Roxana Elena Mirică

Background/Objectives: Chronic obstructive pulmonary disease (COPD) causes functional consequences that may not be fully captured by conventional measures of disease severity. Methods: This retrospective cross-sectional study explored associations between clinical-functional characteristics and limitations in activities of daily living (ADL) among 184 patients with COPD undergoing specialized functional-capacity evaluation. Associations of clinical severity, forced expiratory volume in one second (FEV₁), dyspnea, exercise capacity, and the BODE index with ADL limitation were evaluated using multivariable ordinal regression models. Results: In exploratory adjusted analyses, lower FEV₁ (adjusted OR 0.87, 95% CI 0.81–0.94), greater dyspnea severity (mMRC: adjusted OR 32.09, 95% CI 6.67–154.46), and poorer exercise capacity (6MWT impairment score: adjusted OR 6.77, 95% CI 1.66–27.56) were associated with increasing ADL limitation. In a separate exploratory adjusted model, GOLD C (adjusted OR 5.14, 95% CI 1.65–16.02) and GOLD D (adjusted OR 33.65, 95% CI 8.15–138.88) were associated with greater functional limitation compared with GOLD A. The BODE index was also strongly associated with increasing ADL limitation. Conclusions: Functional impairment in COPD is multidimensional and cannot be adequately characterized by airflow limitation or disease classification alone. Integrating physiological, symptomatic, exercise, and functional measures may provide a more comprehensive characterization of disease impact in specialized functional-capacity evaluation.

Background: Liver cirrhosis imposes a substantial clinical, functional, and psychosocial burden, significantly affecting patients’ health-related quality of life (HRQoL). The aim of this study was to evaluate the relationship between disease severity, functional status, and HRQoL in patients with liver cirrhosis. Methods: This cross-sectional observational study included 144 adult patients with liver cirrhosis of diverse etiologies. Clinical, demographic, and laboratory data were collected, while HRQoL was assessed using the Short Form Liver Disease Quality of Life (SF-LDQOL) questionnaire. Disease severity was evaluated according to the Child–Pugh classification. Statistical analysis included descriptive statistics, Spearman correlation, the Kruskal–Wallis test, and Firth penalized multivariable logistic regression. Results: Most patients were classified as Child–Pugh A (75.7%), followed by Child–Pugh B (17.4%) and Child–Pugh C (6.9%). Overall quality of life was predominantly rated as fair or poor. Greater liver-related symptom burden and limitations in daily activities were significantly associated with poorer patient-reported quality-of-life outcomes. Overall quality of life differed significantly across Child–Pugh classes (p < 0.001), with poorer ratings in Child–Pugh B and C than in Child–Pugh A, although impaired quality of life was also observed among patients with compensated cirrhosis. In the forced-entry multivariable clinical model, Child–Pugh B was significantly associated with higher odds of impaired overall quality of life compared with Child–Pugh A (adjusted OR 33.32, 95% CI 1.90–582.94, p = 0.016), whereas age, sex, and etiology were not independently associated with the outcome. Conclusions: Health-related quality of life in patients with liver cirrhosis is associated with disease severity as well as with functional and psychosocial aspects of the patient-reported disease experience. Integrating patient-reported outcome measures with conventional clinical assessment may provide a more comprehensive evaluation of disease burden and support individualized multidisciplinary patient management.

Background: Lactose intolerance is a common gastrointestinal condition with variable clinical expression, often requiring both clinical and genetic evaluation. While genetic testing identifies genetic predisposition to lactase persistence or non-persistence, the relationship between specific LCT genotypes and clinical response to dietary intervention remains incompletely understood. Aim: To assess the association between LCT genotypes (CC, CT, TT) and symptom improvement following a lactose-free diet in an adult population and to explore the implications for clinical assessment. Methods: A retrospective observational study was conducted including 538 adult patients evaluated for suspected lactose intolerance. Genotype distribution and its association with clinical response to a lactose-free diet were analyzed. Group comparisons were performed using chi-square and non-parametric tests, and logistic regression analysis was used to identify genotype-specific predictors of symptom improvement. Results: The CC genotype was the most prevalent (70.8%), followed by CT (22.9%) and TT (6.3%). No significant differences were observed between genotype groups regarding age, sex, or area of residence. A significant association was identified between LCT genotype and clinical response to lactose restriction (p < 0.001). CT carriers demonstrated the highest rate of symptom improvement (70.7%), followed by CC (43.8%) and TT (17.6%). Logistic regression analysis confirmed higher odds of improvement among CT carriers (OR = 11.28, 95% CI: 4.30–29.56, p < 0.001) and CC carriers (OR = 3.64, 95% CI: 1.47–9.00, p = 0.005) compared with TT individuals. Conclusions: LCT genotype was significantly associated with clinical response to a lactose-free diet. These findings suggest that genetic variation may contribute to differences in symptom response to dietary lactose restriction and support the use of genotypic information as a complementary component of clinical assessment. However, the observed variability in clinical outcomes across genotype groups highlights the multifactorial nature of lactose intolerance and indicates that genetic predisposition alone does not fully explain symptom expression or dietary response.

Background: Alcohol-related liver cirrhosis imposes a substantial clinical, functional, and psychosocial burden, significantly affecting patients' health-related quality of life (HRQoL). The aim of this study was to evaluate the relationship between disease severity, functional status, and HRQoL in patients with alcohol-related liver cirrhosis. Methods: This cross-sectional observational study included 144 adult patients with alcohol-related liver cirrhosis. Clinical, demographic, and laboratory data were collected, while HRQoL was assessed using the Short Form Liver Disease Quality of Life (SF-LDQOL) questionnaire. Disease severity was evaluated according to the Child–Pugh classification. Statistical analysis included descriptive statistics, Spearman correlation, the Kruskal–Wallis test, and multivariable logistic regression. Results: Most patients were classified as Child–Pugh A (75.7%), followed by Child–Pugh B (17.4%) and Child–Pugh C (6.9%). HRQoL was predominantly rated as fair or poor. Greater liver-related symptom burden and limitations in daily activities were significantly associated with poorer HRQoL. Patients with more advanced liver disease reported significantly lower HRQoL scores (p = 0.02), although impaired HRQoL was also observed in a substantial proportion of patients with compensated cirrhosis. In the multivariable analysis, social isolation remained independently associated with impaired overall HRQoL after adjustment for demographic and clinical characteristics. Conclusions: Health-related quality of life in patients with alcohol-related liver cirrhosis is influenced not only by disease severity but also by functional and psychosocial factors. Integrating patient-reported outcome measures with conventional clinical assessment may provide a more comprehensive evaluation of disease burden and support individualized multidisciplinary patient management.

Background: Romania's social health insurance system is based on the Bismarck model and aims to provide universal healthcare access through compulsory contributions. While financing and institutional design have been widely studied, the ethical responsibilities of physicians, particularly social insurance physicians, remain under-explored. Objective: This study analyzes Romania's social health insurance system through an integrated institutional and ethical lens, focusing on social insurance physicians who operate at the interface of clinical assessment and social protection eligibility. Methods: A structured narrative review was conducted, synthesizing national legislation, international ethical frameworks (Declaration of Geneva, International Code of Medical Ethics), peer-reviewed literature (2010–2025), and comparative analyses with European health insurance models. The analysis identified systemic challenges, including underfunding, workforce migration, and demographic pressures, and examined their impact on professional ethics. Results: Romania ensures broad formal coverage, yet persistent challenges—underfunding, regional disparities, informal payments, and physician shortages—create ethical tensions for social insurance physicians. Comparative analysis shows that other European countries (Germany, France, Netherlands) mitigate such pressures through stronger institutional safeguards, higher funding, and protected professional autonomy. Conclusion: This study contributes to health services research by conceptualizing ethical vulnerability in resource-constrained insurance systems and linking institutional structures to professional autonomy, fairness, and system resilience. Findings highlight the need to strengthen ethical frameworks, safeguard physician independence, and align institutional reforms with ethical governance to ensure transparent, equitable, and resilient social health insurance systems.

Histological healing is increasingly recognized as a sensitive marker of disease remission in ulcerative colitis (UC). However, the dynamics of mucosal T lymphocytes and proinflammatory cytokines during healing remain incompletely understood. In this paired, within-subject observational study (retrospective analysis of paired biopsies), colonic biopsy sets from 20 adult UC patients were analyzed during active inflammation and at a subsequent time point of histologic healing. Immunohistochemistry was performed for CD3, CD4, CD8, and IL-6. Lymphocyte densities were quantified in intraepithelial and lamina propria compartments, while IL-6 expression was scored semi-quantitatively. Histological activity was assessed using the Geboes score. Intraepithelial CD4⁺ T cells significantly decreased during histologic healing (mean 6.8 → 3.75 cells/100 epithelial cells, p < 0.05), whereas lamina propria CD4⁺ cells remained variably persistent, suggesting ongoing immune regulation. Intraepithelial CD8⁺ cells increased during remission, indicating a potential reparative or surveillance role. IL-6 expression markedly declined in epithelial and stromal compartments during healing, reflecting resolution of mucosal inflammation. Correlation analyses revealed enhanced coordination between CD4⁺ and CD8⁺ cells in the healing phase, consistent with immune homeostasis. Histologic healing in UC involves compartment-specific shifts in T lymphocyte populations and a marked reduction in IL-6 expression, reflecting coordinated immune regulation beyond clinical remission. These findings highlight the potential of combined cellular and cytokine biomarkers to monitor mucosal healing and guide immunomodulatory therapies.

Background: Histologic healing is increasingly recognized as a sensitive marker of disease remission in ulcerative colitis (UC). However, the dynamics of mucosal T lymphocytes and pro-inflammatory cytokines during healing remain incompletely understood. Methods: In this observational, cross-sectional study, paired colonic biopsies from 20 adult UC patients were analyzed during active inflammation and subsequent histologic healing. Immunohistochemistry was performed for CD3, CD4, CD8, and IL-6. Lymphocyte densities were quantified in intraepithelial and lamina propria compartments, while IL-6 expression was scored semi-quantitatively. Histologic activity was assessed using the Geboes score. Results: Intraepithelial CD4⁺ T cells significantly decreased during histologic healing (mean 6.8 → 3.75 cells/HPF, p < 0.05), whereas lamina propria CD4⁺ cells remained variably persistent, suggesting ongoing immune regulation. Intraepithelial CD8⁺ cells increased during remission, indicating a potential reparative or surveillance role. IL-6 expression markedly declined in epithelial and stromal compartments during healing, reflecting resolution of mucosal inflammation. Correlation analyses revealed enhanced coordination between CD4⁺ and CD8⁺ cells in the healing phase, consistent with immune homeostasis. Conclusions: Histologic healing in UC involves compartment-specific shifts in T lymphocyte populations and a marked reduction of IL-6 expression, reflecting coordinated immune regulation beyond clinical remission. These findings highlight the potential of combined cellular and cytokine biomarkers to monitor mucosal healing and guide immunomodulatory therapies.

Objectives: This study explores the importance of social factors, Social Determinants of Health (SDOH), particularly poverty, on patients with type 2 diabetes mellitus (T2DM), who developed gastroparesis. The analysis aimed to correlate social variables such as income, education, occupation, and loneliness with clinical outcomes and their association with clinical outcomes and healthcare utilization, using hospitalization frequency and symptom burden as proxy indicators of quality of life.Methods: This retrospective observational study analyzed a subgroup of 50 patients with diabetic gastroparesis, selected from a larger cohort of 250 patients diagnosed with gastroparesis. Diabetic gastroparesis was confirmed via gastric scintigraphy. Demographic, clinical, and social variables were analyzed, and data collection was facilitated through a structured instrument using the software EpiInfo.Results: In this retrospective observational study, the majority of patients were obese females over 60 years of age, retired, and residing in rural areas. Loneliness emerged as a significant aggravating factor. Low income was associated with increased complications, frequent hospitalizations, and higher overall healthcare expenditure.Conclusion: Diabetic gastroparesis is an underdiagnosed complication of T2DM, frequently worsened by social vulnerability. In this study, low income, rural residence, obesity and loneliness were identified as key social determinants modulating disease severity and healthcare utilization. Greater emphasis on addressing these SDOH is necessary to optimize outcomes and reduce hospitalization rates, insurance expenses, and overall healthcare burden (used herein as proxy indicators of reduced quality of life).

Background and Clinical Significance: Rhabdomyosarcoma (RMS) is a rare and aggressive malignant soft-tissue sarcoma (STS) arising from skeletal connective tissues and is most commonly seen in the pediatric population. The pleomorphic subtype is mostly seen in adults in the sixth and seventh decades of life, representing 1% of all histological types of RMS and having a very poor prognosis. Case Presentation: This report presents the case of a 63-year-old male with a medical history of papillary thyroid cancer, who presented with an ulcer-hemorrhagic malignant tumor, namely, a poorly differentiated desmin-positive pleomorphic rhabdomyosarcoma (PRMS), with impressive dimensions located on the posterior thoracic wall. This tumor was surgically removed via a wide resection, followed by palliative chemotherapy and radiotherapy. However, the patient relapsed locally, with pulmonary, bone, and lymph node metastases. The peculiarity of this case is represented by the rapid growth, aggressive nature, and high metastatic potential of the adult RMS, as well as its poor response to treatment. Conclusions: The presented case underscores the need for early diagnosis, multidisciplinary management, and exploration of molecular profiling for therapeutic planning.

Objectives: This study explores the importance of social factors, Social Determinants of Health (SDOH), particularly poverty, on patients with type 2 diabetes mellitus (T2DM), who developed gastroparesis. Among the analyzed cohort, 72% were classified as low-income. The analysis aimed to correlate social variables such as income, education, occupation, and loneliness with clinical outcomes and their impact on patients’ quality of life in terms of diabetic gastroparesis. Methods: From a larger cohort of 250 patients diagnosed with gastroparesis, we identified a subgroup of 50 patients with diabetic gastroparesis confirmed via gastric scintigraphy. We analyzed the demographic, clinical, and social variables including sex, age, place of residence, socioeconomic status, obesity, chronic alcohol consumption and tobacco use, and self-reported loneliness. Data collection was facilitated through a structured instrument using the software EpiInfo. Results: The majority of patients were obese females over 60 years of age, retired, and residing in rural areas. Loneliness emerged as a significant aggravating factor, contributing to neglect in self-care. The clinical presentation was often non-specific, masking the severity of the gastric dysfunction and complicating the disease management; in total, 92% of patients underwent upper endoscopy. Low income was associated with increased complications, frequent hospitalizations, and higher overall healthcare expenditure. Conclusions: Diabetic gastroparesis is a complex and underdiagnosed complication of T2DM, frequently worsened by social vulnerability. Low income, obesity, rural residence, and limited social support significantly contribute to the disease progression and poor quality of life. Greater emphasis on the SDOH is necessary to optimize outcomes and reduce the healthcare burden, hospitalization rates, and household and insurance expenses in this population.