDLINE, Web of Science, and SCOPUS for eligible articles before 19 October 2021. Results: We identified 13 eligible studies with HIV-positive patients with PTB. At a CRP threshold of 10 mg/L, CRP pooled sensitivity was 87% (76%-93%) and pooled specificity was 67% (49%-81%), with an area under the curve (AUC) of 0.858. Using a CRP threshold of 8 mg/L, pooled sensitivity was 82% (72%-89%) and pooled specificity was 82% (67%-92%), with an AUC of 0.879. We found that CRP has a high sensitivity in the screening of PTB in HIV-positive outpatients, consistent with findings reported previously. Conclusions: Regardless of pooled specificity, better results were found using the CRP threshold of 8 mg/L as a test screening of PTB, meeting the need of further approaching specific TB diagnostic methods and reducing resource consumption. [ABSTRACT FROM AUTHOR]

Patients with cirrhosis often develop malnutrition and micronutrient deficiencies, leading to a worse prognosis and increased mortality. Our purpose was to assess the prevalence of micronutrient deficiencies especially calcium and phosphorus in patients with decompensated liver cirrhosis (LC). This was a retrospective study including 143 consecutive patients hospitalized for acute decompensation of cirrhosis, most of them with alcoholic etiology along with viral B or viral C and autoimmune induced cirrhosis. A blood test including minerals was performed on admission. Lower serum calcium levels were found in patients with a more severe forms of LC and also the ones diagnosed with viral and alcoholic LC rather than autoimmune induced LC. Peritoneal ascitic fluid was observed in 51 patients with hypocalcemia and only 24 patients with normal calcium levels had fluid accumulation. Low levels of phosphorus were noted in patients with a more severe form of LC (chi-square: 20.2504; p-value 0.000446). Ascitic fluid was found in patients with low values of phosphorus as well as in those with hypocalcemia (chi-square 5.235; p-value 0.022137). In conclusion, this study confirmed that patients with advanced liver disease had lower values of calcium and phosphorus and a more severe form of LC can be associated with hypocalcemia and hypophosphatemia. [ABSTRACT FROM AUTHOR]

There is a growing interest in the management of long-term conditions and increasing awareness of the need for compliance/adherence's assessment. An inexpensive and simple way to measure patients' treatment compliance is pharmacoeconomic measurement tools. The aim of the study is to increase the quality of assessment of patients' compliance through statistical methods in order to obtain a more accurate estimation and a shorter, easy-to-respond selfadministered questionnaire. We used the Compliance Questionnaire-Rheumatology (CQR) translated into Romanian and we verified the reliability and the internal consistency of this instrument. The research included 140 consecutive patients diagnosed with rheumatoid arthritis according to currently used criteria, with different treatment strategies and from different parts of Romania. Two methods for CQR's optimization were used. The first method identified associations between CQR score and patient compliance. An exploratory factor analysis was performed, as an alternative method, to reduce the number of items in CQR. The factor analysis identified a two-dimensional 9 item model that explains 66.78% of the variance in adherence and has a good internal consistency and fits the data. A shortened and optimized version of the CQR increases the clinical utility by reducing the patient's burden while maintaining a good level of reliability. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis represents the most common inflammatory rheumatism, affecting about 1% of the general population. Inappropriately untreated usually has a progressively aggressive perspective, generating pain and joint inflammation and functional disability. The severity of the disease results from the fact that more than 50% of patients cease their professional activity in the first 5 years of the disease and 10% of cases show severe disability in the first two years of evolution. The aim of the study is to conduct a comparative price analysis between a conventional remission therapy and a biological therapy for rheumatoid arthritis in Romania. Biologics are huge financial burden due to their high price, large number of patients and the considerable budget impact. The data was obtained from the official pages of National Health Insurance House in Romania up to date December 2018, and also the algorithm treatment for rheumatoid arthritis is followed. Conventional remission therapy is 30-100 times cheaper than biological therapy. The results show that two out of eight INNs (International non-proprietary name or a generic name) have authorized biosimilars (similar biological medicinal product) in Romania, despite of bigger number of authorized biosimilars in EMA (European Medicines Agency) for rheumatoid arthritis. Biosimilars' prices have a 19.66-29.68% reduction in the price of biologics. Introduction of biosimilars on the Romanian market will lead to significant decrease in reimbursed prices paid by public funds and thus increase the patients' access to biological therapy. [ABSTRACT FROM AUTHOR]

Patients adherence to treatment in rheumatoid arthritis case is less than optimal (patients do not take their medications half of the time) and the economic costs are emphasizing this problem. A non-adherent patient is costly and time-consuming. It was demonstrated that every dollar spent improving adherence saves seven dollars in total healthcare costs. The level of adherence can be improved if we can understand the correlation between patients behavior in taking their medication and the advices from doctors providing medical services. In order to assess the correct adherence, it is necessary to start using pharmacoeconomic instruments such as CQR-19, DAS, Morisky scale etc. These tools will guide the conversation and alert the physician or the pharmacist to discuss any potential issues during the patient's meeting. Patients who are involved in decisions about the medications they are prescribed are more likely to adhere their rheumatoid arthritis treatment plan. If medication costs are a barrier to adherence for the patients, they should use generic medicines. Other research wrote about the health impact of non-adherence and this analysis will emphasize the health-economics consequences of low adherence to medication-taking in rheumatoid arthritis. [ABSTRACT FROM AUTHOR]