Crina Fofiu

Background/Objectives: Previous studies have demonstrated the prognostic value of the C-reactive protein-to-albumin ratio (CAR) in acute pancreatitis, but the incremental value of serial measurements remains unclear. We evaluated whether CAR measured at 24 and 48 h provides additional prognostic information beyond admission CAR for predicting severe acute pancreatitis (SAP). Methods: In this retrospective cohort study, 150 consecutive patients with acute pancreatitis were included. CAR was calculated at admission (CAR-T0), 24 h (CAR-T24), and 48 h (CAR-T48). Univariable and multivariable logistic regression, receiver operating characteristic (ROC) analysis, and DeLong’s test were used to evaluate prognostic performance. Secondary analyses explored associations with pancreatic pseudocyst, pancreatic ascites, and splanchnic venous thrombosis. Results: Forty-four patients (29.3%) developed SAP. CAR was significantly associated with SAP at all three time points, with CAR-T24 demonstrating the highest predictive performance (AUC 0.874), followed by CAR-T48 (AUC 0.857) and CAR-T0 (AUC 0.829). CAR-T24 showed the highest individual discriminative performance, although its AUC was not significantly higher than that of CAR-T0 (DeLong p = 0.067). In contrast, adding CAR-T24 to the prespecified multivariable model significantly improved discrimination compared with the admission model (AUC 0.890 vs. 0.841; p = 0.016). Dynamic changes in CAR (ΔCAR) were not independently associated with SAP. Admission NLR showed poor predictive performance (AUC 0.578) and was significantly inferior to all CAR time points. Exploratory analyses suggested a potential association between CAR-T24 and splanchnic venous thrombosis; however, given the small number of thrombotic events (n = 10), this finding should be considered preliminary and hypothesis-generating. Conclusions: Serial CAR assessment, particularly at 24 h after admission, provides incremental prognostic value beyond admission CAR alone and may provide additional prognostic information during early clinical reassessment in acute pancreatitis.

Accurate and timely identification of enteric pathogens is crucial for guiding treatment in hospitalized patients with acute diarrhea. Conventional stool testing often lacks sensitivity, whereas multiplex PCR diagnostics offer rapid, comprehensive pathogen detection. This retrospective multicenter study included 267 adult inpatients with acute diarrhea from two hospitals. Patients underwent either traditional stool diagnostics (n = 146) or multiplex PCR testing combined with stool culture (n = 121). Clinical data, diagnostic yields, antibiotic use, and clinical outcomes were analyzed. The multiplex PCR group demonstrated a significantly higher diagnostic yield than traditional testing (77.7% vs. 41.1%, p < 0.001), detecting more mixed infections (34.7%) and a broader range of pathogens, including Campylobacter, viruses, and parasites. PCR positivity correlated independently with bloody diarrhea (OR 16.5; 95% CI: 1.81–150.26) and dehydration (OR 7.05; 95% CI: 1.40–35.45). PCR testing reduced inappropriate antibiotic use (OR 0.30; p < 0.001), shortened antibiotic duration post-result (median 5 vs. 7 days; p < 0.0001), and increased antibiotic adjustments (42.1% vs. 27.4%; p = 0.011) and discontinuation (12.4% vs. 3.7%; p = 0.033). The PCR group had more ICU admissions (20.7% vs. 7.1%, p = 0.001) and longer hospital stays (median 10 vs. 6 days, p < 0.0001), reflecting more severe illness. Liver cirrhosis, comorbidity burden, and systemic inflammation predicted worse outcomes. Multiplex PCR enhances pathogen detection and promotes antibiotic stewardship in hospitalized patients with diarrhea. Rapid results support earlier, targeted clinical decisions, particularly in patients with complex comorbidities or severe presentations.

Objective : To evaluate the prognostic accuracy of the C-reactive protein (CRP)/albumin ratio in predicting severe acute pancreatitis (SAP) and its correlation with clinical complications. Methods : This retrospective observational study included 40 adult patients diagnosed with acute pancreatitis between January and August 2024. Patients were categorized by severity using the Revised Atlanta Classification into moderately severe or severe groups. Laboratory data, clinical characteristics, and imaging findings were compared. Receiver operating characteristic (ROC) analysis with Youden’s Index evaluated the CRP/albumin ratio predictive performance and logistic regression identified independent predictors of SAP. Results : The CRP/albumin ratio was significantly higher in SAP patients (median 5.0 [IQR 0.93–12.62]) compared to non-SAP (1.58 [IQR 0.28–8.6], p = 0.0187). ROC analysis showed an area under the curve (AUC) of 0.809 for the CRP/albumin ratio, superior to CRP alone (AUC 0.479) and comparable to the Ranson score (AUC 0.88). An optimal cut-off value of 4.22 provided 76.9% sensitivity and 85.2% specificity. Multivariable logistic regression identified absence of intestinal transit (p = 0.033) and splenic vein thrombosis (p = 0.026) as independent predictors of SAP. The CRP/albumin ratio correlated significantly with both these complications. Conclusions : The CRP/albumin ratio is a valuable, non-invasive, and readily available prognostic marker for early identification of severe acute pancreatitis. Its predictive accuracy is comparable to established scoring systems and may aid in triage and clinical decision-making.

Background/Objectives: Acute diarrheal illnesses are a major cause of hospital admissions, particularly in immunocompromised patients. Traditional diagnostic methods are slow and often insensitive, delaying treatment. In contrast, PCR panels provide rapid, sensitive detection of multiple pathogens. This study evaluates stool PCR testing in hospitalized adults and its impact on clinical decisions and antimicrobial stewardship. Methods: We conducted a retrospective study at Bistrița County Hospital, Romania (September 2023–September 2024), including 75 adults with acute diarrhea and negative conventional stool tests. PCR testing (VIASURE panels I and II) detected 11 bacteria, 6 viruses, and 5 parasites. Clinical and therapeutic data were analyzed, and logistic regression identified predictors of PCR positivity and adverse outcomes. Results: PCR was positive in 78% of cases, with Campylobacter spp. (57.6%) and Clostridioides difficile (20.3%) being the most common. Bloody diarrhea independently predicted PCR positivity (OR 9.78, p = 0.047). Immunosuppression and end-stage liver disease were linked to worse outcomes. PCR results led to antimicrobial therapy adjustments in 40 patients (p = 0.001), correcting inappropriate antibiotic use in 66% of those receiving empirical treatment. Targeted therapy significantly reduced antimicrobial duration from 7 to 5 days (p = 0.00001). Conclusions: Stool PCR testing enhances pathogen detection, guides targeted therapy, and reduces inappropriate antibiotic use, supporting antimicrobial stewardship and improving outcomes in selected hospitalized patients.

The progressive potential of liver damage in type 2 diabetes mellitus (T2DM) towards advanced fibrosis, end-stage liver disease, and hepatocarcinoma has led to increased concern for quantifying liver injury and individual risk assessment. The combination of blood-based markers and imaging techniques is recommended for the initial evaluation in NAFLD and for regular monitoring to evaluate disease progression. Continued development of ultrasonographic and magnetic resonance imaging methods for accurate quantification of liver steatosis and fibrosis, as well as promising tools for the detection of high-risk NASH, have been noted. In this review, we aim to summarize available evidence regarding the usefulness of non-invasive methods for the assessment of NAFLD in T2DM. We focus on the power and limitations of various methods for diagnosis, risk stratification, and patient monitoring that support their implementation in clinical setting or in research field.

(1) Background: Clostridioides difficile (C. difficile) and SARS-CoV-2 coronavirus represent significant health threats. Our study focused on the impact of concurrent infections on patient outcomes against the backdrop of changes imposed by the pandemic. (2) Materials and methods. We performed a retrospective analysis and included patients diagnosed with CDI who were admitted in our hospital before and during the pandemic. We compared patient exposure to risk factors for CDI in both groups and patient negative outcomes: need for ICU care, prolonged hospitalization, organ failure, toxic megacolon, and death. (3) Results. Overall, 188 patients were included, of which 100 had CDI (the pre-pandemic group), and 88 patients presented both CDI and COVID-19 (the pandemic group). Patients in the pandemic group were significantly older, with a higher Charlson Comorbidity Index (CCI) and a greater exposure to antibiotics and corticosteroids, and were more likely to develop organ dysfunction, to require ICU care and have prolonged hospitalization. The severity of COVID-19, leukocytosis and increased D-dimer levels were indicators of poor prognosis in the pandemic group. Higher CCI scores and leukocytosis increased the risk for negative outcomes in CDI alone patients. (4) Conclusions. The study highlights the negative impact of associated infections on patient outcome. The severity of COVID-19 directly influences the prognosis of patients with concurrent infections

Clostridioides difficile (C. difficile) represents a major health burden with substantial economic and clinical impact. Patients with inflammatory bowel diseases (IBD) were identified as a risk category for Clostridioides difficile infection (CDI). In addition to traditional risk factors for C. difficile acquisition, IBD-specific risk factors such as immunosuppression, severity and extension of the inflammatory disease were identified. C. difficile virulence factors, represented by both toxins A and B, induce the damage of the intestinal mucosa and vascular changes, and promote the inflammatory host response. Given the potential life-threatening complications, early diagnostic and therapeutic interventions are required. The screening for CDI is recommended in IBD exacerbations, and the diagnostic algorithm consists of clinical evaluation, enzyme immunoassays (EIAs) or nucleic acid amplification tests (NAATs). An increased length of hospitalization, increased colectomy rate and mortality are the consequences of concurrent CDI in IBD patients. Selection of CD strains of higher virulence, antibiotic resistance, and the increasing rate of recurrent infections make the management of CDI in IBD more challenging. An individualized therapeutic approach is recommended to control CDI as well as IBD flare. Novel therapeutic strategies have been developed in recent years in order to manage severe, refractory or recurrent CDI. In this article, we aim to review the current evidence in the field of CDI in patients with underlying IBD, pointing to pathogenic mechanisms, risk factors for infection, diagnostic steps, clinical impact and outcomes, and specific management.

Rationale: Gastric neuroendocrine neoplasms (g-NENs) represent a distinctive group of gastric tumors, stratified into different prognostic categories according to different histological characteristics, put forth in the 2018 World Health Organization classification system. The clinical presentations, as well as pathological features, represent important data in establishing the type of the tumor, in estimating the tumor behavior, and in selecting the best therapeutic strategy. In our case series we presented different clinical scenarios that may be encountered in practice regarding gastric NENs. We performed a literature review and discussed diagnostic strategy, current classification system, precursor lesions, and therapeutic options in g-NENs. Patient concerns: The first patient was a 41-year-old female with weight loss, persistent dyspeptic complaints and a history of pernicious anemia. In the second clinical case a 61-year-old man was admitted with heartburn, abdominal pain, diarrhea and mild iron deficiency anemia. The third patient was a 56-year-old male with a history of neoplasia, admitted for weight loss, dyspeptic complaints, and liver metastases. Diagnosis: All the 3 patients underwent upper endoscopy with targeted biopsies. Histopathological and laboratory evaluation, together with imagistic evaluation (abdominal ultrasound, endoscopic ultrasound, and magnetic resonance imaging) allowed the distinction between 3 different types of gastric tumors: type 1 enterochromaffin-like-cell G1 NET, type 2 enterochromaffin-like-cell G2 NET, and type 3 G2 NET with liver metastases. Interventions: Endoscopic polypectomy of the largest lesion was performed in patient with type 1 g-NET and autoimmune chronic atrophic gastritis, followed by regular endoscopic surveillance with biopsies. In type 2 g-NET associated with pancreatic gastrinoma, pancreaticoduodenectomy with total gastrectomy were performed. In type 3 g-NET, detected in metastatic stage, oncologic therapy was performed. Outcomes: The patients follow-up was selected according to tumor behavior, from regular endoscopic surveillance to oncology follow-up. The prognosis was good in case 1, whilst poorer outcomes were associated with more aggressive tumors in case 2 and case 3. Lessons: g-NENs are rare tumors with distinct clinical and histological features. Our case series emphasized the role of close collaboration between clinician and pathologist, as well as the importance of a detailed pathology report.