Our work presents the smoking-related attitude, the methods for the development knowledge and antismoking commitment among health-care workers. We analyzed a 20 items questionnaire in 209 healthcare employees (specialists physicians, interns, medical assistants/nurses). Smoking is widespread among health professionals 34.7% comparing with the country average (28%). In the last 10 years smoking has declined in physicians -27.1% but remains constant in assistants 43.3% and nurses 46.3% (comparison with a previous study). Smoking is lower in young physicians and pulmonologists (by information achieved along courses and traineeships in Pulmonology Discipline). Smoking is predominant in males 55% vs 27.7% in females. Medical personnel�s knowledge about the harmful effects of smoking is still insufficient. 32% of smokers do not consider that smoking affects the health entourage. 20% report smoking in the hospitals. The methods used for providing antismoking activities in medical personnel were complexes: thematic conferences for physicians/nurses (6 in the last 4 years), 2 workshops for practical implementation the antismoking techniques, curricular courses (4 h/semester for the fifth-grade medical-students and third-grade assistants, 6 hours optional courses for all students) and by promoting the antismoking policy in our universities and pulmonology clinics. Medical personnel are a target group in the anti-smoking activity (like health promoters) considering the great potential for further education for large groups of patients.

To identify and to determine the resistance pattern of bacterial pathogens involved in infections of the elderly patients (� 65 years) admitted in the intensive care unit (ICU) at County Emergency Clinical Hospital Craiova, Romania. A retrospective study of bacterial pathogens was carried out on 463 elderly patients (� 65 years) admitted to the ICU, from January to December 2017. The analysis of the resistance patterns for the action of the appropriate antibiotics was performed using Vitek 2 Compact system and diffusion method. In this study there were analyzed 617 samples from 463 elderly patients (� 65 years). A total of 776 bacterial isolates were obtained, of which 175 strains of Klebsiella spp. (22.55%), followed by MRSA - Methicillin-Resistant Staphylococcus Aureus (108 -13.91%) and Escherichia coli (99 -12.75%). The most common isolates were from respiratory tract (572 isolates -73.71%). High rates of MDR were found for Pseudomonas (73.07%), MRSA (62.03%) and Klebsiella (44.57%). The study revealed an alarming pattern of antibiotic resistance in the majority of ICU isolates from elderly patients (�65 years), which draws attention to the need for judicious use of antibiotics and for careful monitoring of the drug resistance of patients.

The fight against smoking through various smoking cessation methods could be very effective by early education especially in young people for preventing the occurrence or the severity of obstructive lung diseases. The aim of the study was to present the impact of varenicline, a selective partial nicotine agonist, in adults of 40-49 year-old, active smokers, recently diagnosed with COPD, from 2009 to 2011, in a Smoking Cessation Center of the Pulmonary Rehabilitation Clinic Iasi, Romania. There were included all male employees, without occupational exposure, active smokers, with a personal history of smoking �10 packs-year cigarettes, recently diagnosed with COPD, who inform consented to be enrolled for counseling and smoking cessation treatment provided by varenicline. All patients received COPD therapy, according to the current GOLD recommendations. The method of evalution the impact of smoking cessation methods consisted in the COPD Assessment Test (CAT) completed by cases before and after 12 weeks program of smoking cessation counseling and therapy and respiratory rehabilitation. The CAT is a short questionnaire, simple and validated tool of COPD symptoms assessment, measuring the severity of COPD on a patient�s quality of life. Results reveals an important decreasing of CAT score with important amelioration of symptoms especially in severe COPD patients. Counseling, smoking cessation and respiratory rehabilitation interventions have shown positive effects of smoking cessation with varenicline among young COPD patients 40-49 year-old.

Association between chronic obstructive pulmonary disease (COPD) and sleep apnea SA (overlap syndrome - OS) includes serious clinical manifestations and high mortality due to early respiratory failure, cardiovascular and metabolic complications from both diseases. 90 COPD patients (85.5% males) were strongly suspected to have concomitant SA after clinical examination and sleep questionnaires. We performed a cardio-ventilatory poligraphy during sleep. 82 patients (91.1%) from our OS group had obstructive sleep apnea (OSA), 8 patients (8.9%) mixed apnea and 20% had also OHS. 17 (18.8%) of OS were overweight and 66 (73.3%) obese. A third of them were in a very active group of age: 49 patients (54.4%) under 60 year-old and 11 patients (12.2%) between 61-65 year/old. We noted severe complication/comorbidities in our OS group: 63.3% hypertension, 43.3% core pulmonale, 31.1% arrhythmia, 32.2% cardiac failure, 38.8% dyslipidemia, 31.1% diabetes. The second night investigation permitted titration for the targeted pressures for CPAP therapy (Continuous Positive Airways Pressure). Treatment of OS patients had an interdisciplinary approach: CPAP in OSA, BPAP (Bi-level Positive Airways Pressure) in OHS, inhaled bronchodilators, treatment of cardiovascular comorbities, pulmonary rehabilitation, weight loss, tobacco/alcohol cessation counseling, and oxygen therapy in remaining hypoxemic patients. 51.2% of patients had not accessibility for long time CPAP (lack of coverage by the public health system). OS included clinical aspects of severity due to both COPD and OSA. Clinical investigation, sleep questionnaires, assessment of the diurnal somnolence and sleep cardiorespiratory poligraphy are recommended in all COPD patients. Obesity was the main risk factor for OSA in COPD patients.

Antibiotherapy is the main determinant of Clostridium difficile infection due to the imbalance determined in the intestinal flora. Clostridium difficile infection can be considered a current public health problem, given the increased incidence, both as a nosocomial infection as well as at community level, by excessive, uncontrolled and unjustified use of antibiotics, high contagiousness, negative influence on health systems in the increased number of days of hospitalization and implicitly increased costs, and last but not least, the substantial deterioration of the quality of the patient�s life. The retrospective study over a 12-month period over a group of 106 patients revealed the following profile of the patient affected by Clostridium difficile infection: females, aged 66.75 � 15.66, from the urban area, hospitalized in the medical section, who had diarrhea more than 2 days after admission, but up to 28 days after this event, due to prolonged antibiotic therapy with ceftriaxone, associated with a gastric secretion inhibitor, on a background of multiple associated pathologies. It is very important for all health systems to control this phenomenon and this is only possible by applying effective measures to prevent the onset of CDI, of relapses and contamination, thus identifying the judicious use of antibiotics.