Search Results (648)

Background: Leishmaniasis is a vector-borne neglected tropical disease caused by obligate intracellular protozoan parasites of the genus Leishmania and transmitted by bites from infected female phlebotomine sand flies. Visceral leishmaniasis (VL), the most severe clinical form, remains a major public health concern in Eastern Africa and a priority for control and elimination. Although Baringo County is a well-established endemic focus in Kenya, the spatial distribution of human exposure and the socio-environmental determinants of infection remain inadequately characterized. This hospital-based cross-sectional study therefore estimated Leishmania seroprevalence. It assessed the sociodemographic, behavioral, and environmental predictors of seropositivity among patients presenting with clinical features suggestive of VL in two endemic sub-counties of Baringo County. Methods: A hospital-based cross-sectional study was conducted from January to March 2026 at Marigat and Chemolingot Sub-County Hospitals. We enrolled 260 patients with clinical features suggestive of VL through systematic sampling and tested them using the rK39 rapid diagnostic test (RDT) and an indirect enzyme-linked immunosorbent assay (ELISA). We collected sociodemographic, behavioral, household, and environmental data using a structured questionnaire. Associations between explanatory variables and ELISA seropositivity were evaluated using Pearson’s chi-square test or Fisher’s exact test. We included variables with p < 0.25 in multivariable logistic regression to identify independent predictors of seropositivity. Agreement between the rK39 RDT and ELISA was assessed using Cohen’s kappa statistics. We confirmed classical positive cases using bone marrow aspirates. Results: Overall Leishmania seroprevalence was 18.5% (95% CI: 14.2–23.7) by rK39 RDT and 20.8% (95% CI: 16.2–26.2) by ELISA. ELISA seroprevalence was substantially higher in Tiaty Sub-County (36.6%) than in Baringo South Sub-County (4.7%). Residence in Tiaty was independently associated with markedly higher odds of seropositivity than residence in Baringo South [aOR] = 11.30, 95% CI: 1.96–64.97; p = 0.007. Compared with children aged < 15 years, participants aged 15–44 years had lower odds of seropositivity (aOR = 0.30, 95% CI: 0.11–0.93; p = 0.037). Residents without a dog had higher odds of seropositivity (aOR = 3.17, 95% CI: 1.06–9.50; p = 0.039) than those with a dog. After adjustment, no other predicted factors were independently associated with seropositivity, suggesting that geographical differences may have confounded the unadjusted associations. Conclusion: Leishmania seroprevalence was substantial and unevenly distributed, with Tiaty Sub-County and children under 15 years bearing the greatest burden. Therefore, targeted, child-focused surveillance and integrated One Health interventions, including early case detection, improved housing, personal protection, vector-habitat management, and community education, are needed to strengthen VL control and advance the WHO 2030 targets for the Neglected Tropical Diseases Roadmap 2021–2030. Full article

Background and Objectives: Antimicrobial resistance among Gram-negative bacilli is a major clinical challenge, particularly in hospitals where carbapenem-resistant and multidrug-resistant organisms limit therapeutic options. This study aimed to characterize the distribution and resistance profiles of Gram-negative bacilli isolated in a university-affiliated hospital in western Romania during 2024–2025, focusing on temporal variation, intensive care unit (ICU) origin, carbapenem resistance, and multidrug resistance (MDR). Materials and Methods: This retrospective, single-center study included 8931 Gram-negative isolates recovered from clinical specimens between January 2024 and December 2025. Bacterial identification was performed using the VITEK 2 Compact system and/or MALDI-TOF mass spectrometry, whereas antimicrobial susceptibility testing was performed using the VITEK 2 system and interpreted according to EUCAST criteria. Carbapenem resistance was defined as resistance to meropenem, imipenem, or ertapenem for Enterobacterales and to meropenem or imipenem for Pseudomonas aeruginosa and Acinetobacter baumannii. MDR was defined as resistance to at least one agent in at least three antimicrobial classes. Factors associated with MDR were evaluated using multivariable logistic regression. Results: Escherichia coli was the most frequent isolate (36.0%), followed by Klebsiella pneumoniae (22.8%), P. aeruginosa (9.6%), A. baumannii (9.4%), and Proteus mirabilis (8.0%). Among 8708 isolates evaluable for both outcomes, carbapenem resistance was 30.8% and MDR was 44.5%; both were significantly more frequent in 2025 than in 2024. ICU isolates showed higher carbapenem resistance (56.1% vs. 18.0%) and MDR (65.3% vs. 33.9%) than non-ICU isolates. A. baumannii had the highest burden, with 87.4% carbapenem resistance and 87.5% MDR. MDR was independently associated with study year, ICU origin, age group, sex, specimen type, and bacterial species; the strongest association was observed for A. baumannii versus E. coli (adjusted OR 23.45, 95% CI 18.38–29.91). Conclusions: Carbapenem resistance and MDR were frequent, particularly among ICU isolates and high-risk pathogens. The findings support intensified local surveillance, antimicrobial stewardship, and targeted infection prevention and control measures. Full article

Rapid metropolitan expansion and population redistribution have posed increasing challenges to the spatial coordination between healthcare supply and demand. This study examines urban Shijiazhuang, a rapidly urbanizing provincial capital in the Beijing–Tianjin–Hebei urban agglomeration (BTHUA), to investigate how accessibility and spatial equity vary between central and peripheral urban districts at each healthcare level. The Gaussian two-step floating catchment area (Ga2SFCA), Gini coefficient, and accessibility-based population location quotient (APLQ) were employed to identify spatial inequities in healthcare resource allocation. The results indicate that tertiary healthcare resources remain disproportionately concentrated in central urban districts, while their spatial expansion has lagged behind population growth in the peripheral urban districts. Secondary hospitals partially alleviate this imbalance by forming regional service nodes toward peripheral areas, whereas primary healthcare institutions provide broader coverage but cannot compensate for the insufficient supply of higher-level healthcare resources. Spatial equity is generally higher in the central than in the peripheral urban districts, indicating that healthcare disparities in Shijiazhuang exhibit a pronounced central–peripheral pattern rather than being explained solely by the conventional urban–rural divide. Localized supply–demand deficits are particularly evident in northern Zhengding County and parts of Gaocheng District. Accordingly, five functional healthcare zones were identified to guide differentiated planning and resource allocation, promoting healthcare equity and sustainability in rapidly urbanizing regions. Full article

Background/Objectives: Noninvasive imaging of the skin in the assessment of basal cell carcinoma (BCC) is a promising field of research. Ultrasound stands out because of its ease of use, low price point and versatility. Ex vivo ultrasound can be used to obtain detailed measurements of tumor size, depth and margin assessment. These measurements can be compared with histopathological measurements. Methods: We performed a prospective study on formaldehyde-fixed tissue samples at the Pathology Department of Timisoara County Hospital. A total of 19 consecutive basal cell carcinomas from 17 patients were included in the study. Results: The study cohort was predominantly male (76.5% versus 23.5%), with a median age of 73 years (interquartile range: 62–77 years). Most lesions were excised from the head and neck region (84.2%) and were primarily classified as nodular (42.1%) and infiltrative (36.8%) subtypes by histopathological assessment. Bland–Altman analysis comparing ultrasound measurements to histopathology revealed no statistically significant systematic or proportional bias for tumor depth and deep margin measurements; however, the limits of agreement were wide for all three parameters: tumor depth (−3.35 to +3.77 mm), deep margin (−3.36 to +2.65 mm), and maximum diameter (−17.32 to 14.55 mm). Statistically significant proportional bias was observed in ultrasound-based assessments of tumor size. An additional exploratory analysis evaluated the diagnostic accuracy of ex vivo ultrasound in identifying tumors with invasion depths exceeding 2 mm relative to histological analysis. Conclusions: Our results suggest that ex vivo HFUS at 22 MHz is not interchangeable with histopathology. Nevertheless, the results reported in this pilot study will be useful to inform future research and will serve as a framework for reporting HFUS results in dermato-oncology. Full article

Background and Objectives: This exploratory single-center retrospective cross-sectional study characterized patients with documented diabetic peripheral neuropathy (DPN) according to documented GLP-1-based medication status. GLP-1-based medication status was defined by a hospital medication-field entry for exenatide, dulaglutide, semaglutide, a fixed-ratio insulin/GLP-1 receptor agonist combination, or tirzepatide, a dual GIP/GLP-1 receptor agonist. Materials and Methods: Medication-level records from a hospital-defined February 2024–February 2026 reporting window were aggregated by PatID for 4120 unique patients in active-patient exports from the Clinical County Emergency Hospital Bihor. The files lacked patient-level encounter, diagnosis, and treatment dates; therefore, they were analyzed as an undated reporting snapshot. DPN and diabetes type were defined from export fields and were not independently clinically validated. Results: GLP-1-based medications were documented in 852 patients (20.7%). Patients with these medications in their records had longer documented diabetes duration (14.85 ± 8.64 vs. 11.72 ± 8.73 years; p < 0.001) and a higher documented comorbidity count (2.64 ± 1.65 vs. 1.89 ± 1.55; p < 0.001). Heart failure was documented in 35.7% versus 22.2%, and any lower-limb amputation in 3.3% versus 1.2%. For heart failure, the adjusted odds ratio was 1.68 (95% CI 1.41–1.99) in the primary model and 1.37 (1.12–1.67) in the expanded exploratory model; the corresponding robust Poisson prevalence ratio was 1.45 (1.30–1.63). Because only 66 amputations were recorded, amputation was retained as a descriptive, unadjusted outcome and was not modeled multivariably. Conclusions: A GLP-1-based medication record identified a clinically complex subgroup with documented DPN. The findings are exploratory and hypothesis-generating; because treatment and outcome dates were unavailable, they do not establish temporality, treatment benefit, or treatment harm. Full article

Background and Objectives: Superior mesenteric artery syndrome (SMAS) is an uncommon cause of proximal duodenal obstruction that requires clinicoradiological correlation. Materials and Methods: We retrospectively reviewed 13 patients with SMAS identified at the Clinical County Emergency Hospital Bihor, Romania, during 2019–2024. Clinical records and contrast-enhanced computer tomography (CT) examinations were reviewed descriptively. Results: The cohort included 13 adults aged 19–85 years (mean 45.5 ± 17.8; median 43 years). Abdominal pain was reported in 12/13 patients (92.3%), vomiting or emetic symptoms in 6/13 (46.2%), feeding difficulty or appetite disturbance in 5/13 (38.5%), and documented weight loss in 3/13 (23.1%). CT measurements were available for the aortomesenteric angle in 7/13 patients (range, 10–25°) and for the aortomesenteric distance in 8/13 (range, 3–8 mm); direct third-part duodenal compression and proximal dilatation were interpreted together with compatible symptoms. Imaging showed Nutcracker-type left renal vein compression in 3/13 patients (23.1%) and possible May–Thurner anatomy in 1/13 (7.7%); these findings were not adjudicated as clinical syndromes without corresponding manifestations. Based on the management labels, 9/13 patients (69.2%) underwent surgery at some point and 4/13 (30.8%) received medical therapy only. Standardized follow-up and procedure-level outcome data were not available for all patients. Conclusions: This small, retrospective series is descriptive and cannot estimate prevalence, diagnostic delay, or comparative treatment effectiveness. It illustrates heterogeneous adult presentations and supports interpreting aortomesenteric measurements together with compatible symptoms and evidence of duodenal obstruction. Full article

Municipal wastewater catchments are significant sources of symbiotic, opportunistic, and drug-resistant bacteria that can acquire or enhance their resistance. This “re-emergence of threats” presents a serious public health issue, especially during crisis conditions (COVID-19). The aim of this study was to propose a sampling algorithm, identify strategically important sites within the wastewater catchment, expand the range of bacterial indicators, and rapidly confirm potential threats using in vitro diagnostics in both raw and treated sewage. A parallel objective was to evaluate the effectiveness of sequencing methods in pre-epidemic studies. The research was conducted as part of a long-term surveillance program at transportation hubs, healthcare facilities, residential complexes, and wastewater treatment plants in Warsaw, Poland. Total nucleic acid (TNA) was isolated from samples, amplified using qPCR kits, and selected samples underwent next-generation sequencing. In raw sewage, the most frequently detected regions included sequences complementary to the bacterial vanB gene, the Integron Verona-encoded metallo-β-lactamase (VIM) gene, and markers for Mycobacterium tuberculosis. Treated environmental effluents primarily contained DNA fragments complementary to the bacterial vanB sequence, along with genes related to resistance against oxacillin and imipenem, as well as the VIM gene and Legionella sp. 16S rRNA sequencing of the sewage samples revealed the presence of 12 promising bacterial indicators relevant to public health and environmental hygiene. The proposed algorithm aligns with the provisions of EU Directive 2024/3019 and in vitro diagnostic tests demonstrated the potential and utility of rapid screening analyses of wastewater during disruptions or crises, as well as in situations involving equipment shortages and logistical challenges in healthcare. The proposed expanded range of bioindicators could expedite decision-making regarding preventive measures and medical support for various counties, hospitals, and transportation hubs in large urban areas. The sequencing results further emphasized the need to broaden the scope of the bacterial indicators for environmental surveillance. Full article

Hospitalized COVID-19 frequently involves several organ systems at once, yet neuropsychiatric manifestations are often examined in isolation. In a retrospective single-center cohort study, a five-axis phenotype atlas was constructed (respiratory, cardiovascular, neuropsychiatric, hepato-gastrointestinal, and renal-urinary) from ICD-linked hospital records of 1361 adults hospitalized with confirmed SARS-CoV-2 infection at a Romanian county emergency hospital between March 2020 and January 2025. Candidate neuropsychiatric associations were evaluated under prespecified cross-axis adjustment, treatment- and indication-bias gates, penalized outcome models, and pandemic-era comparison. Multi-organ involvement was almost universal: 91.0% of admissions carried at least two axes. Neuropsychiatric positivity reached 22.9% but was dominant in 0.8%, while 98.1% of these patients carried another chronic organ axis. Of the 42 initial laboratory candidates, three correlated electrolyte associations remained after adjudication, suggesting that these associations were more consistent with shared renal-metabolic burden than with neuropsychiatric-specific biology. Renal-urinary involvement was independently associated with intensive care admission (OR 1.97) and in-hospital death (OR 2.58); neuropsychiatric positivity was not. The previously reported Late Omicron enrichment of severe neurological presentations remained evident after age and sex adjustment (adjusted OR 3.35) and was the only one of 35 prespecified claims retained as neuropsychiatric-specific. Renal-urinary rather than neuropsychiatric involvement carries the adjusted prognostic weight in hospitalized COVID-19, and, given the dependence of retrospective record-derived phenotypes on clinical documentation, multi-organ adjudication should precede organ-specific inference from hospital records. Full article

The implication of vitamin D in the pathophysiology of depression has generated interest regarding its role as a biomarker in the context of mental health. Given the limited data on this association in the Romanian population, the present study aimed to evaluate the correlation between vitamin D status and the severity of depressive symptomatology in a sample of adult patients from Romania. This cross-sectional study was conducted on 90 patients diagnosed with major depressive disorder who were admitted to the Department of Psychiatry at the County Clinical Emergency Hospital of Bihor during the period of 2024–2025. Serum vitamin D concentrations were determined by measuring the 25-hydroxyvitamin D metabolite in blood using the chemiluminescence microparticle immunoassay method. The severity of depressive symptomatology was quantified using two validated scales: the Beck Depression Inventory-II (BDI-II) and the Hamilton Depression Rating Scale 17 (HAM-D17). Multivariable linear regression and ordered probit regression were used to assess the relationship between vitamin D status and depression severity, with adjustments for relevant covariates. A statistically significant negative association was identified for the BDI-II scale (B = −0.3170444, β = −0.2621328, p = 0.007) and the HAM-D17 scale (B = −0.1495026, β = −0.2829461, p = 0.002), which remained robust after adjustment for covariates (BDI-II: B = −0.2110473, β = −0.1744942, p = 0.050; HAMD17: B = −0.1153659, β = −0.2183397, p = 0.018). In comparison with subjects with vitamin D deficiency, those with sufficient levels presented a significantly lower probability of belonging to higher severity categories of depression for both scales (BDI-II: coefficient = −0.6855429, p = 0.004; HAM-D17: coefficient = −0.7029572, p = 0.005). The study highlighted a statistically significant negative correlation between vitamin D status and depression severity, which remained after adjustment for covariates. Sufficient vitamin D levels were associated with a significantly lower probability of belonging to a higher depression severity category compared with deficiency. Full article

Background: Diabetes mellitus is frequently complicated by cardiovascular, neurological, and limb-threatening conditions, yet these complications are often evaluated separately. Heart failure, peripheral neuropathy, and lower-limb amputation may coexist in patients with advanced diabetes and may define a clinically severe cardio-neurovascular multimorbidity phenotype. This study evaluated the real-world overlap between these complications. Methods: This retrospective hospital-based study used four routinely generated patient-level exports from the electronic diabetes registry/clinical information system of the Clinical County Emergency Hospital Bihor, Oradea, Romania. The primary cohort comprised 2246 unique patients with diabetes and a recorded heart failure diagnosis; linked exports identified peripheral neuropathy and below- or above-ankle amputation. Results: Peripheral neuropathy was documented in 1028 patients (45.8%). Patients with neuropathy were older (median 70 [IQR 63–76] vs. 67 [IQR 59–73] years, p < 0.001) and had longer diabetes duration (15 [IQR 9–21] vs. 6 [IQR 1–11] years, p < 0.001) than patients without neuropathy. Any lower-limb amputation occurred in 35 patients (1.6%) and was more frequent among patients with neuropathy than among those without neuropathy (2.6% vs. 0.7%, p < 0.001). In the adjusted analysis, male sex, diabetes duration, and insulin therapy were independently associated with lower-limb amputation, whereas the association with neuropathy was attenuated. Conclusions: In this hospital-based retrospective cohort, peripheral neuropathy was common and identified a subgroup with longer-standing diabetes, more intensive therapy, and greater amputation burden. The findings indicate associations within a selected clinical population and should not be interpreted as causal or population-based estimates. Full article

Background: Toxoplasma gondii infection during pregnancy may lead to congenital toxoplasmosis and serious pregnancy complications. In Kenya, however, toxoplasmosis is not screened during routine antenatal care, and there is limited local data on maternal seroprevalence and associated risk factors. This study determined the seroprevalence of T. gondii infections. It examined its association with socio-demographic, obstetric characteristics, awareness levels, and exposure behaviours among pregnant women visiting the antenatal clinic at Pumwani Maternity Hospital in Nairobi, Kenya. Methods: A cross-sectional study was conducted among 298 pregnant women consecutively recruited at Pumwani Maternity Hospital in Nairobi County between July and October 2025. Data on socio-demographics, obstetric characteristics, knowledge, and exposure practices were collected using a structured questionnaire. Blood specimens were obtained from consenting prenatal patients, and anti-T. gondii IgG antibodies were detected by indirect enzyme-linked immunosorbent assay (ELISA). Associations between seropositivity and risk factors were assessed using univariable logistic regression, followed by two separate multivariable models. Variables with p < 0.25 were considered for multivariable analysis, followed by backward likelihood-ratio elimination. Model calibration was assessed using the Hosmer–Lemeshow test. Results: The overall seroprevalence of anti-T. gondii IgG was 24.5% (73 of 298). In the sociodemographic model, women who were self-employed (adjusted odds ratio [AOR] = 0.26, 95% CI: 0.13–0.53) and formally employed (AOR = 0.25, 95% CI: 0.11–0.59) had lower odds of seropositivity than unemployed women. Women aged 25–33 years had higher odds than those aged 18–24 years (AOR = 2.45, 95% CI: 1.06–5.62). Having two children was associated with lower odds than a first birth (AOR = 0.40, 95% CI: 0.18–0.90), while parity of four or more showed a borderline increase in odds (AOR = 3.11, 95% CI: 0.99–9.76). In the knowledge/exposure model, good awareness of population risk groups was linked to higher odds of seropositivity (AOR = 3.34, 95% CI: 1.21–9.24), but exposure-practice variables were not independently associated. Stratified analyses showed significant demographic differences in exposure practices, such as eating undercooked meat in the third trimester of pregnancy (p = 0.021) and unwashed vegetable consumption by pregnant women from Kamkunji Sub-County (p = 0.005). Parity of three increased infection risk (p = 0.007). Conclusions: About 25% of participants showed evidence of prior T. gondii exposure. Seropositivity correlated with specific sociodemographic and obstetric factors as well as awareness of groups at risk. These results endorse targeted antenatal education that emphasises practical food safety and environmental hygiene, aligned with a One Health approach. Further longitudinal and multicenter research, including IgM and IgG avidity testing, is needed to differentiate recent from past infections and to better understand risks associated with congenital toxoplasmosis. Full article

Background and Objectives: Necrotizing fasciitis (NF) is characterized by rapid and aggressive infection of the subcutaneous tissue and fascia, and a high risk of death in case of delay in diagnosis and treatment. Materials and Methods: This 7-year retrospective study (May 2017–May 2024) evaluated 38 patients with upper- and lower-limb NF admitted to the surgery clinic at the County Emergency Hospital in Craiova, Romania. Results: 21.8% of the confirmed NF cases were monomicrobial; Gram-positive strains were predominant, but Gram-negative strains were also involved. The mortality rate was 28.9%; acute kidney injury appears as the only independent risk factor associated with mortality, although in univariate analysis, septic shock and high NLR and INR values were also factors associated with mortality. An increased resistance rate to antibiotics was recorded, with a 32.7% MDR rate; moderate to high resistance to piperacillin + tazobactam, most cephalosporins, most carbapenems (for Gram-negative strains), and quinolones was noted. Conclusions: Multidisciplinary management, comprising intensive medical support, prompt targeted antibiotic therapy, and immediate surgical intervention, was critical for achieving favorable patient outcomes. Increasing antibiotic resistance may alter the prognosis in patients with NF. Full article

Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a severe adverse event associated with antiresorptive therapy, particularly bisphosphonates, and represents a significant challenge in oral and maxillofacial practice. This study aimed to characterize the epidemiological profile, clinical presentation, and anatomical distribution of bisphosphonate-related osteonecrosis of the jaw (BRONJ) and to investigate potential associations between demographic variables and major underlying systemic diseases. Methods: A retrospective single-center observational study was performed using medical records collected between January 2020 and December 2025 at the Emergency County Clinical Hospital of Craiova. After data validation and removal of duplicate records, 121 patients diagnosed with osteonecrosis of the jaw were identified. Among them, 94 patients fulfilled the inclusion criteria for BRONJ and were included in both the statistical and clinical analyses. Demographic characteristics, systemic diseases, bisphosphonate therapy, lesion localization, clinical manifestations, and statistical associations were evaluated using appropriate non-parametric and categorical statistical methods. Results: The final analytical sample comprised 94 patients with BRONJ associated with bisphosphonate therapy. Of these, 75 (79.8%) had received bisphosphonates for malignant disease and 19 (20.2%) for osteoporosis. The mandible was affected in 77% of patients, predominantly in the posterior premolar–molar region, whereas maxillary lesions mainly involved the posterior maxilla and maxillary tuberosity. Exposed necrotic bone was identified in all patients, while purulent discharge and oral fistulas were recorded in 37% and 35% of cases, respectively. Associations involving sex, age, residence, diabetes, hypertension, and other comorbidities were re-evaluated using the final 94-patient cohort. Conclusions: Among the BRONJ cases identified at this referral center, most patients had received bisphosphonate therapy for malignant disease, and lesions showed a marked predilection for the mandible, particularly its posterior region. These findings describe the clinical profile of the cases managed at our institution but do not permit estimation of BRONJ incidence or comparative risk between treatment regimens. The results support careful dental assessment before bisphosphonate therapy and multidisciplinary follow-up of patients receiving antiresorptive treatment. Full article

Background: Romania has one of the highest cervical cancer incidence and mortality rates in the European Union (EU) and one of the lowest levels of screening participation. We examined eight years of screening activity at an accredited centre in Bihor County, north-western Romania, encompassing the pre-pandemic period (2018–2019), the COVID-19 pandemic (2020–2021), the post-pandemic recovery (2022–2023) and the transition from primary cytology to primary human papillomavirus (HPV) DNA screening (2024–2025). Methods: This retrospective, single-centre study included 17,807 de-identified screening-episode records collected between 2018 and 2025 at Pelican Clinical Hospital, Oradea. Cytology was the primary screening test in the cytology era (2018–2023), whereas high-risk HPV (HR-HPV) DNA testing (cobas HPV Test, Roche, Pleasanton, CA, USA) with reflex cytology was used in the HPV-primary era (2024–2025). Screening activity was expressed relative to the provider’s registered administrative catchment of 65,978 women. Because quarterly counts were markedly overdispersed, changes in screening volume were analysed using negative-binomial incidence-rate ratios (IRRs) and a segmented negative-binomial interrupted time-series; cytological positivity was evaluated using age-adjusted logistic regression and the Cochran–Armitage trend test. Results: The number of screening episodes recorded over eight years corresponded to 27.0% (95% confidence interval [CI] 26.6–27.3) of the registered catchment, while annual throughput never exceeded 5.2%. Mean monthly screening volume declined from 264.5 tests in the pre-pandemic period (2018–2019) to 88.6 during the pandemic (2020–2021; IRR 0.335, 95% CI 0.177–0.634; 66.5% reduction; p < 0.001), corresponding to an estimated deficit of approximately 3700 tests; the interrupted time-series estimated an immediate 86% reduction at lockdown onset. Activity recovered to 61% of the pre-pandemic rate during the post-pandemic recovery (2022–2023; IRR 0.614, 95% CI 0.482–0.783) and to 90% in the HPV-primary era (2024–2025; IRR 0.898, 95% CI 0.733–1.100), coinciding with the transition to primary HPV screening. All primary HPV tests produced valid results, compared with an annual unsatisfactory-sample rate of 2.9–4.2% during primary cytology. Cytological positivity remained stable during 2018–2023, and the cytological high-grade squamous intraepithelial lesion (HSIL) detection rate per 1000 screened did not change significantly during the pandemic, although absolute HSIL detections declined with screening volume. In 2024–2025, HR-HPV positivity was 22.8% (1301/5700; 95% CI 21.8–23.9), and 47.9% of HPV-positive women had abnormal reflex cytology. Conclusions: The pandemic substantially reduced screening activity at a provider already operating with low throughput relative to its registered catchment. Activity subsequently returned to near pre-pandemic levels during the period coinciding with the introduction of primary HPV screening, which also improved primary-sample adequacy. However, the absence of persistent patient linkage and of follow-up data from colposcopy, histology and treatment precluded estimation of population-based coverage, screening intervals and detection of histologically confirmed cervical intraepithelial neoplasia grade 3 or worse (CIN3+). The findings support population-based invitation and recall, clearly defined age-specific screening and follow-up algorithms, self-sampling, targeted catch-up after pandemic-related delays and longitudinal evaluation using histologically confirmed CIN3+ as the principal clinical endpoint. Full article

(1) Background: Communication barriers may complicate forensic psychiatric assessment of deaf or hard-of-hearing individuals. (2) Methods: This retrospective descriptive case series reviewed 450 unique adults with institutional and forensic psychiatric records at a high-security hospital in Iasi County, Romania (2015–2025). Six individuals (N = 6; 6/450, 1.33%) met the record-based criteria for profound bilateral hearing loss with severe speech or spoken-language impairment. No examination was performed specifically for the study. (3) Results: Four of six individuals had documented congenital or prelingual profound bilateral hearing loss, and two had profound bilateral coexisting conductive and sensorineural hearing-loss components. Four had no formal schooling, and two had partial compulsory schooling; all six lacked documented standardized sign-language competence. Initial records did not document effective communication access or audiological confirmation, and psychiatric formulations were inconclusive or changed over time. Forensic discernment was recorded as absent in 5/6 individuals (83.3%). (4) Conclusions: Communication limitations may have contributed to assessment uncertainty alongside educational, cognitive, psychiatric, and social factors. The series does not confirm misdiagnosis, causation, or population prevalence. Full article