Rares Nicolae Vadana

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.

Background: Despite advances in prostate cancer (PC) radiotherapy, including intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic body radiotherapy (SBRT), genitourinary (GU) and gastrointestinal (GI) toxicities remain important complications. Identifying reliable predictors is essential for personalized treatment. Objective: The aim of this study was to summarize current evidence on clinical, dosimetric, immunological, and genetic predictors of acute and late GU and GI toxicities after PC radiotherapy. Materials and Methods: A structured literature review of studies published between 2000 and 2026 was conducted using PubMed, Scopus, and Europe PMC. Eligible studies included clinical investigations, randomized controlled trials, meta-analyses, and reviews assessing toxicity according to RTOG and/or CTCAE criteria. Results: GU toxicity was associated with pretreatment International Prostate Symptom Score (IPSS), large prostate volume, prior TURP, smoking, alpha-blocker use, and bladder/urethral dose. GI toxicity correlated with rectal dose–volume parameters, anorectal irradiation, anticoagulant therapy, and cardiovascular comorbidities. Acute grade ≥ 2 toxicity predicts late toxicity. Preliminary data from small single-center cohorts associate elevated IL-6, TGF-β1, TNF-α, and systemic immune-inflammation index with higher toxicity risk, and higher lymphocyte counts with lower risk; these findings require prospective validation. The PROSTOX radiogenomic signature is promising for the prediction of late GU toxicity but still requires independent external validation in larger, ethnically diverse cohorts with longer follow-up, and is not currently suitable for routine clinical decision-making. Conclusions: GU and GI toxicities have distinct predictive profiles. Integrating clinical, dosimetric, immunological, and genetic factors may improve personalized radiotherapy, although prospective multicenter validation remains necessary.

Background/Objectives: Oral structural and functional impairment and depressive outcomes frequently coexist in older adults, but the strength and interpretation of their association remain uncertain. This systematic review and meta-analysis evaluated whether poorer oral status or function is associated with depressive outcomes in older populations. Methods: Six databases were searched for observational studies published from 1 January 2016 to 5 January 2026, with an update on 19 April 2026. Eligible studies examined oral impairment as the exposure and depressive outcomes as the endpoint in older adults. Risk of bias was assessed using Newcastle–Ottawa criteria and certainty using GRADE. Comparable adjusted odds ratios (ORs) were pooled using random-effects meta-analysis with restricted maximum likelihood and Hartung–Knapp adjustment; non-comparable metrics were synthesized separately. Results: Thirty studies were included; fifteen contributed to the primary OR meta-analysis. In the primary model, poorer oral status or function was associated with higher odds of adverse depressive outcomes (OR = 1.61, 95% CI: 1.31–1.99), although between-study heterogeneity was substantial (I² = 88.1%). In the trim-and-fill sensitivity analysis, the pooled estimate decreased to OR = 1.29 (95% CI: 0.99–1.69; p = 0.0584) and no longer reached conventional statistical significance. The certainty of the primary evidence was very low. Conclusions: Poorer oral structural or functional status is associated with worse depressive outcomes in older adults, but the magnitude is heterogeneous and sensitive to small-study-effect assumptions. The evidence remains observational and of very low certainty and should be interpreted as hypothesis-generating rather than causal or treatment evidence.

Background: Dental anxiety constitutes a prevalent barrier to oral healthcare utilization, yet patient-centered data on its prevalence, symptom profile, and preferred management strategies remain scarce in Romanian adult populations. Objectives: This study aimed to assess the prevalence and demographic correlates of self-reported dental anxiety, identify the most anxiety-provoking procedures, evaluate the perceived efficacy of anxiety-reduction strategies, and characterize patient preferences for improved anxiety management in the dental setting. Methods: A cross-sectional observational study was conducted using an anonymous 18-item online questionnaire (Google Forms) among 223 Romanian adults (≥18 years), recruited via convenience sampling between May and June 2025. Descriptive statistics, Pearson’s chi-square tests, Fisher’s exact test, Cramér’s V, and ordinal logistic regression (proportional odds model) were applied (Python 3.11; pandas, scipy, statsmodels). Results: Any degree of self-reported pre-procedural anxiety was endorsed by 60.5% of respondents, with 11.7% reporting moderate-to-severe levels. In the fully adjusted multivariable model (Model 2), female sex (OR = 1.80, 95% CI: 1.04–3.14, p = 0.037) and chronic medical conditions (OR = 3.84, 95% CI: 1.21–12.20, p = 0.022) were independent predictors of higher anxiety severity, although the chronic disease estimate was based on a small subgroup (n = 13) and its wide confidence interval indicates limited precision. Tooth extractions (49.8%) and periodontal surgery (39.5%) were the most anxiety-provoking procedures. Despite this high prevalence of self-reported anxiety, 66.4% of participants had never employed any coping strategy. Detailed procedural explanations provided by the clinician were consistently identified as the dominant patient-preferred intervention across four independent survey items (endorsed by 24.7–77.6% of respondents). A highly significant association was observed between anxiety status and perceived inadequacy of staff anxiety management (χ² = 22.406, p < 0.001). Conclusions: Self-reported dental anxiety affects the majority of this Romanian adult sample, with communication-based strategies representing the primary patient-centered priority. These findings support integrating structured communication training and standardized anxiety screening into routine dental practice.