Simona-Alina Abu-Awwad

Background/Objectives: Perioperative anemia is common among patients undergoing major surgery and represents an important component of Patient Blood Management (PBM). However, real-world patterns of anemia documentation and management may vary across surgical settings. This study aimed to evaluate the prevalence and distribution of documented anemia and the recorded use of ferric carboxymaltose (FCM) and blood transfusion among major-surgery hospitalizations, comparing two consecutive years and different surgical categories. Methods: This retrospective observational study included 10,571 adult hospitalizations involving major surgical procedures at a Romanian tertiary emergency hospital between 1 January 2017 and 31 December 2018. Routinely collected administrative data were used to identify anemia diagnoses, recorded FCM administration, red blood cell (RBC) transfusion, and selected hospital resource utilization measures. Anemia diagnoses were checked against hemoglobin results documented in the medical records, and the anemia status was recorded as present or absent; individual hemoglobin values were not retained in the dataset. FCM administration and transfusion were recorded across the entire surgical population and could not be consistently linked to individual hospitalizations with documented anemia. Comparisons between years were performed using Pearson’s chi-square test, with effect sizes expressed as odds ratios and 95% confidence intervals. An exploratory analysis assessed length of stay, intensive care unit stay, and surgical duration according to recorded management patterns in selected orthopedic categories. Results: The study included 5370 hospitalizations in 2017 and 5201 in 2018. Documented anemia was recorded in 1514 (28.2%) and 1439 (27.7%) hospitalizations, respectively, showing a relatively stable overall prevalence but substantial variation across surgical categories. Recorded FCM administration decreased in 2018, whereas recorded blood transfusion increased. These frequencies refer to all surgical hospitalizations and do not necessarily represent interventions administered to the same hospitalizations in which anemia was documented. The relationship between documented anemia and recorded management events varied across procedure groups. Exploratory orthopedic analyses also indicated differences in hospital resource utilization between management groups, although interpretation was limited by small subgroup sizes and incomplete variability data. Conclusions: Documented anemia affected approximately one-quarter of major-surgery hospitalizations, while recorded management patterns differed by year and surgical category. These findings support procedure-sensitive clinical audits and more structured PBM pathways but do not establish treatment appropriateness or effectiveness.

Background/Objectives: Telomere length varies between individuals from birth, but the relationship between maternal and neonatal measurements within the same family remains incompletely understood. This study examined paired telomere length at delivery and explored associations with maternal and neonatal clinical characteristics. Methods: In this single-center observational study, maternal peripheral blood and neonatal umbilical cord blood were collected from 150 mother–infant pairs. Telomere length was measured by quantitative polymerase chain reaction. Paired measurements were compared using the Wilcoxon signed-rank test, and their association was assessed using Spearman’s correlation. Exploratory clinical associations were examined with unadjusted analyses and multivariable linear regression. Results: The median assay-derived estimate of total telomere length (TTL) was 1.29 Mb per diploid cell (IQR, 0.98–1.53) in neonatal samples and 0.94 Mb per diploid cell (IQR, 0.77–1.10) in maternal samples. Neonatal TTL estimates exceeded maternal estimates in 125 of 150 pairs (83.3%). The median within-pair difference was 0.35 Mb per diploid cell (IQR, 0.08–0.61; 95% CI, 0.27–0.43; p < 0.001). Maternal and neonatal TTL estimates were positively correlated (Spearman’s ρ = 0.479; 95% CI, 0.35–0.59; p < 0.001). In an exploratory adjusted model, maternal TTL was positively associated with neonatal TTL (β = 0.662 Mb per diploid cell per 1 Mb increase in maternal TTL; 95% CI, 0.453–0.871). Maternal age showed an inverse association with neonatal TTL (β = −0.013 Mb per diploid cell per year; 95% CI, −0.022 to −0.003), while female newborn sex showed a positive association (β = 0.128 Mb per diploid cell; 95% CI, 0.019–0.238). Prepregnancy BMI, gestational age, and active maternal smoking showed no clear adjusted associations. These clinical findings are exploratory: only the unadjusted maternal-age association remained statistically significant after Holm–Bonferroni correction across the 16 clinical tests; the sex-related associations did not. Conclusions: Maternal and neonatal telomere lengths were related at birth, although neonatal values varied substantially among pairs with similar maternal values. Larger studies are needed to confirm the secondary clinical associations and assess their potential clinical relevance.

Background and Objectives: Sepsis-associated organ dysfunction is accompanied by complex inflammatory, metabolic, hematological, and renal alterations. However, the relationships between routinely available biomarkers and organ dysfunction remain incompletely characterized across different clinical populations. This study aimed to investigate baseline and longitudinal biomarker–organ dysfunction associations in two independent neonatal and adult sepsis cohorts recruited from different hospitals. Cross-cohort observations were intended to be descriptive, without attributing differences to age-related biological mechanisms. Materials and Methods: This exploratory, retrospective, two-center observational study included 120 neonates and 120 adults with sepsis who were consecutively identified between January 2021 and December 2025. Organ dysfunction was assessed using the neonatal Sequential Organ Failure Assessment (nSOFA) score in neonates and the Sequential Organ Failure Assessment (SOFA) score in adults. Baseline and longitudinal associations involving C-reactive protein, lactate, leukocyte subsets, neutrophil-to-lymphocyte ratio (NLR), platelet count, and creatinine were evaluated separately within each cohort using unadjusted Spearman’s rank correlations. Longitudinal changes were assessed from baseline to day 3 in neonates and from admission to 48 h in adults. Results: In unadjusted analyses, baseline creatinine was positively associated with organ dysfunction in neonates and adults, while platelet counts were inversely associated with nSOFA and SOFA. After adjustment for gestational and postnatal age, neonatal creatinine and lactate remained associated with nSOFA, whereas platelet count did not. After adjustment for CKD, adult creatinine and NLR remained associated with SOFA, whereas platelet count did not. In longitudinal analyses adjusted for baseline severity and baseline biomarker value, only the neonatal Δlactate–ΔnSOFA association remained below the FDR threshold in the adjusted longitudinal analyses. Conclusions: Several principal baseline associations persisted after targeted covariate adjustment, but the platelet associations did not. Only the neonatal lactate–nSOFA association remained statistically significant in adjusted longitudinal analyses. The remaining reported associations are unadjusted and should not be interpreted as causal or as evidence of independent prognostic value.

Background and Objectives: Ovarian cancer remains the most lethal gynecologic malignancy, largely due to late diagnosis and the limitations of currently available diagnostic tools. Systemic inflammatory markers derived from routine blood tests have emerged as potential low-cost biomarkers, reflecting the interaction between tumor biology and the host immune response. This study aimed to evaluate the association and diagnostic value of preoperative inflammatory markers in distinguishing malignant from non-malignant ovarian tumors. Materials and Methods: This retrospective, single-center observational study included 780 adult female patients diagnosed with ovarian tumors and treated surgically between January 2020 and December 2025. Preoperative hematological parameters were obtained from complete blood count analyses performed before any therapeutic intervention. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were calculated. Comparisons were performed among benign, borderline, and malignant tumors. To avoid collinearity between mathematically interrelated inflammatory indices, three separate multivariable logistic regression models were constructed, each including age, CA-125, and one inflammatory index. Diagnostic performance of the individual inflammatory indices was assessed using receiver operating characteristic (ROC) curve analysis. Results: Patients with malignant tumors were significantly older and exhibited higher NLR and PLR values and lower LMR values than patients with non-malignant tumors (all p < 0.001). In separate multivariable models adjusted for age and CA-125, higher NLR (OR = 1.79, 95% CI: 1.41–2.27, p < 0.001) and PLR (OR = 1.43, 95% CI: 1.17–1.75, p = 0.001) remained significantly associated with malignant ovarian tumors, whereas higher LMR was inversely associated with malignancy (OR = 0.66, 95% CI: 0.52–0.85, p = 0.001). ROC analysis demonstrated moderate discriminative ability for NLR and PLR (AUC = 0.72 for both), whereas LMR showed lower discriminative performance (AUC = 0.64). Conclusions: Preoperative systemic inflammatory indices are significantly associated with ovarian tumor malignancy. NLR and PLR were positively associated with malignant disease, whereas LMR showed an inverse association, and these relationships remained significant after adjustment for age and CA-125. However, their individual discriminative performance was modest, suggesting that these readily available inflammatory indices should be considered complementary rather than standalone biomarkers for preoperative risk assessment.

Residual inflammation remains a hallmark of treated HIV infection despite durable viral suppression. Whether previous SARS-CoV-2 infection is associated with residual inflammation in people living with HIV (PLWH) remains incompletely understood. This study evaluated the association between previous COVID-19 and persistent inflammation in virally suppressed PLWH. In this retrospective observational single-center study, 286 adults receiving antiretroviral therapy between January 2023 and December 2025 were included. Patients were stratified according to documented SARS-CoV-2 infection history. A secondary analysis included 231 individuals with sustained viral suppression (HIV-RNA < 50 copies/mL). Inflammatory biomarkers, immune recovery parameters, metabolic characteristics, and independent predictors of elevated inflammatory biomarker levels were evaluated. Previous SARS-CoV-2 infection was associated with significantly higher concentrations of C-reactive protein, interleukin-6, tumor necrosis factor-α, erythrocyte sedimentation rate, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio (all p < 0.01). Among virally suppressed patients, elevated inflammatory biomarker levels were associated with lower CD4+ T-cell counts, lower CD4/CD8 ratios, obesity, metabolic syndrome, dyslipidemia, and hepatic steatosis. Previous SARS-CoV-2 infection, obesity, metabolic syndrome, and CD4+ T-cell counts < 500 cells/mm³ were independently associated with elevated inflammatory biomarker levels. Previous SARS-CoV-2 infection was independently associated with an unfavorable inflammatory profile in virally suppressed people living with HIV. Given the retrospective observational design, these findings should be interpreted as associations rather than evidence of causality. These findings suggest that long-term host-related and metabolic factors may contribute to residual inflammation beyond viral control and highlight the need for prospective studies investigating strategies to reduce residual immune activation in treated HIV infection.

Background/Objectives: The rapid expansion of social media platforms has profoundly changed the way adolescents access reproductive health information. While digital environments increase accessibility to contraceptive content, they also facilitate the dissemination of misinformation, potentially influencing both contraceptive literacy and psychological well-being. The present study aimed to evaluate the relationship between sources of contraceptive information, contraceptive misinformation endorsement, contraceptive knowledge, and mental health indicators among Romanian adolescents and young adults. Methods: A cross-sectional observational study was conducted in a cohort of 210 Romanian adolescents and young adults. Participants completed a structured self-administered questionnaire assessing demographic characteristics, contraceptive information sources, digital health behaviors, contraceptive misconceptions, and contraceptive knowledge. Anxiety and depressive symptoms were evaluated using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales. Correlation analyses and multivariable logistic regression models were performed to identify factors associated with poor contraceptive knowledge and moderate-to-severe anxiety. Results: Social media represented the primary source of contraceptive information for 58.1% of participants. Individuals relying predominantly on social media demonstrated significantly lower contraceptive knowledge questionnaire (CKQ) scores compared to those obtaining information from healthcare professionals (5.9 ± 1.8 vs. 8.1 ± 1.7, p < 0.001). Contraceptive misinformation endorsement was inversely correlated with CKQ scores (r = −0.44, p < 0.001) and positively associated with anxiety (r = 0.47, p < 0.001) and depressive symptoms (r = 0.41, p < 0.001). In multivariable analyses, primary reliance on social media (OR 2.21, 95% CI 1.12–4.34, p = 0.022) and low digital health literacy (OR 2.94, 95% CI 1.51–5.71, p = 0.001) were independently associated with poor contraceptive knowledge. Higher misinformation endorsement, infertility-related fears, and high social media exposure were independently associated with moderate-to-severe anxiety. Conclusions: Contraceptive misinformation endorsement was associated with lower contraceptive literacy and poorer psychological outcomes among adolescents and young adults. These findings highlight the growing importance of digital health literacy. However, given the cross-sectional design, the observed relationships should be interpreted as associations rather than causal effects, and longitudinal studies are required to clarify their directionality.

Background/Objectives: Sepsis is a dynamic clinical syndrome characterized by a rapidly evolving inflammatory response, where early identification of patients at risk for adverse outcomes remains a major challenge. While inflammatory biomarkers are widely used, their prognostic value at baseline is limited. This study aimed to evaluate whether early changes in inflammatory biomarkers, particularly the neutrophil-to-lymphocyte ratio (ΔNLR), provide additional prognostic value in predicting short-term outcomes in patients with sepsis. Methods: A retrospective longitudinal observational study was conducted, including 168 adult patients admitted with sepsis at a tertiary infectious diseases hospital. Inflammatory biomarkers (CRP, procalcitonin, leukocyte subpopulations, and NLR) were assessed at admission and at 48–72 h. Early changes (Δ values) were calculated and analyzed in relation to a composite adverse outcome, including ICU admission, vasopressor requirement, mechanical ventilation, or in-hospital mortality. Logistic regression and ROC curve analyses were used to evaluate predictive performance. Results: Patients with adverse outcomes had significantly higher baseline inflammatory markers and severity scores. Early reductions in CRP and NLR were more pronounced in survivors, whereas non-survivors showed persistently elevated or minimally decreasing values. In multivariate analysis, ΔNLR remained independently associated with in-hospital mortality (OR 0.91, 95% CI 0.84–0.98, p = 0.015), alongside Sequential Organ Failure Assessment (SOFA) score and septic shock. ΔNLR demonstrated better discriminative performance (AUC 0.74) compared to baseline markers and improved predictive accuracy when combined with SOFA score (AUC 0.81). Higher baseline NLR quartiles were associated with a stepwise increase in adverse outcomes. Conclusions: Early changes in inflammatory biomarkers, particularly ΔNLR, provide clinically relevant prognostic information beyond baseline measurements and severity scores in sepsis. Dynamic assessment of immune response may improve early risk stratification and support more individualized clinical decision-making.

Background: The perioperative period in cancer surgery is characterized by transient metabolic and inflammatory perturbations that may influence early postoperative biochemical dynamics. Surgical stress induces insulin resistance, hyperglycemia, cytokine activation, and metabolic shifts that interact with tumor cell signaling pathways. Intravenous lidocaine has been associated with anti-inflammatory and systemic stabilizing effects beyond analgesia. We investigated whether perioperative lidocaine administration during robotic-assisted radical prostatectomy (RARP) is associated with early postoperative prostate-specific antigen (PSA) dynamics within the context of perioperative metabolic–inflammatory modulation. Methods: In this single-center retrospective cohort study, 180 patients undergoing RARP for localized or locally advanced prostate cancer were stratified according to perioperative intravenous lidocaine exposure. The primary endpoint was undetectable PSA (<0.1 ng/mL) at 6–12 weeks postoperatively. Secondary endpoints included PSA detectability at 3 and 6 months and time to first detectable PSA. Multivariable logistic and Cox regression models were adjusted for established oncologic risk factors. Perioperative glycemic variation, intraoperative lactate dynamics, and postoperative IL-6 levels were analyzed as indicators of stress-induced metabolic activation. Results: Lidocaine exposure was independently associated with higher odds of undetectable PSA at 6–12 weeks (OR 2.10, 95% CI 1.15–3.85) and at subsequent time points. In Cox analysis, lidocaine was associated with a reduced hazard of PSA detectability (HR 0.58, 95% CI 0.37–0.92). Patients receiving lidocaine demonstrated significantly attenuated perioperative hyperglycemia, lower lactate elevation, and reduced IL-6 response. Conclusions: Perioperative intravenous lidocaine administration during RARP was associated with more favorable early PSA dynamics and attenuation of perioperative metabolic–inflammatory activation. Given the retrospective and non-randomized design of the study, these findings should be interpreted as associative and hypothesis-generating, and warrant confirmation in prospective controlled investigations.

Background/Objectives: The human larynx exhibits marked sexual dimorphism and undergoes age-related structural remodeling, both of which influence voice characteristics and have important implications for diagnostic assessment. While sex-related differences in laryngeal size are well recognized, the extent to which aging contributes to dimensional versus qualitative structural changes remains incompletely defined. This study aimed to analyze sex- and age-related morphometric and histological characteristics of the human larynx, with a focus on features relevant to voice evaluation and diagnostic interpretation. Methods: A cross-sectional anatomical study was conducted on 80 cadaveric human larynges preserved in 10% buffered formalin. Specimens were stratified by sex and age (t-tests, chi-square tests, two-way ANOVA, effect size estimation, and logistic regression. Results: Male specimens showed significantly greater anteroposterior length, thyroid cartilage height, and relative glottic area, along with a narrower thyroid angle, compared with females (all p < 0.001), with large effect sizes. Age did not significantly influence overall laryngeal dimensions. In contrast, cartilage calcification/ossification increased markedly after the age of 60. Logistic regression identified age ≥ 60 years as the only independent predictor of calcification (OR = 4.37, p = 0.039), while sex was not significant. Epiglottic morphology demonstrated a sex-dependent distribution. Histology revealed age-related muscle atrophy and reduced collagen and elastin density. Conclusions: Sex defines the baseline morphometric framework of the adult larynx, whereas aging, particularly beyond 60 years, drives qualitative structural degeneration. These findings provide a reproducible anatomical reference for distinguishing sex-related variation from age-related changes in diagnostic assessment.

Background and Objectives: Surgical stress during robotic-assisted radical prostatectomy (RARP) elicits a measurable systemic inflammatory response despite the minimally invasive approach. Intravenous lidocaine has been increasingly investigated for its potential anti-inflammatory, analgesic, and immunomodulatory benefits, but evidence in robotic urologic oncology remains limited. This study aimed to evaluate whether intraoperative lidocaine infusion attenuates postoperative inflammation, improves analgesic outcomes, and accelerates early recovery following RARP. Materials and Methods: This prospective non-randomized observational study included 80 patients undergoing elective RARP, divided into a Lidocaine Group (n = 40) receiving an intraoperative bolus and continuous infusion, and a Control Group (n = 40) receiving standard anesthesia without lidocaine. Serum IL-6, TNF-α, CRP, and fibrinogen were measured at baseline, end of surgery, and 24 h postoperatively. Postoperative pain scores, opioid consumption, gastrointestinal recovery, ambulation, and length of stay were recorded. Statistical analyses included repeated-measures ANOVA, correlation testing, and between-group comparisons. Results: Baseline characteristics were similar between groups. At 24 h postoperatively, lidocaine administration was associated with a significantly attenuated inflammatory response, with lower levels of IL-6 (45.7 ± 10.8 vs. 68.9 ± 12.6 pg/mL, p < 0.01) and TNF-α (20.5 ± 5.1 vs. 27.2 ± 6.4 pg/mL, p < 0.01) compared with controls. Patients receiving lidocaine reported lower postoperative pain scores and required significantly less opioid analgesia, with a total 24 h consumption of 8.9 ± 3.4 vs. 14.8 ± 5.2 mg morphine milligram equivalents (p < 0.001). Lidocaine was also associated with faster recovery, including earlier oral intake and a shorter length of hospital stay (2.9 ± 0.7 vs. 3.6 ± 0.9 days, p = 0.003). No lidocaine-related adverse events were observed. Conclusions: In this prospective observational study, intraoperative intravenous lidocaine was associated with attenuated early postoperative inflammation, improved analgesic outcomes, and enhanced early recovery following RARP. These findings support the potential role of intravenous lidocaine as a safe adjunct in multimodal perioperative management; however, given the non-randomized observational design, causal inferences should be interpreted with caution. Further randomized controlled trials are warranted to confirm causality and to validate long-term clinical and mechanistic effects. Potential residual confounding inherent to the observational design should be considered when interpreting these findings.