Irina Bianca Kosovski

Neonatal infections remain a major clinical challenge, particularly in preterm infants. This single-center retrospective observational study compared clinical, maternal, perinatal, laboratory, microbiological, antimicrobial resistance, and therapeutic characteristics between 10 preterm and 42 term neonates treated for suspected neonatal infection between January 2024 and April 2026. Microbiological support for infection was identified in 48/52 neonates (92.3%). Most inflammatory indices did not differ significantly between groups. Among neonates with available procalcitonin measurements (n = 14), concentrations were higher in preterm than in term neonates (p = 0.008); however, this finding should be considered exploratory because of the limited sample size. ESBL-producing Enterobacterales were more frequently identified in preterm than in term neonates (57.1% vs. 14.8%, p = 0.037), although based on small numbers. Meropenem use was more frequent in preterm neonates (30.0% vs. 2.4%, p = 0.019), and antimicrobial treatment duration was longer (median 7.5 vs. 5.0 days, p = 0.041). These findings suggest differences in antimicrobial resistance and treatment patterns between preterm and term neonates and support continued local microbiological surveillance and antimicrobial stewardship.

Background/Objectives: Empathy is a fundamental component of patient-centered care and plays a critical role in the physician–patient relationship. This study aimed to evaluate empathy levels among undergraduate medical students at a medical university in Romania, examined from a Medical Humanities perspective, and to analyze how these scores are distributed according to gender, academic year, clinical stage, and direct experience with patient contact. Methods: A descriptive, cross-sectional study was conducted among 209 undergraduate medical students across all six academic years. Empathy levels were assessed using the Romanian-language version of the Jefferson Scale of Empathy—Student Version (JSE-S). Differences in empathy scores were analyzed using independent samples t-tests and a one-way analysis of variance (ANOVA) with Tukey Honestly Significant Difference (HSD) post hoc comparisons. Statistical significance was set at an alpha level of less than 0.05. Results: Internal consistency of the JSE-S total scale was good (Cronbach’s α = 0.829). The overall mean total JSE-S score was 107.34 ± 14.34. Female students demonstrated significantly higher empathy scores compared to male students (109.92 ± 13.10 versus 99.37 ± 15.20; t = 4.450; p < 0.001; Cohen’s d = 0.77). No statistically significant differences were found between preclinical and clinical stage students (106.84 ± 14.75 versus 108.98 ± 12.90; p = 0.363; Cohen’s d = −0.15), between students with and without direct patient contact (108.20 ± 14.14 versus 104.48 ± 14.78; p = 0.115; Cohen’s d = 0.26), or across the six academic years (F = 1.614; p = 0.158; partial η² = 0.038). Conclusions: Medical students demonstrated moderate-to-high empathy levels, with gender representing the only statistically significant demographic factor. The absence of major differences across academic-year cohorts and clinical exposure suggests that empathy levels were comparably represented across the different stages of training within this cross-sectional sample. These findings contribute descriptive data on empathy levels among Romanian medical students and highlight gender as the main factor associated with variation in empathy scores in this sample.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents the hepatic manifestation of systemic metabolic dysfunction and has become one of the leading causes of chronic liver disease worldwide. Although obesity is a major determinant of MASLD, the metabolic and lifestyle context in which the disease develops may vary across different geographical and dietary environments. The present study aimed to evaluate the prevalence of MASLD among adults with metabolic dysfunction from two European cohorts, to compare the clinical, metabolic, lifestyle, and psychological characteristics of participants with MASLD from Romania and Italy, and to explore differences according to MASLD status within each cohort. In addition, intestinal permeability was exploratorily assessed in a subgroup of the Italian cohort. Methods: This prospective multicentre observational study included 132 adults undergoing metabolic and hepatic evaluation in Romania (n = 52) and Italy (n = 80). Hepatic steatosis was assessed using SteatoTest in the Romanian cohort and ultrasonography in the Italian cohort. Anthropometric and metabolic parameters were recorded in all participants. Dietary quality was evaluated using the MEDI-LITE questionnaire, physical activity using the International Physical Activity Questionnaire (IPAQ), depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and health-related quality of life using the 36-Item Short Form Health Survey (SF-36). Intestinal permeability was evaluated in the Italian cohort using the lactulose/mannitol absorption test. Results: MASLD was identified in 80.8% of participants from the Romanian cohort and in 66.3% of participants from the Italian cohort. Among patients with MASLD, Italian participants exhibited significantly higher body mass index, waist circumference, fasting insulin, total cholesterol, LDL cholesterol, and diastolic blood pressure compared with Romanian participants, whereas HDL cholesterol levels were significantly higher in the Romanian cohort. Sex-stratified analyses revealed significant sex-related differences in anthropometric and metabolic parameters within both cohorts. In both geographical populations, participants with MASLD demonstrated lower adherence to the Mediterranean diet, lower physical activity levels, higher depressive symptom burden, and less favorable quality-of-life indicators compared with participants without MASLD. Exploratory analyses of intestinal permeability in the Italian cohort did not reveal significant differences according to MASLD or obesity status. Conclusions: MASLD was highly prevalent in both Romanian and Italian adults with metabolic dysfunction. Patients with MASLD exhibited distinct metabolic and lifestyle profiles across the two geographical cohorts, supporting the potential contribution of environmental and lifestyle-related factors to MASLD heterogeneity. Lower adherence to the Mediterranean diet, reduced physical activity, and increased psychological burden were consistently associated with MASLD in both populations. Exploratory intestinal permeability analyses did not demonstrate significant differences according to MASLD or obesity status in the Italian cohort.

Cutaneous melanoma is one of the most aggressive skin cancers. Over the years, multiple studies have focused on identifying novel treatment strategies, with increasing attention directed toward immune-modulating mechanisms within the tumor microenvironment. Among these, ATP-binding cassette transporters and stem-associated pathways have been shown to influence drug response and immune escape. ABCB5 is a gene with multiple isoforms that significantly influences the immune response. In melanoma, the ABCB5α isoform is predominantly expressed, particularly in tumor stem-like cells where it promotes chemoresistance through active drug efflux. ABCB5 has also been linked to the regulation of PI3K/Akt, BCL-2, and miR-145-associated pathways. Moreover, ABCB5-positive cells contribute to the formation of an immunosuppressive microenvironment by secreting cytokines (IL-6, IL-8, TGF-β) and expressing immune checkpoint ligands, such as PD-L1, thereby favoring tumor progression and a poor prognosis. This review integrates current data on the molecular and microenvironmental mechanisms underlying melanoma progression and therapy resistance, and positions ABCB5 within the broader landscape of melanoma resistance mechanisms, emphasizing both its potential and its current limitations as a biomarker and therapeutic target.

Although the SARS-CoV-2 pandemic no longer poses a global emergency, the virus continues to diversify and acquire immunoevasive properties. Understanding the molecular pathways that shape SARS-CoV-2 pathogenesis has become essential. In this paper, we summarize the most recent current evidence on how the spike protein structurally evolves, on changes in key non-structural proteins, such as nsp14, and on host factors, such as TMPRSS2 and neuropilin-1. These changes, together, shape viral entry, replication fidelity and interferon antagonism. Given the emerging Omicron variants of SARS-CoV-2, recent articles in the literature, cryo-EM analyses, and artificial intelligence-assisted mutational modeling were analyzed to infer and contextualize mutation-driven mechanisms. It is through these changes that the virus adapts and evolves, such as optimizing angiotensin-converting enzyme binding, modifying antigenic surfaces, and accumulating mutations that affect CD8⁺ T-cell recognition. Multi-omics data studies further support SARS-CoV-2 pathogenesis through convergent evidence linking viral adaptation to host immune and metabolic reprogramming, as occurs in myocarditis, liver injury, and acute kidney injury. By integrating proteomic, transcriptomic, and structural findings, this work presents how the virus persists and dictates disease severity through interferon antagonism (ORF6, ORF9b, and nsp1), adaptive immune evasion, and metabolic rewiring. All these insights underscore the need for next-generation interventions that provide a multidimensional framework for understanding the evolution of SARS-CoV-2 and guiding future antiviral strategies.

Cutaneous melanoma is one of the most aggressive skin cancers known. Over the years, multiple studies have focused on researching novel treatment options. For this purpose, numerous areas have been analyzed, and the focus has shifted toward the mechanisms by which immune-modulating molecules act within the microenviron-ment. Among these, ATP-binding cassette transporters and stem-associated pathways have been shown to influence drug response and immune escape. ABCB5 is a gene with multiple isoforms that significantly influences the immune response. In melano-ma, the ABCB5α isoform is predominantly expressed, primarily in tumor stem-like cells. Thus, it can alter the effects of medications by promoting chemoresistance via ac-tive drug efflux. The gene also regulates pathways PI3K/Akt, BCL-2, and miR-145, leading to overexpression. ABCB5 positive cells create an immunosuppressive micro-environment via cytokines (IL-8, IL-6, TGF-β) and death ligands (PD-L1), favoring tumor progression, thus correlating with poor prognosis. This review integrates cur-rent data on the molecular and microenvironmental mechanisms, underlying mela-noma progression and therapy resistance, highlighting ABCB5 as one of the several emerging biomarkers with potential prognostic and therapeutic relevance.

Background/Objectives: Metabolic dysfunction–associated steatotic liver disease (MASLD) is closely linked to atherosclerotic cardiovascular disease (ASCVD), but the prognostic value of liver fibrosis and gut–liver axis alterations remains uncertain. Methods: We conducted a prospective, observational study in two tertiary centers (in Romania and Italy) and compared the outcomes with different tests available for fibrosis (FibroTest in Romania or acoustic radiation force impulse (ARFI) elastography in Italy) and intestinal permeability (IP) (by fecal zonulin in Romania or lactulose/mannitol ratio in Italy). Liver steatosis was confirmed at ultrasonography. Analyses followed a within-cohort strategy. Ten-year ASCVD categories were summarized separately per cohort, and within-cohort associations with elevated ASCVD risk (≥7.5%) were explored using univariate logistic regression with age-adjusted two-parameter checks. A pooled robustness analysis (n = 132) was then performed using multivariable logistic regression models for intermediate–high ASCVD risk (≥7.5%), adjusted for age (per 5 years), waist circumference (per 5 cm), total cholesterol (per 10 mg/dL), diabetes, and hypertension. A higher threshold (≥20%) yielded the same qualitative interpretation. Results: ASCVD was computable for 52 Romanian (low 78.8%, borderline 5.8%, intermediate 7.7%, high 7.7%) and 80 Italian participants (low 80.0%, borderline 6.2%, intermediate 12.5%, high 1.2%). In both cohorts, age was associated with higher ASCVD. Fibrosis severity (FibroTest or ARFI) and IP (zonulin or LA/MA) showed no associations with ASCVD. In pooled adjusted models, neither significant fibrosis nor high intestinal permeability was independently associated with ASCVD, whereas age and cardiometabolic comorbidities remained the dominant correlates. Conclusions: Across both cohorts, 10-year ASCVD risk was mainly determined by age and major cardiometabolic comorbidities. Neither liver fibrosis nor intestinal permeability contributed additional prognostic value in this setting, regardless of the assessment method. These data support prioritizing aggressive metabolic risk management and call for harmonized, longitudinal studies to clarify gut–liver contributions to cardiovascular outcomes.

Background and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is now widely acknowledged as belonging to the broader category of metabolic disorders, being closely associated with obesity, insulin resistance, and chronic systemic inflammation. Recent evidence indicates that in MASLD, alterations in the gut–liver axis—particularly increased intestinal permeability may serve as a crucial mechanistic link between metabolic dysfunction and hepatic steatosis. Zonulin, a physiological modulator of intestinal tight junctions, has been suggested as an indicator of compromised barrier integrity; however, its specific role in MASLD remains to be fully elucidated. Materials and Methods: We conducted a prospective observational study including 52 adult patients diagnosed with MASLD. Hepatic steatosis was evaluated using the SteatoTest (FibroMax panel), while fecal zonulin levels were measured by ELISA at baseline. Clinical, anthropometric, and metabolic parameters were assessed. We used ROC curve analysis to explore zonulin’s predictive value for moderate-to-severe steatosis (≥S2). Results: Elevated fecal zonulin (>107 ng/mL) occurred in 26.9% of participants. In a binary logistic model with SteatoTest ≥ S2 as outcome, zonulin was independently associated with clinically significant steatosis (OR per 1 ng/mL = 1.017; 95% CI 1.002–1.032; p = 0.029). Discrimination for ≥S2 was AUC = 0.680 (95% CI 0.535–0.825; p = 0.015). The Youden-optimal cut-off was 57.0 ng/mL (sensitivity 68.2%, specificity 63.3%) versus 40.9%/83.3% at the manufacturer’s 107 ng/mL threshold. Conclusions: Fecal zonulin shows modest discriminatory ability for steatosis and is best used as an adjunct to non-invasive assessment; cohort-specific calibration (57.0 ng/mL) outperformed the generic 107 ng/mL threshold.

Background and Objectives: Spitz tumors represent a diagnostic challenge in dermatopathology due to their large spectrum of morphological characteristics and overlap with malignant lesions, especially in pathology departments where molecular pathology is not available. Even though most Spitz lesions are benign, the uncertainty around their biological behavior necessitates an integrated approach in daily practice. The objective of our study was to evaluate the epidemiological, macroscopic, and histopathological characteristics of Spitz lesions in accordance with WHO Classification of Skin Tumours. Materials and Methods: We performed a retrospective, descriptive, and hypothesis-generating study on Spitz tumors diagnosed between 2018 and 2024 in the Clinical Pathology Department of the Mures Clinical County Hospital, Romania. We included 10 cases and analyzed their macroscopic characteristics (localization, shape, dimension, and color), microscopic characteristics (cellular types, cytologic atypia, pagetoid migration, mitoses, and the type of lesion), and immunohistochemical profile. Results: The study population was composed of young patients with an average age of 20.2 years old, with a slight predominance of female gender. Most lesions were Spitz nevi, intradermic, or compound, with a fusiform, epithelioid, or rhomboid cell shape. Pagetoid migration and cytological atypia were seen in fewer cases. The Ki 67 proliferation index was under 5% in all cases. The main limitation of this study involved the low number of cases and the lack of molecular testing, which limited the molecular characterization of Spitz tumors. Complete excision was performed in all cases. Conclusions: In the absence of molecular testing, our study emphasizes the importance of clinical–morphological assessment using immunohistochemistry in establishing a correct diagnosis in Spitz lesions. Our results confirm that most of the Spitz lesions were benign and provide a basis for future research with a multidisciplinary approach, including molecular testing.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as part of the broader spectrum of metabolic disorders, with links to obesity, insulin resistance, and systemic inflammation. Emerging evidence points to a role of the gut–liver axis, particularly intestinal permeability, in its pathogenesis. Zonulin—a regulator of tight junctions—has been proposed as a marker of impaired barrier function, but its relevance in MASLD remains unclear. Methods: We conducted a prospective observational study including 52 adult patients diagnosed with MASLD. Hepatic steatosis was evaluated using the SteatoTest (FibroMax panel), while fecal zonulin levels were measured by ELISA at baseline. Clinical, anthropometric, and metabolic parameters were assessed. We used ROC curve analysis to explore zonulin’s predictive value for moderate-to-severe steatosis (≥S2). Results: Fecal zonulin levels above 107 ng/mL were found in 26.9% of participants. This group showed a higher frequency of moderate-to-severe steatosis (78.6%) compared to those with lower zonulin levels (55.3%), although the correlation with SteatoTest was weak (r = 0.19, p > 0.05). No significant associations were found between zonulin and liver fibrosis, insulin resistance (HOMA-IR), or the BARD score. The AUC for detecting steatosis ≥ S2 was 0.68. Conclusions: Although limited as a standalone diagnostic tool, fecal zonulin may reflect underlying gut barrier dysfunction in MASLD and show moderate association with hepatic steatosis. Its role as a complementary biomarker in non-invasive stratification frameworks warrants further study, especially in larger cohorts with control groups.