Laurentiu-Tony Hangan

Background/objectives: Spontaneous abortion (SAb) is the most frequent first-trimester complication, often with unclear etiology. This study compared hematological and biochemical markers of maternal nutritional status at clinical presentation in women with ongoing pregnancy and first-trimester SAb. Methods: A prospective analytical observational comparative study included 127 women at 6 to 11 gestational weeks admitted between September and December 2025. The ongoing pregnancy group included 105 women, and the SAb group included 22 women. Hematological indices, serum proteins, vitamin B12, iron, ferritin, folate, vitamin D, calcium, and magnesium were assessed. Results: SAb was associated with lower hemoglobin, hematocrit, iron, folate, and vitamin D levels, while vitamin B12 was higher. Ferritin, calcium, and magnesium did not differ significantly. Conclusions: Serum folate and vitamin D remain associated with SAb, without proving causality or predictive value.

Spleen tyrosine kinase is a non-receptor tyrosine kinase that couples receptor engagement to cellular survival, immune responses, and tissue injury. This narrative review compares its biology in malignancies and sepsis to examine how cellular compartment, receptor architecture, activation state, and signaling duration alter the meaning of a common signaling hub. A structured narrative search of PubMed/MEDLINE, Scopus, and Web of Science covered English-language publications from January 2000 to August 2026, supplemented by older seminal studies. In several hematological malignancies, sustained receptor signaling or oncogenic cooperation supports malignant-cell persistence; solid tumors show both tumor-promoting and tumor-suppressive functions. In sepsis, dynamically changing immune and vascular responses link spleen tyrosine kinase to pathogen recognition, inflammatory and oxidative responses, endothelial dysfunction, and organ injury. Oncology includes mechanistic studies, human cohorts, and early clinical therapeutic trials, whereas sepsis evidence remains predominantly experimental, with limited human observational and ex vivo validation. Transcript abundance, total protein, and phosphorylation are distinct biomarker endpoints whose interpretation requires identification of the cellular source and sampling context. Kinase inhibitors have shown clinical activity in selected malignancies and protection in experimental sepsis, but these findings do not establish a validated predictive biomarker or clinical efficacy in sepsis. Translation requires disease-specific validation, standardized cellular assessment, and attention to treatment timing and preservation of host defense.

Background/Objectives: Sexually transmitted infections (STIs) are resurgent globally, yet sub-national epidemiological data from Romania remain sparse. This study characterizes long-term STI trends in Galați County (population ~500,000) and examines whether observed morbidity patterns reflect transmission dynamics or surveillance system performance. Methods: Retrospective analysis of all notified STI cases in Galați County, 2017–2025 (nine years; n = 253), from the County Public Health Directorate surveillance database. Data included demographics, clinical stage, detection route, and temporal trends. Quasi-Poisson regression with a population offset estimated the annual change in notification rates; standardized morbidity ratios (SMR) compared local to national levels (2021–2024). Results: Over nine years, 253 cases were notified: 204 syphilis (80.6%), 49 gonorrhea (19.4%), and no chlamydia. Notification rates declined across 2017–2025 (rate ratio per year = 0.87; 95% CI 0.78–0.97; p = 0.014), reached a trough in 2020 and recovered partially thereafter, a pattern that may reflect variation in case detection, although testing volumes were not available to confirm this. Over 2021–2024, syphilis notification rates exceeded national levels in both males (SMR = 2.35; 95% CI 1.79–3.03; p < 0.0001) and females (SMR = 1.76; 95% CI 1.15–2.57; p = 0.011). Primary-stage disease was recorded in 13 of 204 syphilis cases (6.4%); antenatal screening identified 32 maternal infections over nine years with zero congenital syphilis notifications. Conclusions: The notification pattern is compatible with an important role of case detection, in particular the contrast between structured antenatal screening and opportunistic detection pathways, but testing and outcome data are needed to confirm this interpretation.

Introduction: Fear of progression, anxiety and depression are highly interconnected in breast cancer patients and survivors, and they shape adaptation to the disease. Materials and Methods: This observational, cross-sectional, multicentre, non-interventional study was conducted in two hospitals in Romania during one month (July 2026). A total of 120 patients with breast cancer were assessed with three questionnaires: the Hospital Anxiety and Depression Scale (HADS), the Illness Cognition Questionnaire (ICQ) and the Short Fear of Progression Questionnaire (FoP-12). Results: Anxiety reached at least the borderline band in 58 patients (48.3%) and depression in 59 patients (49.2%). Fear of progression was dysfunctional in 46 patients (38.3%). High acceptance (64, 53.3%) and high perceived benefits (61, 50.8%) each described about half the sample, whereas high helplessness was uncommon (10, 8.3%). Discussion: Anxiety and depression were strongly related (ρ = .77, 95% CI [.67, .84], p < .001). Helplessness, anxiety, depression and fear of progression were all significantly and positively intercorrelated, with coefficients from .27 to .77, all q < .01. Conclusions: Anxiety, depression and fear of progression were common and closely interrelated, whereas differences between patient subgroups were few and modest once multiple testing was taken into account. These findings are exploratory and support routine psychological screening of breast cancer patients, but they do not identify established risk factors.

The skin microbiome is continuously exposed to solar ultraviolet radiation (UVR), but the magnitude, direction and clinical meaning of the associated microbial changes remain uncertain. This narrative review critically evaluates evidence from controlled human, environmental, phototherapy, animal and in vitro studies linking UVA/UVB exposure to changes in skin microbial composition or function and to epidermal barrier outcomes. The available evidence indicates that UVA and UVB can alter community composition within minutes to days. However, these effects vary according to dose, wavelength, body site, host and sampling time, and may partly recover. The evidence does not support a universal pattern of decreased Cutibacterium acnes and increased Staphylococcus aureus. Dose is central to this relationship: repeated very-low or suberythemal exposure can induce antimicrobial peptides and adaptive responses, whereas single high exposures are more likely to cause inflammation, barrier injury and immunosuppression. Microbiome-dependent mechanisms include changes in tryptophan metabolites and AhR signaling, short-chain fatty acids, extracellular DNA and modulation of cytokine responses. Evidence from phototherapy studies shows that microbial remodeling can accompany clinical improvement, while sunscreen studies suggest that some formulations preserve microbial features without measurably disrupting dominant resident taxa. Because the available studies differ substantially in exposure, site, platform and endpoint, quantitative pooling is not currently defensible. Numerical results are therefore summarized in a structured evidence table Broad-spectrum photoprotection remains foundational. Microbiome-compatible formulations and microbial or metabolite adjuncts are promising but still require randomized, dose-resolved, multi-omic clinical validation.

This systematic review examines chronic kidney disease-associated pruritus (CKD-aP) as a complex clinical manifestation in patients undergoing hemodialysis. Traditionally considered a secondary symptom of end-stage renal disease, emerging evidence now positions CKD-aP as a multidimensional disorder with substantial pathogenic influence on patient outcomes. Using the PRISMA 2020 methodology, we critically evaluated 54 peer-reviewed studies published between 2020 and 2025. Our synthesis highlights a convergence of five mechanistic frameworks underpinning CKD-aP: elevated levels of uremic toxins originating from gut microbial dysbiosis, immune activation driven by IL-31 and other pro-inflammatory cytokines, heightened peripheral and central neural sensitization, dysregulation of endogenous opioid receptor pathways favoring μ-receptor activation, and xerosis-related epidermal barrier dysfunction. These mechanisms contribute to a systemic cycle of microinflammation, pruritogenic signaling, and neural hyperexcitability. We also identified and compared validated assessment tools—including the NRS, VAS, Skindex-10, and the UP-Dial scale—that facilitate standardized quantification of disease burden. While available treatments such as gabapentinoids and phototherapy offer partial relief, targeted therapies—including κ-opioid receptor agonists—represent a major advancement, although long-term effectiveness and accessibility remain under investigation. Growing scientific consensus establishes CKD-aP as a priority therapeutic target in hemodialysis care, underscoring the need for integrated, mechanism-based management strategies to improve quality of life and clinical outcomes. This work represents a narrative systematic review, integrating evidence from mechanistic, translational, and clinical studies to critically examine the biological pathways underlying CKD-associated pruritus.

As Parkinson’s disease (PD) progresses to advanced stages, treatment optimization becomes imperative for managing refractory motor fluctuations and non-motor symptoms. Conventional oral and transdermal therapies demonstrate limited efficacy in >70% of patients after 5-7 years of treatment. Device-aided therapies (DATs) providing continuous dopaminergic stimulation represent an established approach, reducing OFF-time by 4-6 hours/day in clinical trials. The novel levodopa-entacapone-carbidopa intestinal gel (LECIG) formulation, approved in 202X, uniquely combines continuous duodenal levodopa delivery with peripheral COMT inhibition, enhancing bioavailability while reducing dose requirements. This article has two primary aims: firstly to review LECIG’s pharmacokinetic profile and synthesize clinical evidence from real-world experience, including patient-reported outcomes from early adopters (e.g., Swedish cohorts); and secondly to offer practical guidance for clinicians initiating LECIG, covering transitions from oral therapies or other DATs (e.g., LCIG), stepwise dosing titration, and adverse event management. Notably, LECIG demonstrates motor improvements comparable to standard levodopa–carbidopa intestinal gel (LCIG) but achieves therapeutic plasma concentrations at lower doses due to entacapone’s enhancement of levodopa bioavailability. These features position LECIG as a valuable option for personalized advanced PD care.

Background and Objectives: Psoriasis is a chronic immune-mediated inflammatory disease requiring reliable diagnostic and monitoring tools. Salivary interleukins have emerged as promising non-invasive biomarkers, reflecting systemic inflammation and offering practical advantages such as ease of collection and improved patient compliance. Materials and Methods: This review synthesizes the current evidence on key salivary cytokines—IL-1β, IL-6, TNF-α, and IL-17—in relation to psoriasis pathogenesis, diagnosis, and treatment monitoring. It also compares saliva to blood-based diagnostics, emphasizing benefits like cost-effectiveness and suitability for repeated sampling. Methodological challenges, including heterogeneity in collection protocols and limited longitudinal data, are critically examined. Results: Advances in biologic therapies have deepened the understanding of psoriasis immunopathogenesis, highlighting interleukins as central biomarkers. Recent findings identify IL-37 and IL-38 as novel regulatory cytokines with anti-inflammatory roles. While elevated serum TNF-α levels in psoriatic patients are well documented, some inconsistencies persist. Notably, saliva has proven to be a viable alternative diagnostic fluid, supporting large-scale screening and routine clinical monitoring. Conclusions: Salivary interleukins—particularly IL-1β, IL-6, TNF-α, and IL-17—represent valuable, non-invasive biomarkers for early detection, disease severity assessment, and therapeutic response monitoring in psoriasis. Standardizing saliva-based methods and conducting large-scale studies are essential next steps to support their integration into personalized clinical practice.

Background and Objectives: Tobacco smoking is the most important cause of chronic diseases and premature death worldwide. Very brief advice (VBA) and brief advice (BA) represent evidence-based interventions designed to increase quit attempts. These are appropriate for all smokers, regardless of their motivation to quit, and involve several steps regarding the assessment, advice, and action. This review aimed to evaluate the effectiveness of these brief interventions offered by general practitioners (GPs) in smoking cessation. Materials and Methods: A systematic search for articles that presented these interventions as an aid to support smoking cessation was conducted. The rate of successful smoking cessation was evaluated following interventions offered by general practitioners, regardless of the patients’ present motivation to quit. Results: We have checked if these interventions can be used as an innovative method to help active smokers make an informed decision regarding their behaviour. Conclusions: Assisted/supported/guided by a general practitioner, current cigarette smokers can decide to quit smoking and identify the best way of cessation. We processed relevant data where brief interventions were used as the main counselling method to aid smoking cessation, regardless of using nicotine replacement therapy (NRT), heated tobacco products (HTPs), or vaping.

Background: This study explores patient acceptance of influenza vaccination administered by pharmacists in Romania during the 2023 season, considering it a novel strategy to address gaps in knowledge. Pharmacy-based vaccination deviates from traditional methods, providing high-risk patients with full reimbursement and others with 50% reimbursement, allowing a choice between family doctors and pharmacies for vaccine administration. Material and Method: The survey includes 15 questions covering socio-demographic data, health information, vaccination preferences, and perceptions of pharmacy-based vaccinations. Results: Respondents showed a positive inclination toward pharmacy-based vaccination, with 68% expressing favorable sentiments, but an awareness gap exists, as only 36% were aware of pharmacy-based vaccination availability. Conclusion: Challenges include a lack of patient awareness and understanding of benefits, emphasizing the need for structured pharmacist-patient dialogues. Legal changes, a defined funding mechanism, and collaboration are crucial for successful implementation. The study provides valuable insights into patient perceptions, contributing to discussions on optimizing influenza vaccination coverage in Romania and beyond and recognizing pharmacies’ potential in achieving broader vaccination goals.