Search Results (88)

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: Intracerebral hemorrhage (ICH) is a severe form of stroke associated with high morbidity and mortality. While neurosurgical evacuation may offer theoretical benefits, its impact on survival and hospital course remains debated. We aimed to compare the outcomes of surgical versus conservative management in patients with lobar, capsulo-lenticular, and thalamic ICH and to identify factors influencing mortality and the surgical decision. Methods: This single-center, retrospective cohort study included adult patients admitted to the County Clinical Emergency Hospital of Sibiu (2017–2023) with spontaneous supratentorial ICH confirmed via CT (deepest affected structure determining lobar, capsulo-lenticular, or thalamic location). We collected data on demographics, clinical presentation (Glasgow Coma Scale [GCS], anticoagulant use), hematoma characteristics (volume, extension), treatment modality (surgical vs. conservative), and in-hospital outcomes (mortality, length of stay). Statistical analyses included t-tests, χ², correlation tests, and logistic regression to identify independent predictors of mortality and surgery. Results: A total of 445 patients were analyzed: 144 lobar, 150 capsulo-lenticular, and 151 thalamic. Surgical intervention was more common in patients with larger volumes and lower GCS. Overall, in-hospital mortality varied by location, reaching 13% in the lobar group, 20.7% in the capsulo-lenticular group, and 35.1% in the thalamic group. Within each location, surgical intervention did not significantly reduce overall in-hospital mortality despite the more severe baseline presentation in surgical patients. In lobar ICH specifically, no clear survival advantage emerged, although surgery may still benefit those most severely compromised. For capsulo-lenticular hematomas > 30 mL, surgery was associated with lower mortality (39.4% vs. 61.5%). In patients with large lobar ICH, surgical intervention was associated with mortality rates similar to those seen in less severe, conservatively managed cohorts. Multivariable adjustment confirmed GCS and hematoma volume as independent mortality predictors; age and volume predicted the likelihood of surgical intervention. Conclusions: Despite targeting more severe cases, neurosurgical evacuation did not uniformly lower in-hospital mortality. In lobar ICH, surgical patients with larger hematomas (~48 mL) and lower GCS (~11.6) had mortality rates (~13%) comparable to less severe, conservative cohorts, indicating that surgical intervention was associated with similar mortality rates despite higher baseline risk. However, these findings do not establish a causal survival benefit and should be interpreted in the context of non-randomized patient selection. For capsulo-lenticular hematomas > 30 mL, surgery was associated with lower observed mortality (39.4% vs. 61.5%). Thalamic ICH remained most lethal, highlighting the difficulty of deep-brain bleeds and frequent ventricular extension. Across locations, hematoma volume and GCS were the primary outcome predictors, indicating the need for timely intervention, better patient selection, and possibly minimally invasive approaches. Future prospective multicenter research is necessary to refine surgical indications and validate these findings. To our knowledge, this investigation represents the largest and most contemporary single-center cohort study of supratentorial intracerebral hemorrhage conducted in Romania. Full article

Background/Objective: Functional near-infrared spectroscopy (fNIRS) is a non-invasive neuroimaging technique with growing relevance in psychiatry. Its ability to measure cortical hemodynamics positions it as a potential tool for monitoring neurofunctional changes related to treatment. However, the specific features and level of consistency of its use in clinical psychiatric settings remain unclear. A scoping review was conducted under PRISMA-ScR guidelines to systematically map how fNIRS has been used in monitoring treatment response among individuals with psychiatric disorders. Methods: Forty-seven studies published between 2009 and 2025 were included based on predefined eligibility criteria. Data was extracted on publication trends, research design, sample characteristics, fNIRS paradigms, signal acquisition, preprocessing methods, and integration of clinical outcomes. Reported limitations and conflicts of interest were also analyzed. Results: The number of publications increased sharply after 2020, predominantly from Asia. Most studies used experimental designs, with 31.9% employing randomized controlled trials. Adults were the primary focus (93.6%), with verbal fluency tasks and DLPFC-targeted paradigms most common. Over half of the studies used high-density (>32-channel) systems. However, only 44.7% reported motion correction procedures, and 53.2% did not report activation direction. Clinical outcome linkage was explicitly stated in only 12.8% of studies. Conclusions: Despite growing clinical interest, with fNIRS showing promise as a non-invasive neuroimaging tool for monitoring psychiatric treatment response, the current evidence base is limited by methodological variability and inconsistent outcome integration. There is a rising need for the adoption of standardized protocols for both design and reporting. Future research should also include longitudinal studies and multimodal approaches to enhance validity and clinical relevance. Full article

Breast thread lifting is a minimally invasive technique for correcting mild to moderate ptosis, offering aesthetic enhancement with reduced morbidity compared to traditional mastopexy. This review examines the anatomical underpinnings, clinical indications, technical nuances and limitations of breast thread lifting. The breast’s fascial architecture, particularly the role of Cooper’s ligaments and the retromammary space, critically influences thread trajectory and vector planning. Classification systems assist in proper patient selection, highlighting the suitability of thread lifts for Grades I–II ptosis with minimal skin excess. Advances in ultrasonography have improved preoperative planning, thread placement accuracy and postoperative monitoring. Various thread types, including PDO, PLLA, PCL and Silhouette Soft, offer different lifting capacities and collagen-stimulatory properties, necessitating tailored material selection. Although thread lifts offer immediate improvements, their transient nature necessitates careful patient counseling to manage expectations regarding durability and potential maintenance sessions. Innovative techniques, including clavicular anchoring and multi-level subdermal scaffolding, have expanded the procedural repertoire. Despite certain limitations, breast thread lifting remains a valuable tool within the aesthetic surgeon’s armamentarium, particularly for patients seeking minimally invasive options with shortened recovery periods and favorable psychosocial outcomes. Future developments are expected to further enhance safety, reproducibility and long-term results. Full article

Background: Recently, vitamin D deficiency (VDD) has been described as a pandemic, affecting all groups of the population. Pregnant women and preterm infants are particularly vulnerable to vitamin D deficiency. Objectives: We aimed to evaluate the maternal and neonatal vitamin D status in relation with maternal vitamin D supplementations during pregnancy and to identify demographic, social, and healthcare risk factors for maternal VDD and vitamin D insufficiency in women delivering at ≤32 weeks of gestation. Methods: This prospective observational study was developed in the regional level III maternity unit of the Clinical County Emergency Hospital Sibiu. It included all admitted mothers who delivered at ≤32 weeks of gestation and their infants between 1 March 2022 and 28 February 2025. Infant deaths in the first 24 h of life, major congenital defects, chromosomal abnormalities, the admission of outborn infants without their mothers, or the transfer of the mother more than 48 h after birth were used as exclusion criteria. Maternal and neonatal data were collected from medical records. Data on maternal vitamin D supplementation were collected through interviews. Univariate and multivariate logistic regressions, linear regression, and predictive models were performed for data analysis. Results: A total of 146 mothers (median (IQR) age 30 (24–35) years) and their 164 preterm infants born at ≤32 weeks of gestation (median gestational age of 30 (27–31) weeks and birth weight of 1200 (900–1527) g) were included in this study. Only 43.15% of the mothers used multivitamins containing vitamin D during pregnancy, and 10.96% used specific vitamin D supplements. Vitamin D supplementation was used for a median of 4 (3–5) months at a median dose of 800 (250–1500) IU/day. Severe VDD (25(OH)D < 10 ng/mL), VDD (25(OH)D < 20 ng/mL), VDI (25(OH)D 20–29 ng/mL) were found in 19.86%, 55.48%, and 23.97% of the mothers and 16.46%, 58.53%, and 25.61% of their infants, respectively. A significant correlation was found between the maternal and neonatal status (r = 0.684, r² = 0.468, p < 0.001, B = 0.62). Both the maternal and neonatal vitamin D status were correlated with the vitamin D duration and dose used for supplementation during pregnancy. The logistic regression analysis showed that birth during a cold season and increased parity are independently associated with severe maternal VDD, while birth during the cold season and a lower educational status were independently associated with maternal VDD. Only an absent vitamin D supplementation (in the form of a multivitamin or specific vitamin D supplements) has been proven as an independent risk factor for VDI. Conclusions: Our findings revealed a worrisome prevalence of severe VDD, VDD, and VDI in mothers delivering very prematurely and in their infants. Additionally, less than half of the mothers in this study used vitamin D supplements during pregnancy despite the national recommendations. The professionals involved in advising pregnant women and policymakers should find solutions to improve the vitamin D status in these vulnerable groups of the population. Full article

Background/Objectives: Over the past three decades, emergency medicine in Romania has evolved from a developing specialty into a cornerstone of the national healthcare system. As we reflect on these 30 years, it becomes evident that the lessons learned and the systems developed form a vital foundation for the future. This study aims to explore how the accumulated experience can guide us toward building a more resilient emergency medical system, one that prioritizes quality, ensures patient and provider safety, and embraces modern principles of healthcare management. The objectives of this study were to explore the long-term perspectives of physicians and nurses working in emergency departments (EDs), to determine the triggering factors that may lead to abandoning the specialty, and to identify of malpractice risks arising from doctor–patient interaction. Methods: This study employed an observational design and utilized an opinion questionnaire to assess the participants’ perspectives. Qualitative data were presented as frequencies and percentages. Quantitative data were expressed as means and standard deviations after verifying normal distribution with the Shapiro–Wilk test. Comparisons between groups for qualitative variables were conducted using the chi-square test. For comparisons of quantitative variables between two groups, Student’s t-test was employed following confirmation of homogeneity of variances with Levene’s test. A p-value of < 0.05 was considered statistically significant. Results: Out of 1228 estimated responders, 641 completed the questionnaire. A total of 577 of participants met the inclusion criteria: 256 (44.4%) nurses and 321 (55.6%) doctors, with an average age of the responders of 40.06 years. Nurses reported the highest level of managerial support (83.2%, p < 0.001). EPs had the highest rate of non-participation in working groups for procedures/protocols/guidelines (49.5%, p < 0.001). Intensive care unit medical doctors (ICU-MDs) and EPs were the main groups reporting a deficiency in employer-provided resources to manage conflict situations (63.7%, 61.7%; p <0.001). EPs (28%) reported practicing defensive medicine (inadequate educational support, the absence of clear protocols). Workplace burnout was reported by the ICU-MDs and EPs responders (96.3%; 93.4%; p < 0.001), and 26% of EPs expressed interest in professional reorientation. Conclusions: This study highlights four strategic directions for rebuilding a resilient healthcare system focused on improving quality of care and safety: development of procedures/protocols, managerial reorganization, restoration of healthcare professionals’ trust through new strategies, and academic development. Full article

This review aims to analyze the role of heat shock protein 47 (HSP47) in thrombosis and evaluate its potential as a therapeutic target for deep vein thrombosis (DVT). A systematic literature review was conducted using PubMed, Scopus, and Web of Science to identify studies on HSP47, thrombosis, and collagen, selecting only relevant and methodologically rigorous articles. HSP47 regulates platelet function and collagen interaction, playing a key role in deep vein thrombosis (DVT). HSP47, known for stabilizing collagen, also improves platelet–collagen binding and thrombus formation. In addition, reduced HSP47 levels reduce platelet adhesion, resulting in reduced thrombus formation, while inhibitors that target HSP47 decrease platelet aggregation in animal models. Naturally low levels of HSP47 during prolonged immobility are also found in hibernating mammals, such as bears, and are associated with reduced formation of thrombi, indicating a possible natural mechanism of thrombo-protection. This observation could inform new therapeutic approaches. Current studies use in vitro platelet aggregation assays, flow chamber assays, and collagen binding studies to investigate the role of HSP47 in clotting. This review aims to synthesize existing evidence to better understand HSP47’s role in clot formation and explore its potential as a target for novel DVT therapies. Full article

Background/Objectives: Worldwide, colon cancer is a major cause of cancer-related mortality, with an increasing incidence influenced by genetic, environmental, and lifestyle factors. Despite advances in diagnosis and personalized treatments, challenges remain in improving patient prognosis, particularly in metastatic colorectal cancer (mCRC). Bevacizumab (BEV), a monoclonal antibody, is widely used in colorectal cancer treatment. This study aimed to analyze adverse events associated with BEV compared with other therapies based on data from the EudraVigilance (EV) database. Methods: A descriptive and disproportionality analysis was conducted on signals reported in the EV database related to BEV. The study included comparisons with other antineoplastic treatments, such as chemotherapy, targeted therapy, and immunotherapy. Patient demographics, severity of adverse drug reactions (ADRs), and distribution patterns were analyzed to assess the safety profile of BEV in colorectal cancer treatment. Results: The majority of the signals for BEV were from patients aged 18–64 years (39.42%) and 65–85 years (34.08%). Hypertension, thromboembolism, proteinuria, and gastrointestinal disorders have been the most frequently reported. Serious ADRs, including gastrointestinal perforations, hemorrhage, and arterial thromboembolism, were observed in 93.74% of Individual Case Safety Reports. BEV was associated with a higher likelihood of vascular and endocrine disorders compared with chemotherapy and other targeted therapies. Immunotherapy was linked to increased immunological ADRs, while BEV demonstrated fewer immune-related toxicities. Conclusions: Continuous monitoring is necessary to optimize patient management, particularly in elderly patients or those with cardiovascular comorbidities. Understanding BEV’s safety profile allows for better personalization of treatment strategies, minimizing risks while enhancing therapeutic outcomes. Full article

Skin microbiota plays a crucial role in host defense. Disruptions in this balance can lead to systemic infections. Colonization by pathogenic microorganisms significantly increases the risk of symptomatic infections, prolongs hospital stays and increases healthcare costs. In Romania, the widespread misuse of antibiotics in the community further complicates the management of bacterial resistance, emphasizing the need for proactive measures. Our institution implemented a comprehensive multi-body-site colonization screening protocol starting from January 2024 until June 2024. The screening targeted high-risk patients, including those in ICUs, Oncology, and Hematology Clinics, and individuals with prior hospitalizations, antibiotic use, or medical devices. This study aimed to investigate the prevalence of colonization by multidrug-resistant organisms upon hospital admission and assess the changes in colonization rates during hospitalization. Samples from nasal, axillary, inguinal, and rectal swabs were processed on specialized chromogenic media to detect multidrug-resistant organisms such as methicillin-resistant S. aureus (MRSA), ESBL-producing Enterobacterales, and carbapenemase-producing bacteria. During the first two trimesters of the year 2024, 1522 patients aged 14 to 99 years underwent multi-body-site colonization screening at the County Clinical Emergency Hospital Sibiu, Romania. A total of 18,993 samples were analyzed, yielding a diverse range of bacterial isolates. The most common results were Escherichia coli-ESBL-negative (3584 cases, 18.9%) and the KESC bacteria group (Klebsiella spp., Enterobacter spp., Serratia spp., and Citrobacter spp.)-MDR-negative (3435 cases, 18.1%). Conversely, positive results were less frequent, with Acinetobacter baumannii-MDR-positive results in 62 cases (0.3%), E. coli-ESBL-positive results in 342 cases (1.8%), and KESC group-MDR-positive results in 491 cases (2.6%). Other notable findings included Enterococcus faecium-VRE-positive (157 cases, 0.8%) and MRSA-positive nasal swabs (141 cases, 0.7%). Rare isolates included Enterococcus faecalis-VRE-positive (4 cases, 0.0%) and Proteeae group-MDR-positive (33 cases, 0.2%). Negative screening for MRSA was prevalent across nasal (1850 cases, 9.7%), inguinal (742 cases, 3.9%), and axillary swabs (1124 cases, 5.9%), with substantially lower positive rates. The diversity of swab types and their distribution across various clinics and departments underscores the broad diagnostic approaches and patient-care strategies adopted during the study. These findings highlight the need for tailored infection prevention strategies and continuous surveillance to mitigate the spread of multidrug-resistant organisms and enhance patient safety across diverse clinical environments. Full article

Background: Due to the increasing global prevalence of Alzheimer’s dementia (AD), neuromodulation techniques such as transcranial direct current stimulation (tDCS) and photobiomodulation (PBM) are considered potential complementary therapies. Objective: We assessed the efficacy and safety of tDCS and PBM and their potential to enhance cognitive functions in individuals with AD. Methods: This review primarily examined studies designed to evaluate the efficacy, followed by an assessment of the safety of tDCS and PBM for people with AD. The databases searched were PubMed, Scopus, and Web of Science Core Collection, resulting in 17 published randomized and controlled trials. References were screened over 5 years (2020–2024). The research design used PRISMA guidelines. Results: Fourteen studies were considered for tDCS, and the current literature supports efficacy and safety at an amperage of 2 mA, with electrodes placed on the dorsolateral prefrontal cortex (DLPFC). Three studies were included for PBM. The heterogeneity of these study measures made them unsuitable for combined efficacy analysis, and they did not provide a safety evaluation. Conclusions: Despite differences in efficacy assessments, tDCS and PBM improved cognitive abilities. There is an urgent need to standardize metrics for evaluating efficacy and safety, particularly for PBM. Future research is encouraged. Full article

Background: Phototherapy, which has traditionally been used for seasonal affective disorder, is now being investigated for its effectiveness in treating non-seasonal depression. This systematic review aims to evaluate the efficacy and safety of phototherapy in this new context, providing a comprehensive overview of its therapeutic potential and limitations. Methods: The review followed PRISMA guidelines and included studies from databases such as Google Scholar, PubMed, and UpToDate. Studies were selected based on their focus on phototherapy’s efficacy, safety, and application methods for non-seasonal depression. Various administration methods were examined, particularly the effects of multiple daily sessions and personalized treatment plans. Results: The findings indicate that while phototherapy alone has limited effectiveness, combining it with antidepressants significantly improves outcomes. The most effective protocols featured multiple daily sessions tailored to individual patient needs, even at lower light intensities. Safety assessments have shown that phototherapy is well tolerated, with no serious side effects reported, only minor and transient reactions. Conclusions: Phototherapy appears to be a promising adjunct therapy for non-seasonal depression, offering safety and flexibility in treatment customization. It provides consistent therapeutic benefits, mainly when used in conjunction with conventional antidepressant treatments. Full article

Background/Objectives: Ventilator-associated pneumonia (VAP) remains a critical challenge in ICU settings, often driven by the biofilm-mediated bacterial colonization of endotracheal tubes (ETTs). This study investigates antimicrobial resistance patterns and biofilm dynamics in ICU patients, focusing on microbial colonization and resistance trends in tracheal aspirates and endotracheal tube biofilms at a county emergency hospital in Romania. Methods: We conducted a longitudinal analysis of ICU patients requiring mechanical ventilation for more than 48 h. Tracheal aspirates and ETT biofilms were collected at three key time points: T1 (baseline), T2 (48 h post-intubation with ETT replacement), and T3 (92–100 h post-T2); these were analyzed using sonication and microbiological techniques to assess microbial colonization and antimicrobial resistance patterns. Results: In a total of 30 patients, bacteria from the ESKAPEE group (e.g., Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus) dominated the microbiota, increasing their prevalence over time. Resistance to carbapenems, colistin, and vancomycin was notably observed, particularly among K. pneumoniae and A. baumannii. Biofilm analysis revealed high persistence rates and the emergence of multidrug-resistant strains, underscoring the role of ETTs as reservoirs for resistant pathogens. The replacement of ETTs at T2 correlated with a shift in microbial composition and reduced biofilm-associated contamination. Conclusions: This study highlights the temporal evolution of antimicrobial resistance and biofilm-associated colonization in a limited number of ICU patients (30 patients). The findings support implementing routine ETT management strategies, including scheduled replacements and advanced biofilm-disruption techniques, to mitigate VAP risk and improve patient outcomes. Full article

The brown bear (Ursus arctos arctos) is the only bear species on the Romanian territory, its natural habitat occupying a third of the country’s surface, including the entire mountain area as well as the hills in the immediate vicinity. The bear population in Romania is the largest in Europe, increasing every year due to legislative protection, the species being present in Annex II of the Habitats Directive. The fragmentation of the bears’ habitat is the main cause of conflict occurrences between bears and the human population, which have occurred increasingly often in recent years. The main aim of this study is the ecological diagnosis of lands populated with bears in Romania to identify the highest quality habitats within the hunting grounds and to identify possible ecological corridors aimed at preserving the connectivity between them, using GIS spatial analysis techniques and taking into account the ecological conditions needed for the brown bear to survive. Following the spatial modelling of the open-source data, it was possible to observe the presence of habitats of the highest quality that could support a bear population outside the areas where bear specimens are concentrated (the counties of Mureș, Bistrița, Harghita, Covasna, Neamț, Buzau, Vrancea, Prahova, Brașov, Sibiu, and Argeș). The analysis of these habitats, where the bear population has exceeded the optimal level that they can support, highlighted that to allow the passage of bear specimens from one habitat to another, it is necessary to create ecological corridors in several key areas deducted on the basis of mathematical models. Full article

Background and Objectives: Anlotinib, a novel multi-kinase inhibitor targeting angiogenesis and tumor proliferation pathways, has shown promising efficacy in various cancers. Its role in treating thyroid cancer, particularly radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC), medullary thyroid carcinoma (MTC), and anaplastic thyroid carcinoma (ATC), is of significant clinical interest. This systematic review aims to evaluate the efficacy and safety of Anlotinib in patients with thyroid cancer, analyzing outcomes such as progression-free survival (PFS), overall survival (OS), response rates, and adverse events. Methods: A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science databases up to October 2023. The review included randomized controlled trials and prospective studies assessing Anlotinib in thyroid cancer patients. Data extraction and quality assessment were performed independently by two reviewers following PRISMA guidelines. Results: Six studies involving a total of 277 patients were included. In patients with RAIR-DTC, Anlotinib demonstrated significant improvement in median PFS and objective response rates. In advanced or metastatic MTC, Anlotinib significantly prolonged median PFS compared to placebo, with high objective response rates. Subgroup analyses showed that older patients and those with bone metastases benefited significantly from Anlotinib treatment. In patients with ATC, Anlotinib-based chemotherapy yielded a 60% objective response rate. Anlotinib was also effective as neoadjuvant therapy in locally advanced thyroid cancer, achieving an objective response rate of 76.9%. Common adverse events included hypertension, proteinuria, and palmar–plantar erythrodysesthesia syndrome, which were generally manageable. Conclusions: Anlotinib appears to be an effective and well-tolerated treatment option for patients with various types of thyroid cancer, providing significant improvements in PFS and objective response rates. Further large-scale randomized studies are warranted to confirm these findings and to explore long-term outcomes. Full article