The Influence of Climate on Critically Ill Pregnant COVID-19 Patients, as Revealed by the Inflammation Indexes, in Spring versus Autumn 2021 Infection

(1) Background: Seasonality is an important environmental factor that influences immune re-sponses (2) Methods: In a retrospective study, we included all pregnant patients admitted to the Elena Doamna Obstetrics and Gynecology Hospital with a critical form of COVID-19 infection between 1 January and 1 December 2021. The blood counts collected on the specific A, H and E Brixia score- collection days, or the ones collected closest to those days, were considered in our study. We also studied the differences between the two groups regarding the inflammation in-dexes exhibited on those specific days: A (admittance), H (highest Brixia score), and E (end of hospitalization). (3) Results: The values of NLR, dNLR, SII, and AISI are significantly higher and IIC is significantly lower for the spring group versus the autumn group, especially on the H and E Brixia score-collection days. (4) Conclusions: These results suggest that severe-COVID-19 in-flammation was significantly higher in the spring of 2021 in Romania than in autumn 2021, in regard to pregnant patients

Prediction of HELLP Syndrome Severity Using Machine Learning Algorithms—Results from a Retrospective Study

(1) Background: HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is a rare and life-threatening complication of preeclampsia. The aim of this study was to evaluate and compare the predictive performances of four machine learning-based models for the prediction of HELLP syndrome, and its subtypes according to the Mississippi classification; (2) Methods: This retrospective case-control study evaluated pregnancies that occurred in women who attended a tertiary maternity hospital in Romania between January 2007 and December 2021. The patients’ clinical and paraclinical characteristics were included in four machine learning-based models: decision tree (DT), naïve Bayes (NB), k-nearest neighbors (KNN), and random forest (RF), and their predictive performance were assessed; (3) Results: Our results showed that HELLP syndrome was best predicted by RF (accuracy: 89.4%) and NB (accuracy: 86.9%) models, while DT (accuracy: 91%) and KNN (accuracy: 87.1%) models had the highest performance when used to predict class 1 HELLP syndrome. The predictive performance of these models was modest for class 2 and 3 of HELLP syndrome, with accuracies ranging from 65.2% and 83.8%; (4) Conclusions: The machine learning-based models could be useful tools for predicting HELLP syndrome, and its most severe form—class 1

Predictive Performance of Machine Learning-Based Methods for the Prediction of Preeclampsia—A Prospective Study

(1) Background: Preeclampsia (PE) prediction in the first trimester of pregnancy is a challenge for clinicians. The aim of this study was to evaluate and compare the predictive performances of machine learning-based models for the prediction of preeclampsia and its subtypes. (2) Methods: This prospective case-control study evaluated pregnancies that occurred in women who attended a tertiary maternity hospital in Romania between November 2019 and September 2022. The patients’ clinical and paraclinical characteristics were evaluated in the first trimester and were included in four machine learning-based models: decision tree (DT), naïve Bayes (NB), support vector machine (SVM), and random forest (RF), and their predictive performance was assessed. (3) Results: Early-onset PE was best predicted by DT (accuracy: 94.1%) and SVM (accuracy: 91.2%) models, while NB (accuracy: 98.6%) and RF (accuracy: 92.8%) models had the highest performance when used to predict all types of PE. The predictive performance of these models was modest for moderate and severe types of PE, with accuracies ranging from 70.6% and 82.4%. (4) Conclusions: The machine learning-based models could be useful tools for EO-PE prediction and could differentiate patients who will develop PE as early as the first trimester of pregnancy

Acceptability of Human Papilloma Virus Self-Sampling for Cervical Cancer Screening in a Cohort of Patients from Romania (Stage 2)

(1) Background: Low patient’s adherence to conventional cervical cancer screening methods determined the need to take into consideration alternative approaches, and vaginal HPV self-sampling is one of them. We aimed to evaluate, using an online survey, the Romanian women’s acceptability of vaginal HPV self-sampling. (2) Methods: A 13-questions online survey was distributed on three Facebook groups, and the results were summarized. (3) Results: Despite of good educational background, 10.8% (n = 60) of the respondents did not know what a Pap smear is, and 33% (n = 183) were not informed about the free national cervical cancer screening program. Multivariate analysis revealed an increased likelihood of vaginal self-sampling acceptance among respondents who did not know about Pap test (OR: 7.80; 95%CI: 1.062–57.431; p = 0.021), national cervical cancer screening program (OR: 1.96; 95%CI: 1.010–3.806; p = 0.02), HPV infection (OR: 7.35; 95%CI: 3.099–17.449; pp = 0.03). Moreover, women who did not previously undergo a cervical cancer screening program were more likely to accept the new screening method (OR: 1.62; 95%CI: 0.878–3.015; p = 0.04). (4) Conclusions: Our results showed high acceptability rates of vaginal HPV self-sampling among participants

Neonatal Cerebral Sinovenous Thrombosis and the Main Perinatal Risk Factors—A Retrospective Unicentric Study

(1) Background: Neonatal cerebral sinovenous thrombosis (CSVT) is a rare disorder, associated with long-term neurological sequelae. The aim of this study was to retrospectively evaluate the most commonly encountered perinatal risk factors for this disease in a cohort of newborns from Romania. (2) Methods: The medical records of neonatal CSVT patients treated between January 2017 and December 2021 were descriptively assessed. (3) Results: The study included nine neonates, five males (55.56%) and four females (44.44%), who were born at term. The most commonly presented clinical manifestations were feeding difficulties, lethargy, respiratory distress, loss of consciousness, and seizures. Maternal-inherited thrombophilia, male sex, complicated delivery, perinatal asphyxia, and mechanical ventilation were frequently identified as potential risk factors for developing CSVT. The lesions were more frequently localized in the superior sagittal sinus (n = 7; 77.78%), followed by the transverse (n = 4; 44.44%), sigmoid (n = 2; 22.22%), and cavernous (n = 1; 11.11%) sinuses. Low-molecular-weight heparin was administered to all patients, and two of them died from thrombotic complications. (4) Conclusions: Recognition of potential risk factors and a prompt diagnosis of neonatal CSVT could lead to better patient management and to a reduction of severe complications

Predictors Associated with Adverse Pregnancy Outcomes in a Cohort of Women with Systematic Lupus Erythematosus from Romania—An Observational Study (Stage 2)

Background: Pregnancy in women with systemic lupus erythematosus (SLE) is accompanied by adverse pregnancy outcomes (APOs). We aimed to investigate the association between clinical, sonographic, and laboratory parameters and APOs (preeclampsia, intrauterine growth restriction, premature birth, and maternal mortality). Methods: This observational retrospective study included all pregnancies in women with SLE who attended two tertiary maternity hospitals from Romania between January 2013 and December 2020. Clinical, sonographic, and laboratory variables were examined. Bivariate associations of APO status and each predictor variable were evaluated, and significant predictors were further included in a classification model based on discriminant analysis. Results: Predictors of APOs included BMI > 25 kg/m2, personal history of lupus nephritis or chronic hypertension, proteinuria, low C3, SLE Disease Activity Index 2000 (SLEDAI-2k score ≥ 4 and physician’s global-assessment (PGA) score ≥ 1 throughout pregnancy, increased mean uterine arteries pulsatility index in the first and second trimesters, cerebroplacental ratio < 1 in the second and third trimesters, and small fetal abdominal circumference in the third trimester. Glucocorticoids, methyldopa, and aspirin use appeared to be protective against APOs. Conclusions: This study provides a comprehensive analysis of the most important predictors for APOs in pregnant patients with SLE, which could constitute a basis for further research

A Multicenter Cohort Study Evaluating the Teratogenic Effects of Isotretinoin on Neonates

(1) Background: Isotretinoin (ISO) is a systemic retinoid known for its teratogenic effects on embryos and fetuses. The aim of this study was to compare the pregnancy outcomes of women who were exposed to isotretinoin with those of women without such exposure from a teratogenic point of view. (2) Methods: A total of 1459 female patients from three clinical hospitals in Poland and Romania, segregated into two groups depending on their ISO exposure, were evaluated between January and December 2019. Medical records were screened to identify the pregnancy outcomes and congenital malformation rates. (3) Results: The congenital malformation rate for the exposed group was 1.2% (four cases), and no specific signs of Accutane embryopathy were identified. Women from the unexposed group were more likely to deliver preterm and through cesarean deliveries and had a higher rate of newborn congenital malformations as compared to women from the exposed group. (4) Conclusions: Even though we could not find a significant association between ISO exposure and teratogenic effects in newborns, effective contraceptive measures are key to preventing unfavorable pregnancy outcomes

Risk Factors Associated with Severe Disease and Intensive Care Unit Admission of Pregnant Patients with COVID-19 Infection—A Retrospective Study

(1) Background: Pregnant patients with severe forms of coronavirus disease 2019 (COVID-19) can experience adverse pregnancy outcomes. The aim of this study was to retrospectively assess the risk factors associated with admission to the intensive care unit (ICU) of pregnant patients with COVID-19, as well as the pregnancy outcomes of these patients; (2) Methods: Medical records of 31 pregnant patients with COVID-19 admitted to three clinical hospitals from Romania, between October 2020 and November 2021 were examined. The patients were segregated into two groups depending on their clinical evolution: non-ICU admission (n = 19) or ICU admission (n = 12). Clinical and paraclinical findings were evaluated using univariate analysis, and the association of significant risk factors with maternal ICU admission was assessed using a multivariate analysis. Pregnancy outcomes of these patients were also recorded; (3) Results: Pulmonary disease, cough, dyspnea, leukocytosis, thrombocytosis, high serum values of transaminases, serum ferritin, and increased duration of hospital admission were identified as significant risk factors associated with maternal admission to the ICU. No significant differences regarding pregnancy outcomes were noted between the evaluated patients; (4) Conclusions: Specific risk factor identification in pregnant patients with severe forms of COVID-19 could improve the patient’s management

Predicting the Feasibility of Curative Resection in Low Rectal Cancer: Insights from a Prospective Observational Study on Preoperative Magnetic Resonance Imaging Accuracy

Background and Objectives: A positive pathological circumferential resection margin is a key prognostic factor in rectal cancer surgery. The point of this prospective study was to see how well different MRI parameters could predict a positive pathological circumferential resection margin (pCRM) in people who had been diagnosed with rectal adenocarcinoma, either on their own or when used together. Materials and Methods: Between November 2019 and February 2023, a total of 112 patients were enrolled in this prospective study and followed up for a 36-month period. MRI predictors such as circumferential resection margin (mCRM), presence of extramural venous invasion (mrEMVI), tumor location, and the distance between the tumor and anal verge, taken individually or combined, were evaluated with univariate and sensitivity analyses. Survival estimates in relation to a pCRM status were also determined using Kaplan–Meier analysis. Results: When individually evaluated, the best MRI predictor for the detection of a pCRM in the postsurgical histopathological examination is mrEMVI, which achieved a sensitivity (Se) of 77.78%, a specificity (Sp) of 87.38%, a negative predictive value (NPV) of 97.83%, and an accuracy of 86.61%. Also, the best predictive performance was achieved by a model that comprised all MRI predictors (mCRM+ mrEMVI+ anterior location+ p Conclusions: The use of selective individual imaging predictors or combined models could be useful for the prediction of positive pCRM and risk stratification for local recurrence or distant metastasis