Mircea Iurciuc

Background/Objectives: Missed nursing care is a patient-safety concern shaped by organizational resources, workload, and care prioritization. No Romanian version of the Revised MISSCARE Survey has previously undergone published cross-cultural and psychometric evaluation. This study translated and culturally adapted the instrument and examined its preliminary measurement properties and item-level findings in a Romanian hospital. Methods: A methodological, cross-sectional, single-centre pilot study invited all 487 nurses employed at a large university-affiliated hospital in western Romania. Translation and back-translation, expert review, and pretesting preceded electronic administration. Part A activities and Part B reasons were summarized descriptively. The Part B structure was investigated using polychoric correlations, parallel analysis, minimum-residual extraction, and promax rotation. McDonald’s omega and ordinal alpha assessed internal consistency. A unique-response-pattern sensitivity analysis evaluated stability. Results: Overall, 266 nurses participated (response proportion, 54.6%). Ambulation or mobilization was the most frequently missed activity, reported as missed at least occasionally by 55.3% of respondents, followed by bathing and skin care (36.8%), turning every two hours (36.5%), and mouth care (35.3%). The leading moderate or significant reasons were inadequate assistive or clerical personnel (84.6%), unexpected patient volume or acuity (83.5%), and inadequate staffing (82.7%). Parallel analysis supported two correlated Part B factors: organizational resources, coordination, and support; and staffing and workload pressure (r = 0.658). Omega was 0.968 and 0.943, respectively. The two-factor solution and item rankings remained stable in sensitivity analyses. Conclusions: The Romanian Revised MISSCARE Survey produced interpretable item-level findings and preliminary evidence of a two-factor structure for Part B, with high internal consistency within each factor.

Background: Preeclampsia is characterized by systemic inflammation, endothelial dysfunction, and progressive abnormalities in the maternal vasculature. Interleukin-6 (IL-6) may indicate inflammatory activity, while aortic pulse wave velocity (PWVao) and augmentation index (AIx) offer complementary assessments of arterial stiffness and vascular function. This study examined the relationships among IL-6, proteinuria, and arterial stiffness in women with preeclampsia. Methods: This observational study involved 87 pregnant women with preeclampsia who were evaluated at the Emergency Clinical Hospital “Pius Brînzeu” in Timișoara, Romania. Arterial stiffness was measured non-invasively with the Arteriograph system during the second trimester (20–24 weeks) and the third trimester (32–36 weeks). PWVao served as the primary marker of arterial stiffness, whereas AIx provided a complementary measure of arterial wave reflection. Serum IL-6 levels were quantified by enzyme-linked immunosorbent assay, and 24 h proteinuria was recorded. Associations among inflammatory, renal, and vascular parameters were examined using Spearman correlation analyses. Multivariable linear regression then identified independent predictors of third-trimester PWVao. Results: The mothers had a mean age of 37.59 ± 2.65 years, and the mean BMI was 30.41 ± 2.70 kg/m². PWVao rose significantly between the second and third trimesters, from 10.94 ± 1.36 m/s to 12.46 ± 1.70 m/s (p < 0.001). AIx also increased, from 1.26 ± 0.85% to 3.66 ± 1.32% (p < 0.001). The mean serum IL-6 concentration was 31.01 ± 35.61 pg/mL. No significant correlation was found between IL-6 and PWVao in either the second trimester (ρ = −0.100, p = 0.356) or the third trimester (ρ = −0.100, p = 0.358), and IL-6 was not significantly correlated with AIx. A significant positive correlation was observed between IL-6 and 24 h proteinuria (ρ = 0.337, p = 0.0014). Proteinuria itself showed no significant association with PWVao or AIx. In the multivariable analysis, only BMI independently predicted third-trimester PWVao (β = 0.634, 95% CI: 0.469–0.799, p < 0.001). Age, systolic blood pressure, proteinuria, and IL-6 showed no independent association with PWVao. Nor were IL-6, proteinuria, or third-trimester PWVao significantly associated with birth weight or the 1 min Apgar score. Conclusions: Among women with preeclampsia, arterial stiffness increased progressively throughout pregnancy. Systemic inflammation, measured by IL-6, was more strongly associated with renal involvement than with mechanical arterial stiffness. BMI was the main independent determinant of third-trimester PWVao. Together, these results support a multidimensional view of preeclampsia, in which inflammatory, renal, metabolic, and vascular abnormalities form related yet partly distinct pathways. Assessing IL-6, proteinuria, BMI, and arterial stiffness together may improve maternal cardiovascular phenotyping and help establish future risk-stratification strategies.

Background: Acute chest pain is a common cause for presentation to the emergency department (ED), where rapid identification of patients at high risk for acute coronary syndrome is essential. The HEART score combines medical history, electrocardiogram, age, risk factors, and troponin levels to provide structured risk stratification. However, evidence regarding the HEART score in COVID-19 survivors presenting with acute chest pain remains limited. This study examined the distribution of HEART scores and their associations with decisions made in the emergency department, hospital management, rises in cardiac troponin levels, coronary revascularization, and in-hospital mortality. Materials and Methods: In this single-center retrospective observational study, 400 consecutive adult COVID-19 survivors who presented to the ED with acute non-traumatic chest pain were included. HEART scores were retrospectively calculated from routinely available clinical and laboratory data, and patients were categorized as low (0–3), moderate (4–6), or high risk (7–10). Results: The median HEART score was 2 (IQR 0–5); 264 patients (66.0%) were classified as low risk, 50 (12.5%) as moderate risk and 86 (21.5%) as high risk. The distribution of the total score was bimodal, with 128 patients (32.0%) scoring zero and 78 (19.5%) scoring 8–10. Cardiac troponin was above the upper reference limit at presentation or at one hour in 96 patients (24.0%): 3 of 264 low-risk patients (1.1%), 7 of 50 moderate-risk patients (14.0%) and all 86 high-risk patients (100%). Eighty-three patients (20.8%) were admitted to hospital, almost all from the high-risk category (82 of 86, 95.3%), compared with 1 of 50 moderate-risk patients (2.0%) and no low-risk patient. All 51 revascularisation procedures (46 percutaneous coronary interventions and 5 coronary artery bypass grafts) and all five in-hospital deaths (1.2% of the cohort) occurred among high-risk patients. In an exploratory, hypothesis-generating multivariable analysis of troponin elevation, older age (adjusted odds ratio 2.38 per decade, 95% CI 1.88–3.09) and smoking (4.10, 2.12–8.06) were associated with elevation and female sex was inversely so (0.22, 0.11–0.41); renal function was not available for adjustment. Conclusions: HEART score categories were associated with ED disposition and in-hospital management in this retrospective cohort of COVID-19 survivors presenting with acute chest pain. High-risk patients accounted for nearly all hospital admissions, coronary revascularizations, and in-hospital deaths. However, systematic post-discharge follow-up was not available; therefore, 30-day or 6-week MACE could not be assessed, and the prognostic performance of the HEART score or the safety of HEART-based discharge cannot be determined. These findings should therefore be interpreted as descriptive associations reflecting real-world clinical practice and warrant confirmation in prospective studies with systematic follow-up.

Background: The adverse cardiometabolic outcomes that have been associated with early menopause include obesity, insulin resistance, and metabolic syndrome. Other studies have also linked metabolic dysfunction with vitamin D deficiency. However, the independent association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with metabolic syndrome and type of menopause is unclear. Thus, the present study was designed to assess the association between vitamin D status and metabolic syndrome in women with early menopause compared with those with natural menopause. Methods: A total of 301 postmenopausal women were enrolled. Metabolic syndrome was assessed independently according to the NCEP-ATP III and IDF diagnostic definitions. They were classified into two groups: early menopause (EM, n = 79) and physiological menopause (PHYSM, n = 222). Demographic, anthropometric, biochemical, and lifestyle characteristics were recorded. The criteria for diagnosing metabolic syndrome were those of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and the International Diabetes Federation (IDF). Serum 25(OH)D was also categorized as deficiency, insufficiency, or sufficiency. Multivariable logistic regression analyses were used to determine independent predictors of metabolic syndrome. Multivariable linear regression analyses were used to determine the association between serum 25(OH)D and individual metabolic parameters. Results: Women with early menopause had a higher body mass index than those with physiological menopause, whereas current smoking was more prevalent among women with physiological menopause. No significant differences were observed between the groups in the prevalence of metabolic syndrome, 25(OH)D concentrations, lipid profile, blood pressure, glycaemic indices, or other biochemical parameters. In multivariable analyses, menopausal status was not independently associated with metabolic syndrome according to either the NCEP-ATP III or IDF criteria. Body mass index was the only independent predictor of metabolic syndrome in the adjusted IDF model (OR 1.2, 95% CI 1.0–1.4; p = 0.047). Serum 25(OH)D concentrations were independently associated only with lower fasting glucose levels and were not independently associated with metabolic syndrome or its other components. Although vitamin D categories showed significant associations with metabolic syndrome in unadjusted analyses, these associations were attenuated after adjustment for demographic, anthropometric, menopausal, and lifestyle-related factors. Conclusions: Menopausal type was not independently associated with the prevalence of metabolic syndrome or vitamin D status. Although metabolic syndrome prevalence differed across vitamin D categories in unadjusted analyses, these associations were attenuated after adjustment for demographic, anthropometric, menopausal, and lifestyle-related factors. Obesity appeared to be the strongest independent predictor of metabolic syndrome within this cohort. Given the retrospective observational design, these findings should be interpreted cautiously, and prospective longitudinal studies are warranted to confirm these associations.

Background: An early menopause (by definition, menopause that occurs at a woman’s age 40 through 45) is often associated with certain changes in the body that can result in risks for health-related conditions, an extended period later. Thus, scientists have begun examining how vitamin D has been suggested to be associated with endocrine function regulating both hormones and reproductive function during this time. However, it is not yet clear as to whether or not vitamin D provides any benefit to women who have experienced an early menopause. Material and Methods: The data was collected from 272 women in this retrospective, observational study at The County Hospital, Department of Obstetrics and Gynecology, Arad. The method of grouping the sample included two stratifications into early and physiological menopause categories based on amenorrhoea for a minimum of 12 consecutive months. 25-hydroxyvitamin D (25(OH)D) levels were classified into three categories: deficiency (p = 0.0016), as well as between progesterone and LH (i.e., r = −0.207, p = 0.026). There was not a statistically significant relationship between total sample vitamin D and estradiol (i.e., r = −0.038, p = 0.686) nor between vitamin D and progesterone (i.e., r = 0.031, p = 0.744). Women with vitamin D blood levels of 30 ng/mL or more showed a strong negative relationship between vitamin D and estradiol (r = −0.780; p = 0.0016) and a moderate positive relationship with progesterone (r = 0.534; p = 0.0104). However, these relationships were inconsistent in other groups. All group comparative analyses showed that women in the early menopause group had much lower estradiol levels than those in the physiological menopause group, regardless of whether they were classified based on their vitamin D levels (p < 0.0001). Conclusions: Women experiencing early or physiological menopause are at risk of having low vitamin D levels. However, our study results do not show a consistent relationship between serum 25(OH)D concentrations and serum estradiol or progesterone concentrations among the study population, suggesting that vitamin D is not a major factor influencing hormonal changes during menopause. These findings were inconsistent across analyses and should be interpreted cautiously. Overall, the results do not support a significant association between serum 25(OH)D concentrations and reproductive hormone levels in our study population.

Background/Objectives: Secondary traumatic stress (STS) affects healthcare professionals indirectly exposed to patients’ trauma, and emergency personnel may be particularly vulnerable. Evidence from Romania is limited. Methods: We conducted a cross-sectional survey (July–August 2025) among emergency medical professionals working across the integrated emergency care system in Timisoara, Romania (prehospital ambulance/SMURD services and hospital Emergency Department). Secondary Traumatic Stress (STS) symptoms were measured using the 17-item Secondary Traumatic Stress Scale (STSS; item coding 1–5). We summarized STSS total/subscale scores and reliability, classified total scores into severity categories (0–68 metric), compared scores by workplace, sex, and professional role, and examined associations with age and years of experience. Results: The analytic sample included 145 participants (49.0% women), with a median age of 44 years [33–50] and median professional experience of 10 years [5–15]. Mean total STSS was 36.4 (SD 11.9; range 17–66) and internal consistency was high (Cronbach’s alpha = 0.92). Most participants were classified as little/no STS (77.2%), followed by mild (12.4%), moderate (5.5%), high (4.1%), and severe (0.7%). STSS scores did not differ significantly between ambulance service and ED/UPU staff. Women reported higher total STSS than men (39.0 vs. 33.9; p = 0.010), with significant differences for intrusion (p = 0.035) and arousal (p = 0.004). Role differences were significant for total STSS, intrusion, and arousal (p ≤ 0.031), with nurses scoring higher than ambulance drivers/attendants in post hoc comparisons. Years of experience showed small positive correlations with total STSS (r = 0.18, p = 0.032) and intrusion (r = 0.21, p = 0.010); age was associated with intrusion only (r = 0.22, p = 0.008). Conclusions: In this Romanian emergency care cohort, most participants reported low STS severity, but a clinically relevant minority had moderate-to-severe symptoms. Higher symptom burden among women and nurses suggests groups that may benefit from targeted monitoring and support within the integrated emergency system.

Background/Objectives: Patients with rheumatoid arthritis (RA) have an increased risk of chronic kidney disease (CKD) and cardiovascular disease, largely driven by persistent systemic inflammation. This study aimed to assess the risk of CKD in RA patients and to evaluate its association with structural joint damage and cardiovascular risk (CVR). Methods: In this cross-sectional study, 70 patients fulfilling the 2010 ACR/EULAR criteria for RA were evaluated. Structural joint damage was assessed using the Sharp/van der Heijde score (SHS). Renal involvement was evaluated by estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (ACR), and intrarenal resistive index (RRI). CVR was assessed using the SCORE system, adjusted according to EULAR recommendations, and carotid ultrasonography was performed to assess intima–media thickness (IMT) and atherosclerotic plaques. Results: SHS was significantly correlated with renal and vascular parameters, showing positive associations with ACR, RRI, and carotid IMT, and a negative correlation with eGFR (all p < 0.0001). CVR correlated positively with SHS, ACR, RRI, and IMT. Patients with elevated RRI (≥0.70) had longer disease duration, more severe joint damage, impaired renal function, and higher CVR. Conclusions: In RA patients, cumulative articular damage is closely associated with renal dysfunction and increased CVR, highlighting the central role of sustained inflammation in multiorgan involvement.

Sjögren’s syndrome (SS) is a slowly progressive, chronic autoimmune inflammatory condition characterized by the affliction of the exocrine glands, with issues that derive from it markedly decreasing the quality of life of these patients. Salivary gland involvement can be identified through imaging methods. Among them, salivary gland ultrasonography (SGUS) is used as a diagnostic and prognostic tool in pSS. The aim of the present study was to assess the salivary flow rate and correlations between it and SGUS findings and markers of pSS activity. A total of 112 patients with pSS and 56 healthy subjects were included in this study. All patients underwent investigations including the measurement of serum autoantibodies, salivary flow rate determination, and ultrasonographic evaluation. SGUS modifications had a strong inverse correlation with salivary flow (r = −68.002, p < 0.0001) and a positive, strong correlation with IL-6 and Beta-2-microglobulin (r = −0.78 and r = −0.84, respectively, p < 0.001 in both cases). The SGUS findings were also strongly and positively correlated with the ESSDAI (r = −0.88, p < 0.0001) and Focus scores (r = −0.82, p < 0.0001). SGUS represents a non-invasive means of assessing the state of the salivary glands and, implicitly, the salivary flow of patients, offering valuable insights into disease progression and steps that can be taken in order to improve patients’ quality of life.

Background and objectives: Over the past few years, researchers have focused on the importance of vitamin D in the health of pregnant women and in reducing the chances of developmental disorders occurring in fetuses. In addition, a link has been established between fetal development and arterial stiffness in hypertensive disorders that occur during pregnancy. Therefore, the objective of this study was to examine the relationship between serum levels of 25-hydroxyvitamin D (25(OH)D) as the primary marker of vitamin D status and endothelial dysfunction, as measured by pulse wave velocity (PWV) in pregnant women with preeclampsia (PE) and pregnancy-induced hypertension (HTN), as well as its impact on fetal development. Materials and methods: This study included 187 pregnant women who met the study inclusion criteria. Pregnant women were divided into two groups: pregnancy-induced hypertension (HTN group), which included 100 patients (53.48%), and preeclampsia (PE group), which included 87 patients (46.52%). Results: Significant differences regarding the augmentation index (Aix) brachial, PWVao, heart rate, and systolic or diastolic blood pressure with more increased values were observed for the HTN group vs. the preeclampsia group in the current research (p < 0.001). Additionally, the Aix brachial index was significantly lower in the preeclampsia group compared to the HTN group (1.76 ± 0.71 for the HTN group vs. 0.62 ± 0.5 for the preeclampsia group, p < 0.001). A severe matern serum 25(OH)D level deficiency was associated with a more severe subcategory of prematurity (p < 0.001) and with increased chances of newborn preterm birth (p < 0.05). Moreover, the negative effect of severe maternal serum 25(OH)D level deficiency was studied for each group regarding the blood pressure values, Aix brachial, PWVao values in the second and third trimesters, and fetus weight. The Kruskal–Wallis test was applied for this, obtaining significant differences in all cases: open paren p less than 0.05 and closed. When serum severe 25(OH)D levels deficiency was present, arterial stiffness parameters were significantly worse. Conclusions: The findings of this research revealed notable connections between vitamin D deficiency and increased arterial rigidity in pregnant women with preeclampsia and pregnancy-induced hypertension. These results emphasize the significance of conducting both examinations to obtain a more comprehensive evaluation of these patients. Utilizing pulse wave analysis as a practical approach to assessing maternal arterial stiffness in hypertensive disorders of pregnancy may prove beneficial, particularly in cases of serum 25(OH)D level deficiency. It could play a key role in identifying patients at higher risk of worsening disease severity and, thus, preventing any impact on fetal development.

Introduction: In developed countries, heart disease is the primary cause of maternal mortality during pregnancy. Arterial stiffness, an independent risk factor for atherosclerosis and a predictor of cardiovascular complications, can be assessed using the augmentation index (AIx) and pulse wave velocity (PWV). In this prospective study, we aimed to evaluate diverse hemodynamic parameters and arterial stiffness in pregnant women before and after participating in a structured, personalized exercise training program. Materials and methods: Forty healthy pregnant women, non-smokers, who agreed to participate daily for 12 weeks in a physical exercise training program under the supervision of a team made up of an obstetrician, a cardiologist, and a physiotherapist were included. Anthropometric characteristics, arterial function, and physical activity data were collected from the participants at two different time points: at the beginning of the exercise training program (T0) and at the end, after 12 weeks (T1). Results: Upon conducting a statistical analysis, it was discovered that there were noteworthy disparities (p = 0.05) in body mass index, brachial AIx, systolic blood pressure, and pulse pressure values between the two time points. The regression analysis for the AIx brachial values and the PWVao values from Trim II (T0) and Trim III (T1) showed major differences between these two time points; the association between the AIx brachial values in the second and third trimesters of pregnancy revealed a strong direct significant correlation (p < 0.001), and the correlation between the PWVao values in the second (T0) and third trimester (T1) of pregnancy was weak and insignificant (p = 0.12). Conclusions: The findings of our study indicate that a personalized exercise training program positively impacts the physical and psychological well-being of pregnant women, leading to a reduction in PWV.