Vlad Ionut Belghiru

Background and Objectives: Neonatal sepsis is time-sensitive, yet the role of interhospital transport in its early care pathway is poorly characterised. This scoping review systematically identified and classified contemporary neonatal transport variables, interventions, and organisational practices potentially relevant to early sepsis care, examined the evidentiary proximity of the available literature to neonatal sepsis, and identified priorities for direct investigation. Materials and Methods: PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library were searched for English-language, peer-reviewed reports published from 1 January 2020 to 30 June 2026. Google Scholar, an academic search engine, and backward citation searching supplemented the database search. Two reviewers independently screened records; a third author charted data using a predefined matrix. Findings were reported according to PRISMA-ScR and synthesised descriptively because the mapping question and non-comparable concepts and outcomes did not support a pooled estimate. Results: Thirty-nine sources of evidence were included. They covered system organisation; respiratory and procedural stabilisation; haemodynamic, metabolic, and thermal management; medication and fluid use; adverse events; environmental exposures; and communication. Evidence was predominantly indirect: 24 sources were classified as indirect clinical, seven as indirect organisational, four as indirect technical, one as indirect experiential, and three as direct transport-process/indirect sepsis-outcome evidence. Few reports addressed infection-related processes, and none established that a transport intervention independently improved sepsis-specific outcomes. Antimicrobial timing, culture status, perfusion trajectories, and structured sepsis handover were rarely reported. Conclusions: Contemporary neonatal transport research identifies measurable care processes that may matter when sepsis is suspected, but the sepsis-specific effect of transport remains unproven. Prospective multicentre studies should directly link transport-phase processes with infection-defined populations and outcomes.

Background/Objectives: Outborn neonates—those born outside tertiary perinatal centres and transferred postnatally—may experience higher mortality and morbidity than inborn infants. This systematic review without meta-analysis synthesised contemporary evidence on neonatal interfacility transfer to tertiary and quaternary neonatal centres, focusing on mortality, major morbidity, physiological instability, prognostic tools, and organisational determinants. Methods: Four electronic databases (PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library) were searched for English-language publications from January 2010 to December 2025. Study selection and data extraction were performed independently by two reviewers, with disagreements resolved by consensus. Narrative synthesis followed PRISMA 2020 and SWiM principles. Of the 2456 records identified, 44 publications were retained: 31 primary studies and 13 contextual or methodological sources. Results: Across the primary evidence, outborn status was generally associated with higher mortality and major morbidity, particularly among very preterm infants, although effect magnitude varied across healthcare systems. Hypothermia, respiratory deterioration, and haemodynamic instability were recurrent transport-related complications. Specialised teams, standardised stabilisation, and thermal-management bundles were associated with better physiological stability. TRIPS and TRIPS-II showed prognostic utility. Conclusions: Predominantly observational evidence suggests that neonatal transport outcomes reflect interactions between biological vulnerability, transport-related stress, and system organisation. Strengthening regionalised transport pathways and standardising stabilisation practices may improve outcomes, but causal inference remains limited.

Background and Objectives: Burnout is highly prevalent among emergency and acute care healthcare workers (HCWs), yet biological correlates remain debated because candidate biomarkers are strongly shaped by circadian timing, shift work, sleep loss, and overlapping affective symptoms. We mapped post-2018 evidence of biological biomarkers assessed alongside validated burnout measures in emergency department (ED), emergency medical services (EMS), and related acute care settings. Specifically, we asked whether reproducible biological correlates of burnout can be identified in emergency and acute-care healthcare workers when biomarker endpoint class and sampling context are systematically considered. Materials and Methods: We conducted a systematic scoping review with evidence mapping (PRISMA-ScR). PubMed/MEDLINE and the MDPI platform were searched for English-language studies published from 2018 onward (through January 2026). Eligible quantitative studies enrolled ED/EMS or acute care HCWs, assessed burnout using validated instruments, and reported at least one biological biomarker. Evidence was charted by biomarker domain and endpoint class (basal measures, stress reactivity paradigms, and chronic indices such as hair-based markers). Results: Overall, 19 studies were included in mapping/synthesis. Biomarker selection clustered around the hypothalamic–pituitary–adrenal axis (cortisol; n = 10/19), with fewer studies focused on autonomic function (heart rate variability; n = 2/19) and immune–inflammatory markers (n = 2/19), and single-study coverage for oxidative stress (n = 1/19), cardiometabolic candidates (n = 1/19), cellular aging (n = 1/19), neuroglial/multi-system candidates (n = 1/19), and feasibility-oriented multi-marker designs (n = 1/19). Reported associations with burnout were heterogeneous in direction and magnitude, but were more interpretable when endpoint class, timing anchors, and shift/sleep-related covariates were explicitly reported. Rates of confounder adjustment were low across studies (e.g., only 3/19 reported multivariable adjustment, and none systematically measured sleep or circadian factors), substantially limiting interpretability. Conclusions: The 2018+ literature does not support a single reproducible biomarker for burnout in emergency and acute care workforces. Evidence instead suggests multi-system dysregulation that is highly sensitive to endpoint class, sampling timing, and contextual confounding. Future studies should prioritize timing-anchored repeated-measures protocols across shift and recovery windows, jointly model sleep/circadian factors and depressive symptoms, and evaluate multi-marker panels and intervention responsiveness.

Point-of-care ultrasound (POCUS) is an essential component of emergency medicine, enabling rapid bedside assessment across a wide spectrum of acute conditions. Its effectiveness, however, remains constrained by operator dependency, variable image quality, and time-critical decision-making. Recent advances in artificial intelligence (AI) offer opportunities to augment POCUS by supporting image acquisition, interpretation, and quantitative analysis. This narrative review synthesizes current evidence on AI-enhanced POCUS applications in emergency care, encompassing trauma, non-traumatic emergencies, integrated workflows, resource-limited settings, and education and training. Across trauma settings, AI-assisted POCUS has demonstrated promising performance for automated detection of pneumothorax, hemothorax, and free intraperitoneal fluid, supporting standardized eFAST examinations and rapid triage. In non-traumatic emergencies, AI-enabled cardiovascular, pulmonary, and abdominal applications provide automated measurements and pattern recognition that can approach expert-level performance when image quality is adequate. Integrated AI–POCUS systems and educational tools further highlight the potential to expand ultrasound access, support non-expert users, and standardize training. Nevertheless, important limitations persist, including limited generalizability, dataset bias, device heterogeneity, and uncertain impact on clinical decision-making and patient outcomes. In conclusion, AI-enhanced POCUS is transitioning from proof-of-concept toward early clinical integration in emergency medicine. While current evidence supports its role as a decision-support tool that may enhance consistency and efficiency, widespread adoption will require prospective multicentre validation, development of representative POCUS-specific datasets, vendor-agnostic solutions, and alignment with clinical, ethical, and regulatory frameworks.

Background: This study presents a comprehensive analysis of cholesteatoma of the middle ear, focusing on its clinical presentation, diagnostic imaging, and treatment outcomes. Cholesteatomas are defined by the keratinized squamous epithelium within the middle ear, leading to significant bone erosion, often affecting the ossicular chain and surrounding structures. Methods: The study explores various mechanisms involved in cholesteatoma progression, including enzymatic lysis, inflammatory responses, and neurotrophic disturbances. The study conducted a retrospective clinical and statistical review of 580 patients over a 20-year period (2003–2023), highlighting the role of advanced imaging, including computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DWI), in preoperative planning and postoperative follow-up. Results: Findings revealed that early detection and intervention are crucial in preventing severe complications such as intracranial infection and hearing loss. Surgical treatment primarily involved tympanoplasty and mastoidectomy, with a recurrence rate of 1.55% within two years. The study underscores the importance of integrating imaging advancements into clinical decision-making to enhance patient outcomes and suggests further investigation into molecular mechanisms underlying cholesteatoma progression and recurrence. Histopathological and microbiological analysis was performed to identify pathological patterns and microbial agents. Conclusions: The study highlights the importance of early diagnosis and intervention to prevent complications such as intracranial infections and permanent hearing loss, while also emphasizing the role of advanced imaging techniques in the management and long-term monitoring of cholesteatoma patients.

Smoke intoxication is a central event in mass burn incidents, and toxic smoke acts at different levels of the body, blocking breathing and oxygenation. The majority of these patients require early induction of anesthesia to preserve vital functions. We studied the influence of hemoglobin (HMG) and myoglobin (MGB) blockade by hydrochloric acid (HCl) in an interaction model with gaseous anesthetics using molecular docking techniques. In the next part of the study, molecular dynamics (MD) simulations were performed on the top-scoring ligand–receptor complexes to investigate the stability of the ligand–receptor complexes and the interactions between ligands and receptors in more detail. Through docking analysis, we observed that hemoglobin creates more stable complexes with anesthetic gases than myoglobin. Intoxication with gaseous hydrochloric acid produces conformational and binding energy changes of anesthetic gases to the substrate (both the pathway and the binding site), the most significant being recorded in the case of desflurane and sevoflurane, while for halothane and isoflurane, they remain unchanged. According to our theoretical model, the selection of anesthetic agents for patients affected by fire smoke containing hydrochloric acid is critical to ensure optimal anesthetic effects. In this regard, our model suggests that halothane and isoflurane are the most suitable choices for predicting the anesthetic effects in such patients when compared to sevoflurane and desflurane.