Search Results (80)

Background and Objectives: Preterm birth and stillbirth are primary adverse pregnancy outcomes. Research during the COVID-19 pandemic revealed reductions in preterm birth in some countries, while stillbirth rates increased or remained unchanged. These findings suggest the presence of preventable risk factors associated with changes in physical activity and lower exposure to community-acquired infections due to lockdown measures, altered social interaction patterns or reduced access to antenatal care. Assessing seasonal variation may offer insights into whether lifestyle changes during the COVID-19 lockdown period influenced preterm birth rates. Materials and Methods: This retrospective cohort study used data from the electronic medical records of Bihor and Sibiu counties. Preterm deliveries (<37 weeks) and stillbirths during the COVID-19 pandemic (2020 and 2021) were compared with the corresponding pre-pandemic (2018 and 2019) and post-pandemic (2022 and 2023) period. Preterm birth rates during summer and winter in the pre-pandemic, pandemic, and post-pandemic years were analyzed. A comparison with rates during strict lockdown was made. Results: Out of 52,021 newborn infants, 4473 were born preterm. Preterm birth rates remained stable across all three periods (p = 0.13), and no significant seasonal pattern was identified (p = 0.65). In contrast, stillbirth rates increased notably during the strict lockdown period, with the median incidence almost doubling compared to other periods (0.87%, p = 0.05), while remaining unchanged during the rest of the pandemic (p = 0.52). Conclusions: Our study found that preterm birth rates remained unaffected by the pandemic and lockdown periods, while stillbirths increased significantly during the strict lockdown. These findings highlight the importance of maintaining access to timely antenatal care during public health emergencies to prevent adverse perinatal outcomes. Full article

Background: Second-generation androgen receptor signaling inhibitors are one of the main treatment options in metastatic castration-resistant prostate cancer (mCRPC). Nonetheless, a considerable proportion show limited response to treatment, which indicates the need for convenient, easily accessible predictor biomarkers, a role suited for liquid biopsy. Methods: We conducted a PRISMA-compliant systematic review of four databases (Embase, Medline, Scopus, Web of Science) to identify all studies (observational studies and clinical trials) investigating cell-free DNA, circulating tumor cells, exosomes, and circulating RNAs as prognostic markers in metastatic castration-resistant patients starting androgen receptor signaling inhibitors. We excluded studies that evaluated combination therapies, rare histological subtypes or included nonmetastatic or castrate-sensitive disease. We also evaluated whether published papers followed reporting guidelines (REMARK, STROBE, or CONSORT for abstracts). Results: We identified a total of 123 reports, from which we identified only a few well-studied and consistent biomarkers: androgen receptor overexpression/copy number gain and splice variant 7, as well as disease burden markers (circulating tumor DNA fraction and circulating tumor cell concentration). Alterations or copy number loss in tumor suppressors PTEN, RB1, and TP53 were second in terms of quantity and consistency of evidence. However, a large majority of identified biomarkers were relatively understudied or inconsistent. We identified two potential vulnerabilities: inconsistent adherence to reporting guidelines and the under-inclusion of patients of non-Western European ancestry. Conclusions: A large number of biomarkers were linked to worse outcomes in prostate cancer; nonetheless, in most cases, the evidence is limited or inconsistent, or even contradictory. The main exceptions pertain to androgen receptor signaling and disease burden, and, to a smaller extent, to certain tumor suppressor genes. Further studies are needed to confirm their clinical utility, using clear and consistent methodologies and including patients from currently understudied populations. Full article

Background: Metabolic syndrome (MetS) and obstructive sleep apnea (OSA) are prevalent and interrelated conditions in older adults, both contributing to decreased quality of life and increased health risks. Nutritional interventions, including dietary changes and probiotic supplementation, may offer effective non-pharmacological strategies to address these conditions. This study aimed to evaluate the impact of diet therapy alone and in combination with probiotics on quality of life and sleep apnea risk in older adults (>60 years) with MetS. Methods: In this controlled interventional study, 192 older adults with metabolic syndrome were assigned to one of three groups: control, diet therapy alone, or diet therapy plus probiotic supplementation. Participants were evaluated at baseline and after the intervention period using the SF-36 quality of life questionnaire and an apnea risk screening tool. Clinical and metabolic parameters, including BMI, HOMA index, and visceral fat, were also assessed. Results: Significant improvements in SF-36 scores were observed in both intervention groups compared to the control group (p < 0.05) (mean difference = −5.31, p = 0.016), with the diet + probiotics group showing the greatest enhancement. Participants who reduced their apnea risk also reported higher post-intervention SF-36 scores. The intervention led to reductions in visceral fat, inflammatory markers (CRP), and insulin resistance (HOMA index), which were correlated with improved quality of life. Conclusions: Integrated nutritional strategies, especially the combination of diet and probiotics, significantly improve quality of life and reduce apnea risk in older adults with metabolic syndrome. These findings support the use of personalized, non-pharmacological interventions targeting both metabolic health and sleep-related outcomes in geriatric populations. Full article

The utilization of geothermal resources as renewable energy is a subject of interest for the regions that possess these resources. The exploitation of geothermal energy must consider local geological conditions and an integrated approach, which should include practical studies on the chemistry of geothermal waters and their effect on thermal installations. Geothermal waters from Bihor County, Romania, have a variable composition, depending on the crossed geological layers, but also on pressure and temperature. Obviously, water transport and heat transfer are involved in all applications of geothermal waters. This article aims to characterize certain geothermal waters from the point of view of composition and corrosion if used as a thermal agent. Atomic absorption spectroscopy (AAS) and UV–Vis spectroscopy were employed to analyze water specimens. Chemical composition includes calcite (CaCO₃), chalcedony (SiO₂), goethite (FeO(OH)), and magnetite (Fe₃O₄), which confirms the corrosion and scale potential of these waters. Corrosion resistance of mild carbon steel, commonly used as pipe material, was studied by the gravimetric method and through electrochemical methodologies, including chronoamperometry, electrochemical impedance spectroscopy (EIS), potentiodynamic polarization method, and open circuit potential measurement (OCP). Statistical analysis shows that the medium corrosion rate of S235 steel, expressed as penetration rate, is between 0.136 mm/year to 0.615 mm/year. The OCP, EIS, and chronoamperometry experiments explain corrosion resistance through the formation of a passive layer on the surface of the metal. This study proposes an innovative methodology and a systematic algorithm for analyzing chemical processes and corrosion phenomena in geothermal installations, emphasizing the necessity of individualized assessments for each aquifer to optimize operational parameters and ensure sustainable resource utilization. Full article

While accelerating globalization and technological transformation, traditional food products occupy a vulnerable yet strategically important position, straddling the line between cultural preservation and the need to remain economically viable. This study assesses both the sustainability and economic potential of traditional food items specific to Bihor County, Romania, with particular attention to their integration into contemporary value chains. A mixed-methods design was employed, combining structured surveys with 137 local consumers and semi-structured interviews with 20 regional producers. This research focused on consumer awareness, purchasing behavior, and producers’ readiness to engage with digital tools, within the broader framework of human-centered development and the Industry 5.0 paradigm. Findings reveal a modest but consistent link between familiarity and the willingness to pay a premium, although the frequency of consumption appeared to be unaffected. Sustainability emerged as a widely held value, commonly associated with seasonality, natural ingredients, and artisanal methods. On the supply side, producers showed a cautious openness to digital adoption, often tempered by a strong desire to preserve traditional practices. Based on these insights, this study outlines a territorially grounded framework for enhancing the resilience of traditional foods. Policy recommendations include support for user-friendly digital platforms, improved rural infrastructure, and initiatives that reinforce the regional gastronomic identity. Full article

Background and Objectives: Assessing risk is essential for optimal care in acute pulmonary embolism (PE). The present research seeks to evaluate the value of admission blood cellular indices as predictors of in-hospital outcome in acute PE and their utility in conjunction with validated risk tools such as the Pulmonary Embolism Severity Index (PESI) score and the European Society of Cardiology (ESC) risk stratification. Materials and Methods: A total of 1058 individuals hospitalized at Bihor County Emergency Hospital, Oradea, Romania, with a diagnosis of acute PE confirmed by contrast-enhanced computed tomographic pulmonary angiography were retrospectively evaluated. Results: A total of 165 patients (18.2%) experienced adverse outcomes, including in-hospital mortality, cardiac arrest, cardiogenic shock, or persistent hypotension, and required rescue thrombolytic therapy. The neutrophil-to-lymphocyte ratio (NLR) was an independent predictor for in-hospital adverse outcome OR = 1.071 (95% CI 1.01–1.137), p < 0.001. NLR as a predictor of adverse outcome had an AUC of 0.712 (95% CI 0.661–0.742), p < 0.001, sensitivity of 72.56%, and specificity of 64.19% for a cutoff value of >5.493. In a combined model with PESI or with ESC risk classification, NLR is leading to a significant improvement in their AUC (p < 0.001). Conclusions: Among hematological markers, NLR holds the greatest relevance for stratifying risk in acute pulmonary embolism and serves as an independent indicator of unfavorable in-hospital prognosis. NLR had an acceptable discriminative power to predict short-term complications and can increase the predictive value of the PESI score and of ESC risk classification. Full article

Here, we report an unusual case of a nonsmoker and hypertensive 72-year-old male who was admitted with a transient ischemic attack to the Neurology Department of Clinical County Emergency Hospital Bihor. He presented a first transient ischemic attack and paroxysmal atrial fibrilation 2 years before, when anticoagulation was started on top of his antihypertensive medication. At that time, carotid Doppler ultrasound revealed nonobstructive atherosclerosis and statin therapy was started, according to current guidelines, in order to lower the initial 70 mg/dL LDL-cholesterol level to under 55 mg/dL. Cardio-embolism was considered the mechanism of stroke at that time. Despite all the medication and the maintenance of LDL below 50 mg/dL, carotid atherosclerosis evolved to an important left internal carotid artery stenosis and transient ischemic attacks reappeared two years later. Carotid stenosis was then considered the most probable cause, although elucidating the exact mechanism was difficult. After medical treatment and subsequent endarterectomy, the patient had a good outcome. The progressive course of atheromatosis, despite maximal medication, urged us to look for further proper measures of prevention. No chronic disease was detected during the postoperative phase, except for early-stage periodontal disease, for which adequate preventive measures were applied. Considering that subclinical inflammation induced by periodontal disease can induce the progression of atherosclerosis, chronic treatment with colchicine was added, with a favorable outcome. Full article

Purpose: Image-guided radiotherapy (IGRT) has been widely implemented in the treatment of prostate cancer, offering a number of advantages regarding the precision of dose delivery. This study provides an overview of factors, clinical and physical alike, that increase treatment accuracy in prostate cancer radiotherapy in the context of IGRT. The following aspects are explored based on recent literature: the radiotherapy technique used in conjunction with IGRT, the type and frequency of IGRT, the impact of radiotherapy technique/IGRT on target dosimetry and organs at risk, the influence of IGRT on planning target volume margins, the impact of treatment time on dosimetric outcome and clinical outcomes using IGRT repositioning or an online adaptive plan. Methods: A systematic search of the literature was conducted within Pubmed/Medline databases to find relevant studies. Of the 152 articles fulfilling the initial search criteria, 79 were selected for final analysis. Results: The frequency of image guidance, the treatment regimen and the radiation technique are important factors that contribute to the optimization and personalization of the treatment plan. The daily anatomy and volume of the bladder and rectum can vary considerably, which can significantly impact the dosimetric effects on these organs. When used in conjunction with volumetric modulated arc therapy, IGRT allows for shaping the dose distribution to avoid nearby critical structures such as the bladder and rectum. Conclusions: Precise tumor targeting via IGRT can result in fewer geometric uncertainties, thereby improving treatment outcome both in terms of superior target coverage and sparing organs at risk. Full article

(1) Background: The increasing prevalence of chronic wounds, along with their significant healthcare burden, underscores the need for innovative and technologically advanced treatment strategies. Electrospun nanofiber-based dressings have emerged as a promising solution, mimicking the skin’s extracellular matrix and promoting efficient tissue regeneration. (2) Methods: This real-world, 10-month observational study conducted at CF Oradea Clinical Hospital enrolled 60 patients with chronic, non-healing wounds. Patients were randomly assigned to two groups: 30 received standard vacuum-assisted wound therapy, serving as the control group. In contrast, 30 received treatment with Spincare™, a novel electrospinning technology that delivers a personalized nanofiber matrix directly onto the wound. Symptom progression, pain levels, and treatment adaptation were assessed using standardized questionnaires. (3) Results: Patients treated with Spincare™ demonstrated faster wound healing, especially in the epithelialization phase, with significantly improved pain scores and quality of life measures. The technology was well-tolerated and reduced the need for repeated hospitalizations. (4) Conclusions: Spincare™ represents an effective and innovative electrospun nanofiber solution for chronic wound management, accelerating healing and enhancing patient outcomes, particularly in individuals with underlying conditions such as peripheral arterial disease. These findings support the integration of electrospinning-based therapies in modern wound care protocols. Full article

Background: Antimicrobial resistance is a growing global health threat, with antibiotic misuse in pediatric populations being a significant contributing factor. In Romania, antibiotic consumption and resistance rates are among the highest in Europe. Objective: To assess Romanian parents’ knowledge, attitudes, and practices regarding antibiotic use in children, and to identify key misconceptions and behavioral risks contributing to inappropriate antibiotic use. Methods: A cross-sectional survey was conducted among 400 parents of hospitalized children in a pediatric department in Romania. Participants completed a 15 item structured questionnaire. Data were analyzed using descriptive statistics, chi-square tests, and binary logistic regression to examine associations and control for potential confounding effects between education level, residential environment, and parental misconceptions regarding antibiotic use. Results: Among the 400 surveyed caregivers, 86% (n = 344) held at least one misconception regarding antibiotic use. Additionally, 42.5% (n = 170) of participants reported that they had never heard of the concept of antibiotic resistance. Misconceptions were significantly more prevalent among individuals with lower levels of education and those residing in rural areas (p < 0.001). While 89.8% (n = 359) stated that they had never administered antibiotics to their children without a physician’s recommendation, a separate subset of 28% (n = 112) acknowledged that they had asked a doctor to prescribe antibiotics for their child. Moreover, 23.3% (n = 93) reported seeking a second medical opinion when antibiotics were not initially prescribed. Conclusions: Despite high adherence to medical advice, widespread misconceptions persist. These findings highlight the need for targeted, population-specific educational interventions to promote rational antibiotic use and address AMR in high-burden settings like Romania. Full article

Introduction: Tuberous sclerosis complex (TSC) is a rare multisystemic genetic disorder characterized by the formation of benign tumors in various organs, including the central nervous system, skin, kidneys, and heart. The diagnosis is based on well-defined clinical criteria, such as those from Schwartz (2007) updated in 2012 by the International Tuberous Sclerosis Complex Consensus Group. The study aims to investigate the clinical, imaging, and molecular characteristics of patients diagnosed with tuberous sclerosis and to explore the correlation between specific genetic mutations (TSC1 and TSC2 genes) and the severity of clinical manifestations. Material and Methods: This is a retrospective longitudinal study of 13 patients diagnosed with tuberous sclerosis, identified in the records of the Bihor Regional Center for Medical Genetics (BRCMG) within the Bihor County Emergency Clinical Hospital from 1984 to 2024. Clinical, imaging, and molecular features were assessed. Patients were evaluated by a multidisciplinary team, including a geneticist, pediatrician, neurologist, psychiatrist, and psychologist. Clinical and imaging data were retrospectively collected from the congenital malformations and genetic disease records of BRCMG Bihor and statistically analyzed. Results: All patients showed clinical and imaging signs consistent with the diagnosis of tuberous sclerosis. Neurological manifestations were present in 83% of patients, including epilepsy and cognitive delays. Renal lesions were detected in 46% of cases, and dermatological lesions, such as facial angiofibromas, were observed in 69% of patients. Mutational variants identified in the TSC2 gene correlated with a more severe clinical presentation, including severe intellectual disability and treatment-resistant seizures, compared to variants in the TSC1 gene. Conclusions: Our study, although involving a small number of patients, highlights the clinical heterogeneity of tuberous sclerosis and the importance of a multidisciplinary approach in patient management. Early diagnosis and ongoing monitoring are essential to improving the quality of life for patients. Further studies are needed to assess the impact of therapeutic interventions and genetic correlations within the studied population. Full article

Background/Objectives: The objective of this study is to assess overall patient satisfaction with hospital services, including cleanliness, ward conditions, and food quality. Another key goal is to determine patient willingness to return for future medical services and identify the factors influencing this decision. Moreover, the study explores the relationship between patient satisfaction and continuity of care, as indicated by previous hospitalizations. Methods: We conducted a retrospective cohort study to evaluate patient satisfaction at the Bihor County Emergency Clinical Hospital in Oradea, Romania. A standardized 40-item questionnaire was developed in accordance with the Framework Agreement on the provision of medical assistance within the Romanian healthcare system. The survey, which was administered over a four-year period (2019–2022), covered seven domains: demographic data, accessibility, hotel conditions, quality of care, patient safety and rights, overall satisfaction, and feedback. A total of 12,802 patients completed the questionnaire, and all statistical analyses were performed using R Studio. Results: This study analyzes patient-reported satisfaction and experiences in a large healthcare facility, based on data from 12,802 participants. Overall, 91% of respondents rated the hospital positively, with 62% giving an excellent score. Spiritual assistance was well received (71%), and 70% of patients expressed willingness to return for future medical needs. Hospital cleanliness and ward conditions were rated highly, with 71% of respondents reporting excellent experiences. Food quality was positively reviewed by 66% of participants. Most patients (95%) confirmed proper hygiene practices by medical staff, and 95% were informed about their diagnosis. However, only 67% were aware of the complaint submission process. The dataset spans 2019–2022, with the highest hospitalizations in 2020 (36%) and obstetrics, cardiology, and general surgery being the most common specialties. Conclusions: This dataset reflects a high level of patient satisfaction across multiple dimensions of hospital services, including cleanliness, quality of care, and patient information. However, areas such as complaint handling and transparency in medication handling require further attention to improve the overall patient experience. The findings underscore the hospital’s strong performance in meeting patient expectations while identifying key areas for continued improvement. Full article

Lung squamous cell carcinoma in situ (SCIS) is the preinvasive precursor lesion of lung squamous cell carcinoma (SCC). Only around two-thirds of these lesions progress to invasive cancer, while one-third undergo spontaneous regression, which presents a significant clinical challenge due to the risk of overtreatment. The ability to predict the evolution of SCIS lesions can significantly impact patient management. Our study explores the use of computational pathology in predicting the evolution of SCIS. We used a dataset consisting of 112 H&E-stained whole slide images (WSIs) that were obtained from the Image Data Resource public repository. The dataset corresponded to tumors of patients who underwent biopsies of SCIS lesions and were subsequently followed up by bronchoscopy and CT scans to monitor for progression to SCC. We used this dataset to train two models: a pathomics-based ridge classifier trained on 80 principal components derived from almost 2000 extracted features and a deep convolutional neural network with a modified ResNet18 architecture. The performance of both approaches in predicting progression was assessed. The pathomics-based ridge classifier model obtained an F1-score of 0.77, precision of 0.80, and recall of 0.77. The deep learning model performance was similar, with a WSI-level F1-score of 0.80, precision of 0.71, and recall of 0.90. These findings highlight the potential of computational pathology approaches in providing insights into the evolution of SCIS. Larger datasets will be required in order to train highly accurate models. In the future, computational pathology could be used in predicting outcomes in other preinvasive lesions. Full article

Background: Vitamin D plays a crucial role in immune system function, and its deficiency has been associated with an increased risk of infections. This study investigates the relationship between vitamin D deficiency and the severity of purulent oropharyngeal infections, considering the need for surgical interventions and the duration of hospitalization. Materials and Methods: This retrospective study included patients diagnosed with peritonsillar phlegmons, laterocervical abscesses, and peritonsillar abscesses. Patients were categorized based on their vitamin D levels: deficiency (<30 ng/mL) and optimal levels (≥30 ng/mL). The clinical parameters, length of hospitalization, and type of treatment were analyzed. Statistical analyses included Student’s t-test, the chi-square test, and ANOVA to assess differences between groups. Results: Patients with vitamin D (25(OH)D3) deficiency had a significantly longer hospital stay (8.50 days vs. 3.24 days, p = 0.001) and required more frequent surgical interventions (55.6% vs. 27.8%, p = 0.002) compared to those with optimal vitamin D levels. A trend toward more complex treatment regimens was also observed, although this relationship was not statistically significant (p > 0.05). Conclusions: These findings suggest that vitamin D (25(OH)D3) deficiency may contribute to a more severe course of oropharyngeal infections, increasing the need for invasive treatments and prolonging hospitalization. This highlights the importance of monitoring vitamin D (25(OH)D3) levels and the potential benefits of supplementation in preventing and managing severe upper respiratory tract infections. Full article

This study examines a range of aspects relating to the projected waste generation in Bihor County, Romania from 2020 to 2040, focusing on key milestones set for 2020, 2025, 2030, 2035, and 2040. The analysis incorporates socio-economic, macroeconomic, and demographic factors, along with household income, economic activities, and waste composition, in order to obtain accurate projections. Furthermore, this study evaluates the current state of waste management, identifies deficiencies, and proposes targeted objectives. The assessment methodology considers targets such as increasing waste reuse and recycling rates, reducing biodegradable waste landfilling, enhancing energy recovery, and improving separate waste collection systems. Three alternative waste management strategies are analyzed, including a “zero” alternative (i.e., maintaining the current system) and two investment-driven alternatives. The evaluation integrates both quantitative criteria—such as financial viability and environmental impacts—and qualitative factors, including market risk and adherence to circular economy principles. Through a comprehensive analysis, this study offers a robust foundation for strategic decision-making in the context of sustainable waste management and the efficient implementation of waste treatment practices in Bihor County. Full article