Medicina, Volume 62, Issue 2 (February 2026) – 188 articles

Background and Objectives: Uterine arteriovenous fistulas (AVFs) and arteriovenous malformations (AVMs) are rare but potentially life-threatening vascular anomalies that most commonly develop after pregnancy-related uterine trauma, such as curettage or surgical evacuation. The widespread use of color Doppler ultrasonography has led to increased recognition of these lesions and a shift from hysterectomy toward fertility-preserving, minimally invasive management. This narrative review summarizes current evidence on acquired uterine AVF/AVM after early pregnancy loss, with particular emphasis on diagnostic challenges and contemporary therapeutic approaches, illustrated by representative clinical experience. Materials and Methods: A narrative review of the literature was conducted focusing on the pathophysiology, ultrasound and Doppler diagnostic criteria, interventional radiologic techniques, hysteroscopic management, and fertility outcomes in acquired uterine AVF/AVM. Illustrative clinical insights from anonymized post-abortion cases managed at our institution were incorporated solely to contextualize diagnostic and therapeutic considerations. Results: Color and spectral Doppler ultrasonography emerged as the diagnostic cornerstone, typically demonstrating serpiginous myometrial vessels with high-velocity, low-resistance turbulent flow, allowing for differentiation from retained products of conception. Uterine artery embolization showed high efficacy in achieving hemorrhage control, while hysteroscopic coagulation or resection represented an effective complementary or, in selected focal lesions, definitive treatment. Clinical experience highlighted that AVF-related vascularity may be evident early or may evolve over time, underscoring the importance of repeat Doppler evaluation in patients with persistent or recurrent bleeding. Conclusions: Acquired uterine AVF should be considered in women presenting with ongoing or recurrent uterine bleeding following aspiration abortion or curettage, even when initial Doppler findings are inconclusive. Individualized, minimally invasive strategies—often combining uterine artery embolization and hysteroscopic techniques—offer effective, uterus-preserving alternatives to hysterectomy. Full article

Background and Objectives: Pulmonary embolism (PE) is a frequent thrombotic complication associated with SARS-CoV-2 infection and is linked to significant early mortality. Accurate early risk stratification in the emergency department (ED) remains challenging, and it is unclear how well commonly used PE prognostic tools perform in patients with concomitant COVID-19. Materials and Methods: We conducted a retrospective, single-centre study including 538 consecutive patients with acute PE and with or without confirmed SARS-CoV-2 infection admitted through the ED. Univariate analysis and machine learning models were employed to assess mortality risk. Results: In univariate analysis, mortality was strongly associated with sepsis (OR 11.68) and PESI class V (OR 5.56) and was also linked to higher neutrophil count (OR 1.19), platelet count (OR 1.12), and NT-proBNP (OR 1.20). In the non-COVID cohort, XGBoost and RF showed better discrimination than PESI class (AUC 0.864 and 0.834 vs. 0.725), while Support Vector Machines (SVM) was lower (AUC 0.740). On COVID-19 external validation, discrimination decreased: XGBoost AUC was 0.635, RF 0.614, PESI 0.584, and SVM showed no discrimination. Conclusions: ML models using routinely available ED variables improved in-hospital mortality prediction compared with PESI in non-COVID PE, but performance declined in COVID-19 patients, suggesting limited generalizability and the need for COVID-specific refinement and prospective multicenter validation. Full article

Acute respiratory distress syndrome (ARDS) is a heterogeneous inflammatory lung injury marked by increased alveolar–capillary permeability, reduced respiratory system compliance, and impaired gas exchange. Despite advances in supportive care, ARDS remains associated with high mortality. Lung-protective ventilation with low tidal volumes and prone positioning is the cornerstone of treatment. However, these strategies do not fully account for patient-specific physiological variability. Recent guidelines emphasize a more individualized approach to respiratory support. Key elements include limitation of driving pressure, optimized use of high-flow nasal oxygen, and application of bedside tools such as the SpO₂/FiO₂ ratio and lung ultrasound. These measures improve diagnosis, monitoring, and physiological assessment at the bedside. This narrative review summarizes current evidence supporting contemporary ventilatory and non-invasive strategies in ARDS. It also examines emerging diagnostic and therapeutic approaches that integrate respiratory physiology into clinical decision-making. Finally, we discuss future directions focused on personalized, physiology-guided management to improve outcomes in patients with ARDS. Full article

Background and objectives: Antiseizure medications are essential for epilepsy management but often cause adverse effects that impact treatment adherence and quality of life. This study investigates the incidence rate and determinants of high-burden adverse effects of antiseizure medications. Materials and Methods: This study was a cross-sectional study including data extraction by a medical record review and administration of a standardized scale. It was conducted at an epilepsy outpatient clinic in Saudi Arabia and included adult patients on antiseizure medications. The validated Arabic version of the Liverpool Adverse Events Profile (LAEP) was used. The total LAEP scores ranged from 19 to 76. In this study, LAEP scores ≥ 45 were classified as high-burden adverse effects. Results: Of 153 included patients, 84 (54.9%) had high-burden adverse effects. The overall mean (SD) LAEP score was 45.63 (21.04). The most frequently rated adverse effects were difficulty in concentrating, with a mean score of 2.71 out of 4, followed closely by disturbed sleep (2.69), sleepiness (2.63), and memory problems (2.56). Of examined variables, generalized seizure and polytherapy were significantly associated with increased adverse effects. Likewise, uncontrolled seizure and presence of depression comorbidity were also associated with increased risk of adverse effects, but not statistically significant. Conclusion: The study reported a high rate of adverse effects of antiseizure medications and identified patients at high risk of adverse effects. Early recognition of these patients is important to provide appropriate care, including counselling, regular monitoring, and management of psychiatric comorbidities. Central nervous system symptoms were the most frequently reported adverse effects. Initiation of antiseizure medications with low doses and gradual titration may improve tolerability. Future research should focus on prediction adverse effects using pharmacogenomic AI-based decision-making tools. Full article

Background and Objectives: This study aimed to verify the validity of markerless gait analysis using both single-camera markerless system (S-ML) and multi-camera markerless system (M-ML) approaches by comparing them with a gold-standard marker-based system (MB). Materials and Methods: Sixteen healthy adults walked at their gait speed, and their gaits were simultaneously analyzed using three systems: S-ML, M-ML, and MB. Intraclass correlation coefficients were used to assess the reliability of the spatiotemporal parameters, and the root mean squared error (RMSE) was calculated to quantify the kinematic differences relative to the MB systems. Results: Both S-ML and M-ML demonstrated good-to-excellent reliability in spatiotemporal parameters, including step length, stance time, and gait speed, whereas stride length and swing time measured by S-ML revealed moderate reliability. In terms of joint kinematics, S-ML demonstrated a performance comparable to that of M-ML, particularly at the hip and knee in the sagittal plane. For certain parameters, such as knee abduction/adduction in the frontal plane, the S-ML demonstrated lower RMSE values than M-ML. In contrast, the ankle joint angles estimated using S-ML exhibited reduced agreement. Conclusions: In conclusion, markerless gait analysis can serve as an alternative to conventional gait analysis. However, certain parameters need to be improved. Full article

Background: Vesicourethral anastomotic stricture (VUAS) remains a clinically relevant complication following radical prostatectomy, with important implications for postoperative urinary function. Minimally invasive approaches may offer technical advantages; however, their impact on stricture formation in patients with microangiopathic risk factors remains incompletely defined. Objective: We aimed to compare the incidence of vesicourethral anastomotic stricture following open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP) in patients with microangiopathic comorbidities and to explore clinical and perioperative factors associated with stricture development. Materials and Methods: A retrospective two-centre cohort study was conducted including 115 patients who underwent radical prostatectomy for clinically localized prostate cancer between 2022 and 2024. All patients had at least one microangiopathic risk factor (diabetes mellitus, hypertension, or coronary artery disease). Seventy-two patients underwent ORP and forty-three underwent LRP. VUAS was defined by obstructive symptoms with endoscopic confirmation requiring intervention within 12 months postoperatively. Univariate analyses and exploratory logistic regression models were performed to assess factors associated with stricture formation. Results: Vesicourethral anastomotic stricture occurred in 21 patients (18.3%). The crude incidence of VUAS was lower after LRP compared with ORP (9.3% vs. 23.6%); however, this difference did not reach statistical significance. Patients who developed VUAS had a significantly higher body mass index, longer operative time, and greater intraoperative blood loss. In exploratory multivariable analyses, body mass index and operative duration were consistently associated with increased odds of stricture, whereas the effect of surgical approach was unstable and imprecise due to limited event numbers. Conclusions: In patients with microangiopathic risk factors, laparoscopic radical prostatectomy was associated with a lower crude incidence of vesicourethral anastomotic stricture compared with open surgery; however, this association was not robust after adjustment. Perioperative and technical factors appear to play a more prominent role in anastomotic healing than surgical approach alone. These findings highlight the importance of optimizing intraoperative conditions to reduce postoperative stricture risk. Full article

Sexual dysfunction (SD), more specifically vasculogenic erectile dysfunction (ED) in men and female sexual arousal disorder (FSAD) in women, is increasingly recognized as a marker of cardiovascular disease (CVD). While extensive literature documents vasculogenic ED as an early warning sign of coronary artery disease (CAD) and other atherosclerotic manifestations, the evidence for analogous phenomena in women is emerging but less mature. This perspective explores epidemiologic associations, shared pathophysiologic mechanisms, clinical implications, and screening paradigms for ED and FSAD as cardiovascular (CV) risk-enhancing conditions. This perspective endorses that clinicians should incorporate genital vasculogenic SD into CV risk stratification and that multidisciplinary care (primary care, cardiology, urology/gynecology) is warranted. A summary table outlines key features and actionable steps. Full article

Confocal laser endomicroscopy (CLE) is an innovative diagnostic modality that facilitates real-time in vivo optical biopsies of various tissues within luminal and ductal structures. Since its introduction in 2004, the application of this tool has broadened from diagnostic purposes to encompass management and prognostic evaluation in fields such as gastroenterology, neurosurgery, urology, and dermatology. This comprehensive review examines the current applications of endomicroscopy in Barrett’s esophagus (BE), inflammatory bowel disease (IBD), and colorectal lesions. Evidence from the literature suggests that CLE offers a potential solution to the diagnostic limitations associated with white-light endoscopy and histology. With a diagnostic accuracy nearly equivalent to that of histology, CLE is emerging as a promising tool to mitigate the delays related to awaiting histology results for clinical and therapeutic decision-making. However, its use is mainly as a complementary diagnostic method rather than an alternative to histopathology or other ancillary studies. Nevertheless, its widespread adoption remains limited, and further research is necessary to ascertain its overall benefits and cost implications of integrating it into patient care. Full article

Background and Objectives: Gestational hypertension (GH) is increasingly recognized as an early manifestation of maternal cardiovascular vulnerability. Ambulatory blood pressure monitoring (ABPM) enables the evaluation of circadian blood pressure behavior, and a non-dipping blood pressure pattern (NDBP), defined as a nocturnal systolic decline of <10%, has been associated with endothelial dysfunction, placental hypoperfusion, and adverse pregnancy outcomes. However, the prognostic value of NDBP for postpartum chronic hypertension (PPCHT) remains insufficiently explored. Materials and Methods: This retrospective observational study included 196 women with gestational hypertension beyond 20 weeks of gestation who underwent ABPM between 2013 and 2025. Patients were classified as dippers (≥10% nocturnal systolic decline) or non-dippers (<10%). The primary outcome was postpartum chronic hypertension, defined as a persistent office blood pressure ≥ 140/90 mmHg or continued antihypertensive therapy at 12-month follow-ups. Secondary outcomes included fetal growth restriction (FGR), preeclampsia, and hypertensive complications. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of PPCHT and FGR. Results: In the cohort, 124 women (63.3%) exhibited a non-dipping blood pressure pattern. At 12 months postpartum, 93 women (47.4%) developed chronic hypertension. Non-dipping was significantly more frequent among women with PPCHT compared with those that remained normotensive (75.3% vs. 52.4%). Non-dippers also demonstrated higher rates of fetal growth restriction and preeclampsia. In multivariable analysis, NDBP remained independently associated with PPCHT after adjustments for age and daytime blood pressure parameters. Furthermore, NDBP and elevated daytime systolic blood pressure were independent predictors of FGR. Conclusions: A non-dipping blood pressure pattern is highly prevalent in gestational hypertension and is independently associated with both fetal growth restriction and postpartum chronic hypertension. Incorporating ABPM-derived circadian blood pressure phenotyping into antenatal assessments may improve risk stratification and support targeted postpartum cardiovascular surveillance strategies. Full article

Background and Objectives: Sarcopenia is a common yet underrecognized condition in cancer patients and is associated with increased treatment-related toxicity, functional decline, and poor clinical outcomes. Practical, rapid, and bedside-applicable tools are needed to detect sarcopenia early in routine oncology practice. This study aimed to evaluate the diagnostic value of rectus femoris muscle ultrasonography within an integrated clinical assessment combining handgrip strength and bioelectrical impedance analysis for the detection of sarcopenia in cancer patients. Materials and Methods: In this prospective cross-sectional study, 147 adult patients with malignancy were evaluated using a multimodal sarcopenia assessment framework. Muscle strength was assessed by handgrip dynamometry, muscle mass was estimated using bioelectrical impedance analysis (BIA)-derived appendicular skeletal muscle mass index (ASMI), and muscle morphology was evaluated using ultrasonographic measurements of the rectus femoris and biceps brachii muscles. Sarcopenia was defined and classified according to the EWGSOP2 criteria. Associations between clinical variables, BIA parameters, and ultrasonographic measurements were analyzed. Receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic performance of muscle ultrasonography for sarcopenia detection. Results: The mean age of the study population was 60.2 ± 11.2 years, and 51% of participants were male. Confirmed sarcopenia was identified in 12.2% of patients, while 27.2% were classified as having probable sarcopenia. Sarcopenic patients were significantly older (68.5 ± 7.6 vs. 59.0 ± 11.2 years, p = 0.001) and had lower handgrip strength (15.8 ± 6.0 vs. 24.3 ± 8.4 kg, p < 0.001) and ASMI values (5.96 ± 0.64 vs. 7.23 ± 1.18 kg/m², p < 0.001). Rectus femoris muscle thickness was significantly reduced in patients with sarcopenia (6.40 ± 1.42 vs. 8.19 ± 2.21 mm, p = 0.001). Rectus femoris muscle thickness demonstrated good diagnostic performance for sarcopenia detection (AUC = 0.752; 95% CI: 0.650–0.853; p = 0.001), with an optimal cut-off value of ≤7.59 mm (sensitivity 83.3%, specificity 61.2%). Conclusions: Rectus femoris muscle ultrasonography is a practical, rapid bedside assessment for detecting sarcopenia in cancer patients. When integrated with handgrip strength and BIA, this multimodal approach provides a feasible, radiation-free strategy for early sarcopenia screening in routine oncology practice. Full article

Background and Objectives: Psychosocial symptoms and oral behaviors can complicate routine dental care, yet available screeners yield multiple separate scores. Explainable artificial intelligence offers a pragmatic way to integrate such multidomain measures into a single, auditable output that can support screening-oriented stratification and standardized documentation (non-diagnostic). Therefore, we aimed to develop an interpretable, deterministic Mamdani fuzzy inference system (FIS) integrating GAD-7, PHQ-9, and OBC-21 into a 0–10 psychobehavioral composite score (PCS) to support screening-oriented stratification and standardized documentation (non-diagnostic). Materials and Methods: Cross-sectional multicenter study in 18 private dental clinics in Romania (October 2024–March 2025; n = 460). A rule-based Mamdani Type-1 FIS was specified a priori (48 rules; triangular membership functions; centroid defuzzification) without supervised training. Internal evaluation assessed coherence across severity strata, robustness to predefined input perturbations (±1 point; ±5%) and membership-function variation (±10%), and benchmarking against linear composites (Z-mean; PCA PC1). Results: Median PCS was 2.30 (IQR 2.03–3.56). PCS correlated with GAD-7 (Spearman ρ = 0.886), PHQ-9 (ρ = 0.792), and OBC-21 (ρ = 0.687) (all p < 0.001), increased monotonically across anxiety and depression severity strata, and was higher in high OBC-21 risk. Robustness was excellent under input perturbations (ICC(3,1) = 0.983 for ±1 point; 0.992 for ±5%) and high under ±10% membership-function variation (ICC(3,1) = 0.959). Concordance with linear baselines was high (Spearman ρ = 0.956 for Z-mean; 0.955 for PCA PC1), with a small systematic nonlinearity at higher scores. Conclusions: PCS provides a fully auditable, rule-based integration of three patient-reported measures with coherent internal behavior and robustness to plausible measurement noise and specification changes. This study reports internal evaluation of a deterministic, rule-based aggregation; external clinical validation against independent outcomes is required before any clinical utility claims. Full article

Background and Objectives: Long spinal fusion terminating at L5 remains controversial because of the risk of postoperative junctional failure. Although degeneration of the residual L5–S1 disc has been suggested as a contributing factor, the relative impact of disc degeneration versus sagittal spinopelvic alignment on different junctional failure patterns has not been fully clarified. Materials and Methods: This retrospective cohort study included 47 patients aged ≥60 years who underwent ≥5-level thoracolumbar fusion ending at L5 with a minimum follow-up of 2 years. Junctional failures were classified as proximal junctional failure (PJF) or distal junctional failure (DJF). Preoperative L5–S1 disc degeneration was assessed using modified Weiner and Pfirrmann classifications. Spinopelvic parameters were measured preoperatively, postoperatively, and at final follow-up. Junctional failure–free survival was analyzed using the Kaplan–Meier method, and risk factors were explored using Cox proportional hazards models. Results: Junctional failures occurred in 28 patients (59.6%), including 16 PJFs (34.0%) and 10 DJFs (21.3%). Lower grades of L5–S1 disc degeneration (Weiner grades 0–1) were more frequently associated with PJFs, whereas higher grades (≥2) were predominantly associated with DJFs (p = 0.024). Multivariate analysis showed that preoperative thoracolumbar kyphosis (hazard ratio [HR] = 1.164), preoperative T1 pelvic angle (HR = 1.269), and postoperative pelvic incidence–lumbar lordosis mismatch (HR = 0.877) as significant risk factors for PJF. Postoperative proximal junctional angle (HR = 0.899) and lumbar lordosis (HR = 0.920) were independently associated with DJF. Conclusions: Sagittal spinopelvic alignment parameters appear to have a greater influence on junctional failure patterns than residual L5–S1 disc degeneration in long fusions terminating at L5. Adequate sagittal correction should be prioritized to reduce the risk of both proximal and distal junctional failures. Full article

Background and Objectives: Diabetes mellitus (DM) has been consistently linked to severe coronavirus disease 2019 (COVID-19) and adverse outcomes; however, the extent to which DM independently predicts mortality and cardiovascular complications in real-world hospitalized cohorts remains debated, particularly in Eastern Europe. This study aimed to evaluate the impact of DM on cardiovascular complications and in-hospital outcomes among adults hospitalized with SARS-CoV-2 infection. Materials and Methods: We conducted a single-center retrospective observational cohort study including consecutive adult patients hospitalized with laboratory-confirmed SARS-CoV-2 infection between March 2020 and December 2024 at the “Victor Babeș” Clinical Hospital of Infectious Diseases and Pneumophthisiology, Timișoara, Romania. DM status (type 1, type 2, or newly diagnosed diabetes) was defined using structured dataset fields. The primary outcome was in-hospital all-cause mortality. Secondary outcomes included ICU admission, length of stay, pulmonary embolism (PE) on CT pulmonary angiography (CTPA), and a composite of in-hospital cardiovascular/thromboembolic complications. Multivariable logistic regression models adjusted for clinically relevant covariates (age, sex, BMI, vaccination status, hypertension, ischemic heart disease, atrial fibrillation, prior ischemic stroke, and admission creatinine). Results: A total of 395 patients were included; 98 (24.8%) had DM. Diabetic patients exhibited a high cardiometabolic burden (arterial hypertension: 83.7% vs. 77.4%, p = 0.242) and higher admission renal markers (urea: 55.6 [41.0–79.1] vs. 48.6 [39.2–68.0] mg/dL, p = 0.047; creatinine: 1.04 [0.76–1.52] vs. 0.88 [0.59–1.33] mg/dL, p = 0.008). In-hospital mortality was numerically higher in DM (9.2% vs. 6.7%, p = 0.560), as was ICU admission (7.1% vs. 4.7%, p = 0.503), without statistical significance. PE on CTPA occurred in 13.3% of DM vs. 11.4% of non-DM patients (p = 0.763). In univariable analysis, DM was not significantly associated with mortality (OR 1.40, 95% CI 0.62–3.19; p = 0.422) or ICU admission (OR 1.55, 95% CI 0.61–3.97; p = 0.356). After multivariable adjustment, DM remained not independently associated with mortality (adjusted OR 1.09, 95% CI 0.42–2.83; p = 0.854) or ICU admission (adjusted OR 1.19, 95% CI 0.42–3.36; p = 0.747). Conclusions: In this real-world Eastern European cohort of hospitalized adults with SARS-CoV-2 infection, diabetes mellitus was common and associated with significantly worse renal function at admission, but it was not statistically associated with in-hospital mortality or ICU admission after multivariable adjustment; however, the limited number of events and low events-per-variable raise concerns about model stability and potential false-negative findings. These findings support a risk-marker model in which adverse COVID-19 outcomes in diabetic patients are driven primarily by clustered vulnerability and organ dysfunction rather than diabetes status alone. Full article

Background and Objectives: Intra-articular injection of adipose-derived stromal vascular fraction (SVF) has emerged as a promising regenerative treatment for knee osteoarthritis (OA) because of its heterogeneous cellular composition and potent anti-inflammatory paracrine effects. Although SVF therapy has demonstrated clinical efficacy, the timing of pain relief and the influence of SVF cell dose on early clinical outcomes remain incompletely defined. Materials and Methods: This retrospective study included 146 patients (217 knees) with Kellgren–Lawrence (K–L) grade II–IV knee OA who underwent intra-articular injection of autologous adipose-derived SVF and completed a minimum follow-up of 1 year. Pain was assessed using the visual analog scale (VAS), and patients reported the time to perceived pain improvement after treatment. Radiographic severity was evaluated using the K–L grading system. Correlation analyses were performed to assess associations between pain-related outcomes, SVF cell number, and radiographic severity. Results: VAS scores improved significantly from baseline to the final follow-up (p < 0.01). Patients reported perceived pain improvement at a mean of 18.9 ± 14.5 days after SVF injection. The mean injected dose was 7.4 × 10⁷ total SVF cells per knee, including approximately 7.0 × 10⁶ stromal cells. Higher SVF cell numbers were significantly associated with greater pain improvement and lower VAS scores at final follow-up (p < 0.001 for both). Radiographic severity was not significantly correlated with pain at final follow-up, the magnitude of pain improvement, or the time to symptom relief. No clinically relevant adverse events were observed. Conclusions: Intra-articular injection of high-dose autologous SVF was associated with rapid and clinically meaningful pain relief, with symptom improvement occurring within approximately 3 weeks after treatment. The dose-dependent association and the lack of correlation with radiographic severity suggest that early pain relief is primarily mediated by the anti-inflammatory and paracrine effects of SVF rather than immediate structural cartilage regeneration. Full article

Trichostrongylus species are zoonotic gastrointestinal nematodes that occasionally infect humans, particularly in rural areas with close contact to livestock. However, the global prevalence of human trichostrongylosis remains uncertain. This systematic review and meta-analysis aimed to synthesize available prevalence data and describe regional and methodological differences in reported infections. Studies published between 2000 and 2025 reporting the prevalence of Trichostrongylus infections in humans (primarily T. colubriformis, T. axei, and T. orientalis) were searched in six databases (EMBASE, Ovid, PubMed, Scopus, Nursing & Allied Health Premium, and Web of Science) and Google Scholar. Pooled prevalence was estimated using a random-effects model. Subgroup analyses were conducted to assess prevalence by continent, country, population group, and diagnostic method. Thirty-seven studies from 14 countries, comprising 111,408 participants, were included. Most studies were conducted in Asia (23, 62.2%), particularly in Iran (12, 32.4%), and in Africa (12, 32.4%), mainly in Nigeria (5, 13.5%). The global pooled prevalence of Trichostrongylus infection was 1.2%. Prevalence was highest in Africa (1.7%), followed by South America (1.2%), Asia (1.0%), and Europe (0.8%). Subgroup analyses revealed substantial heterogeneity in prevalence across study populations, age groups, and detection methods (p < 0.05). Available evidence suggests that human Trichostrongylus infection remains a localized but persistent zoonotic concern in specific endemic regions, rather than a globally uniform problem. Diagnostic variability, limited regional coverage, and high heterogeneity highlight the need for standardized molecular diagnostics and broader surveillance to accurately define the global epidemiology of trichostrongylosis. Full article

Background and Objectives: The pathways mediating the beneficial effect of tibial stump preservation for anterior cruciate ligament (ACL) reconstruction remain insufficiently clarified. This study investigated key vascular, neural, and stromal aspects of cellular remodeling processes occurring across lesion stages in tibial remnant pre-reconstruction. Materials and Methods: Biopsies were obtained from 25 patients undergoing arthroscopic ACL reconstruction (paired free-end and tibial insertion sampling) and 10 from quasi-normal, macroscopically intact ligaments (controls). We evaluated intergroup differences in microvascular density using a t-test. Group comparisons for angiogenesis (CD34), neural components (S100, neurofilament-associated proteins—NFAPs), and stromal activation (vimentin and actin) were conducted using Chi-square or Fisher’s exact tests. Results: ACL remnants revealed a significantly higher microvascular density (37 ± 2.3 vs. 18 ± 3.2 vessels/mm², p < 0.001), in addition to a markedly increased prevalence of synovial angiogenesis (90% vs. 20%, p < 0.001), stellate stromal cells (94% vs. 10%, p < 0.001), and CD34-positive fibrocytes (92% vs. 10%, p < 0.001) compared to control tissues. Elevated intraligamentous neovascularization (with borderline significance) was also found in these tissues (38% vs. 0%, p = 0.045). Both injured and control ACLs showed widespread S100-positive neural fibers, suggesting maintained Schwann cell integrity despite ligament disruption. In contrast, control ligaments showed a substantially richer NFAP+ neural network, particularly in small-caliber fibers and free nerve endings, pointing to preferential vulnerability of small-caliber neural elements during ACL rupture. Vimentin expression changes—from homogeneous fibrocytic staining to diffuse reticular overexpression in fibrotic lesions—were accompanied by the emergence of stellate myofibroblast-like cells, supporting advanced stromal remodeling. Absent in controls, actin immunoreactivity increased with lesion severity, indicating a progressive myofibroblastic response driven by perivascular cells during ligament remodeling. Conclusions: The tibial ACL remnant is a biologically active, compartmentalized repair niche driven by coordinated vascular, neural, and stromal responses, with reparative activity concentrated at the synovial–epiligament interface. These findings support the biological rationale for preserving tibial remnant for ACL reconstruction. Full article

Background and Objectives: Psoriatic arthritis (PsA) is a chronic inflammatory arthritis characterized by marked clinical heterogeneity and variable disease trajectories, underscoring the need for robust biomarkers of inflammatory burden. Serum calprotectin, a neutrophil- and monocyte-derived protein, has been proposed as a surrogate marker of active inflammation in inflammatory arthritis due to its close association with innate immune activation. In this study, we compare serum calprotectin levels among patients with PsA, axial spondyloarthritis (AxSpA), and healthy controls and evaluate their association with disease activity. Materials and Methods: This single-center, cross-sectional study included 123 patients with PsA, 119 patients with AxSpA, and 77 healthy controls. Serum calprotectin levels were measured by enzyme-linked immunosorbent assay, and their associations with disease activity were evaluated using correlation, multivariable regression, and receiver operating characteristic analyses. Results: Serum calprotectin levels were significantly higher in PsA and AxSpA patients compared with healthy controls (p < 0.001 for both) and were higher in PsA than in AxSpA (p = 0.022). In PsA, serum calprotectin levels showed significant correlations with ASDAS-CRP, DAS28-CRP, and DLQI, but not with CRP or ESR. In contrast, in AxSpA, calprotectin showed only a weak association with CRP and was not related to disease activity indices. In multivariable analysis, serum calprotectin was independently associated with ASDAS-CRP in PsA (B = 0.704, p = 0.003), but not in AxSpA. Receiver operating characteristic analysis demonstrated that serum calprotectin discriminated high disease activity in PsA with an area under the curve of 0.669 (95% CI: 0.563–0.775; p = 0.003). Conclusions: Serum calprotectin levels are elevated in patients with PsA and are associated with disease activity, supporting its potential role as a biomarker in this condition. In contrast, serum calprotectin does not appear to reflect disease activity in AxSpA, suggesting disease-specific differences in its clinical utility. Full article

Background and Objectives: Hyaluronic acid (HA) is extensively used in dermo-aesthetic medicine for its hydrating and tissue-repairing properties. Beyond cosmetic use, HA has shown therapeutic effects in inflammatory skin diseases such as seborrheic, radiation-induced, and atopic dermatitis (AD). However, HA-based aesthetic formulations such as Profhilo^®, a hybrid complex of high- and low-molecular weight HA, have not been tested in immunologically driven models of AD. This study aimed to investigate the therapeutic effects of intradermal Profhilo^® injections in a recently developed ovalbumin (OVA)-induced murine model of AD. Specific objectives included assessing changes in skin inflammation, pain sensitivity, and spinal cord pathology. Materials and Methods: Twenty-eight adult female ICR-CD1 mice were sensitized and exposed to OVA via intraperitoneal, subcutaneous, and topical routes over 49 days to induce AD-like lesions. Control animals received saline. On day 50, mice were subdivided into four groups receiving intradermal injections of Profhilo^® or saline. Skin inflammation was evaluated using the SCORAD index on days 49 and 57, and nociceptive responses were measured using the plantar thermal hyperalgesia test. On day 57, dorsal skin and thoracic spinal cord samples were collected for histological and immunohistochemical analysis, including assessments of epidermal and dermal thickness, mast cell density, collagen content, CGRP immunoreactivity, and microglial activation. Results: OVA-treated mice developed significant skin inflammation (p < 0.0001) and thermal hyperalgesia. Intradermal HA injection significantly reduced SCORAD scores (p < 0.01) and mast cell density (p < 0.05) while increasing dermal thickness (p < 0.05). In the spinal cord, HA treatment reduced CGRP immunoreactivity and microglial activation (p < 0.01 and p < 0.05, respectively), especially in OVA-treated animals. Conclusions: Intradermal Profhilo^® alleviated both cutaneous inflammation and neurogenic pain in an OVA-induced AD model. These findings suggest that HA not only improves local skin pathology but also modulates central neuroimmune responses, supporting its therapeutic potential for inflammatory skin conditions involving peripheral and central sensitization. Full article

Background and Objectives: The COVID-19 pandemic profoundly disrupted global healthcare systems, limiting access to diagnostic and therapeutic services for chronic diseases. Patients with decompensated liver cirrhosis were particularly vulnerable due to their fragile clinical status and dependence on continuous medical care. This study aimed to evaluate the temporal evolution of clinical, biological, and prognostic parameters in patients admitted emergently with decompensated liver cirrhosis across three distinct phases: pre-pandemic, pandemic, and post-pandemic. Materials and Methods: A retrospective, single-center study was conducted at the Department of Gastroenterology, Municipal Clinical Emergency Hospital, Timișoara, Romania, including 355 patients hospitalized between February 2018 and February 2024. Clinical, biochemical, and outcome data were collected and analyzed using univariate and multivariate logistic regression models to identify independent predictors of in-hospital mortality for each study period. Results: Significant temporal variations were observed in disease severity, management, and outcomes. The mean MELD score increased from 18.7 to 21.0 during the pandemic (p = 0.043), while endoscopic evaluations declined markedly (59.4% pre-pandemic vs. 42.7% pandemic, p = 0.037). Mortality rose from 21.7% to 30.2% during the pandemic (p = 0.044) and remained elevated post-pandemic (26.4%). Multivariate regression identified Child–Pugh, MELD, and Baveno scores as consistent mortality predictors, though their relative weight varied by period. During the pandemic, acute complications—particularly jaundice (OR = 294) and upper gastrointestinal bleeding (OR = 355)—became dominant determinants of death. Conclusions: The pandemic transformed cirrhosis from a chronic, manageable disease into an acutely unstable condition, primarily due to delayed presentation and restricted procedural access. Although post-pandemic recovery was evident, residual increases in mortality and severity indicate lasting effects of healthcare disruption, underscoring the need to strengthen system resilience and continuity of care for patients with chronic liver disease. Full article

Background and Objectives: People with epilepsy frequently complain of poor sleep quality, excessive daytime sleepiness (EDS), and insomnia. Therefore, this study aimed to evaluate differences in anxiety and depression symptoms, as well as clinical characteristics, across groups defined by sleep quality in patients with epilepsy. Materials and Methods: Seventy-eight adults with epilepsy were assessed using standardized questionnaires for sleep quality (Pittsburgh Sleep Quality Index, PSQI), daytime sleepiness (Epworth Sleepiness Scale, ESS), insomnia severity (Insomnia Severity Index, ISI), and psychiatric symptoms (PHQ-9, GAD-7, and HADS). Demographic data (age and sex), seizure frequency and characteristics, use of antiepileptic drugs (AEDs), and EEG findings were collected. Patients were divided into groups based on sleep quality scores, and comparisons were made regarding anxiety, depression, and selected clinical variables. Associations were analyzed using t-tests, chi-squared tests, and Spearman correlation coefficients. Results: Poor sleep quality (PSQI > 5) was present in 70.9% of patients and was significantly associated with insomnia, daytime sleepiness, depression, and anxiety symptoms (p < 0.001 for all comparisons). Patients who had experienced generalized tonic–clonic seizures (GTCS) in the past year had significantly worse sleep quality compared to those without GTCS (p = 0.025). Clinical insomnia (ISI ≥ 15) was observed in 23.1% of cases and was significantly associated with the presence of seizures (p = 0.015). EDS was present in 19% of cases and was associated with depressive symptoms (p = 0.019). A higher concentration of levetiracetam was associated with better sleep quality, whereas a higher concentration of lamotrigine was associated with worse sleep quality (p = 0.024 for both). EEG abnormalities, seizure frequency, and duration of epilepsy were not associated with sleep quality. Conclusions: Poor sleep quality was reported in 70% of the study patients and was associated with increased insomnia severity, EDS, and psychiatric comorbidities. People with EDS were more likely to have higher levels of depression and anxiety. Patients who experienced GTCS within the past year were significantly more likely to report poor sleep quality. Insomnia was associated with older age and female sex. Seizure-free patients had less insomnia. Nevertheless, no associations were found between sleep evaluation scores and other demographic or clinical epilepsy characteristics. Full article

Background and Objectives: Chronic obstructive pulmonary disease (COPD) is heterogeneous, and phenotype-based classification may better capture differences in clinical burden and healthcare needs beyond standard GOLD categories. We aimed to describe the distribution of GesEPOC COPD phenotypes in Turkey and compare their demographic, clinical, functional, radiological, treatment, and healthcare utilization profiles. Materials and Methods: DIPTUR was a multicenter, observational, cross-sectional study conducted prospectively in 26 centers across 17 Turkish cities (October 2019–June 2021). Stable COPD patients (≥40 years; post-bronchodilator FEV1/FVC < 0.7) without exacerbation or major treatment modification within the previous four weeks were enrolled consecutively. Phenotypes were assigned per GesEPOC: exacerbator with emphysema (EE), exacerbator with chronic bronchitis (ECB), asthma–COPD overlap (ACO), and non-exacerbator (NE). Frequent exacerbators were defined as patients who experienced two or more exacerbations during the 12 months preceding enrollment, based on medical records and patient reports. Results: Among 894 patients, phenotype distribution was NE 44.1%, ECB 26.2%, EE 20.5%, and ACO 9.3%. Male predominance was observed across groups (80–89%; p = 0.006). Active smoking was most frequent in ECB (37.6%; p < 0.001), and BMI was lowest in EE (p < 0.001). Comorbidity patterns differed, with hypertension (p < 0.001), diabetes mellitus (p = 0.029), and heart failure (p < 0.001) most prevalent in ECB. Pulmonary function (FEV1 and FVC) was lowest in EE (both p < 0.001), and severe airflow limitation (GOLD III–IV) was most common in EE and ECB (p < 0.001). Dyspnea (mMRC ≥ 2) was more frequent in EE/ECB than in ACO/NE (p < 0.001). Emphysematous changes on thoracic CT predominated in EE (91.7%; p < 0.001). Long-term oxygen therapy was most common in EE (32.4%; p < 0.001). Emergency admissions, hospitalizations, and total length of stay were markedly higher in EE and ECB than in ACO and NE (all p < 0.001). Conclusions: COPD phenotypes in Turkey show substantial heterogeneity in clinical, functional, radiological, and utilization domains. Exacerbator phenotypes—particularly EE and ECB—represent higher-burden groups, supporting phenotype-oriented management and closer monitoring beyond GOLD classification. Full article

Physiologic changes during pregnancy, advanced maternal age, and cardiovascular comorbidities have been associated with an increased incidence of cardiovascular emergencies (CVEs) manifesting during pregnancy and puerperium, thereby adversely affecting maternal and fetal morbidity and mortality. When a CVE occurs, prompt and high-quality medical management is essential. However, the early diagnosis and management of CVEs in pregnant women are often challenging, as the initial clinical presentation of many of these conditions may mimic common symptoms of a normal pregnancy, resulting in significant diagnostic delays. Furthermore, the administration of optimal medical or interventional therapy in critically ill pregnant women should be carefully considered, balancing maternal well-being and survival against the potential risks that certain medications and interventions may pose to the fetus. Consequently, treatment decisions should involve a multidisciplinary medical team, comprising cardiologists, obstetricians, emergency physicians, anesthesiologists, neonatologists, and other relevant specialists. This review aims to summarize the current diagnostic approaches and management strategies for the most prevalent CVEs encountered during pregnancy, and explore the challenges faced in diagnosing and treating pregnant individuals compared to the non-pregnant population, emphasizing the differences and knowledge gaps in this area. Full article

Background and Objectives: Palmoplantar pustulosis (PPPust) and palmoplantar psoriasis (PPso) are distinct palm/sole dermatoses that have historically shared the abbreviation “PPP”. Though the two—since the advent of advanced biotechnology—are now deemed separate diagnoses, each still falls under the ‘palmoplantar spectrum’. It is important to note that PPso and PPPust are each distinct from generalized pustular psoriasis (GPP), a condition that is outside the scope of our study. We quantified the relative efficacy of biologic and small-molecule monotherapies on the palmoplantar spectrum using Bayesian network meta-analyses (NMAs). Materials and Methods: On 6 November 2025, we searched PubMed, Scopus, ClinicalTrials.gov, and citations (i.e., citation mining) for randomized trials of monotherapy reporting PPP Area and Severity Index (PPPASI) outcomes at 12 or 16 weeks; we secondarily investigated fresh pustule-related outcomes at 4 weeks. We ran Bayesian NMAs with uniform priors; nodes were defined by dose and timepoint. Interventions’ Surface Under the Cumulative Ranking Curve (SUCRA) values were computed; pairwise effects with 95% credible intervals were also estimated. Sensitivity analyses adjusted for diagnosis (pustulosis vs. psoriasis) via network meta-regression. Results: Twenty trials (n = 2030) with 23 active comparators provided data for 10 endpoints (fresh pustules at 4 weeks; PPPASI-50/75 and mean percentage and absolute PPPASI change at 12 and 16 weeks). Conclusions: The NMA indicates efficacy of ixekizumab and brodalumab (IL-17 inhibitors), guselkumab (IL-23 inhibitor), and spesolimab (IL-36 inhibitor) in managing palmoplantar pustulosis. Full article

Background and Objectives: The prognostic significance of pelvic lymph node (PLN) count in surgically staged endometrial cancer remains controversial. This study aimed to evaluate the impact of PLN count on overall survival (OS), disease-free survival (DFS), and recurrence patterns in a large cohort of patients with endometrial cancer. Materials and Methods: This retrospective cohort study included 560 patients with endometrial cancer who underwent total hysterectomy, bilateral salpingo-oophorectomy, and pelvic and/or para-aortic lymph node assessment between January 2005 and May 2025 at a tertiary referral center. Patients were stratified according to the number of harvested pelvic lymph nodes (≤20 vs. >20). Clinicopathological characteristics, adjuvant treatments, recurrence patterns, and survival outcomes were analyzed. Survival analyses were performed using Kaplan–Meier estimates and Cox proportional hazards regression models. Results: Of the 560 patients, 262 (46.8%) had ≤20 pelvic lymph nodes harvested and 298 (53.2%) had >20. The median follow-up duration was 64.5 months. Patients with >20 pelvic lymph nodes had larger tumors, higher FIGO stage, and more frequent para-aortic lymphadenectomy. In multivariate analysis, age, non-endometrioid histology, advanced FIGO stage, tumor grade, and lymphatic metastasis were independently associated with both OS and DFS. Pelvic lymph node count was not independently associated with OS or DFS. Overall recurrence rates were similar between groups; however, recurrence patterns differed significantly, with distant recurrences more frequent in the ≤20 PLN group and local recurrences more common in the >20 PLN group. Conclusions: In surgically staged endometrial cancer, a higher pelvic lymph node count (>20 nodes) was not independently associated with survival or recurrence outcomes after adjustment for established prognostic factors, although recurrence patterns differed between groups. Survival was primarily determined by age, histologic subtype, FIGO stage, tumor grade, and lymphatic metastasis. Pelvic lymph node count appears to reflect surgical staging intensity and intraoperative risk assessment rather than serving as an independent determinant of prognosis. Full article

Background and Objectives: With the increasing demand for gender-affirming procedures, facial feminization surgery (FFS) has become an essential component in the management of patients with gender dysphoria. In this study, ‘male’ and ‘female’ refer to biological sex as recorded in the medical record; gender identity was not assessed. The mandible is widely recognized as one of the most sexually dimorphic facial bones and plays a critical role in defining masculine and feminine facial contours. However, quantitative mandibular data directly applicable to surgical planning for FFS, particularly in Asian populations, remain limited. The purpose of this study was to analyze gender differences in mandibular morphology using three-dimensional (3D) computed tomography (CT) images and to provide clinically relevant anatomic data applicable to mandibular contouring in FFS. Materials and Methods: In this single-center retrospective study, 275 Korean patients who underwent facial CT between January 2017 and December 2019 were enrolled. Three-dimensional cephalometric analysis was performed to obtain surgically relevant mandibular measurements, including angular, linear, and transverse parameters, as well as non-metric characteristics such as chin shape and inferior mandibular border contour. Statistical comparisons were conducted to evaluate gender differences. Results: Significant gender differences were observed in mandibular angle (p < 0.001), mandible length (p < 0.001), antegonial notch distance (p < 0.001), intercondylar width (p < 0.001), and intergonial width (p < 0.001). Ramus length and chin width did not demonstrate statistically significant differences. Non-metric analysis revealed significant gender differences in chin morphology and inferior mandibular border contour (p < 0.01). Males predominantly exhibited a round or square chin (79.5%) and a rocker-shaped inferior border, whereas females commonly demonstrated a pointed chin (82.3%) and a straight inferior mandibular border (94.4%). Conclusions: The sexual dimorphism of the mandible in the Korean population is characterized by differences in angularity, transverse width, antegonial morphology, and inferior border contour. These findings provide population-specific morphological reference ranges that may support individualized preoperative assessment for mandibular contouring in facial feminization surgery. Full article

Background and Objectives: Knee osteoarthritis (OA) is a leading cause of pain and disability, with radiographic severity influenced by age, biomechanical alignment, and structural joint features. Data describing the association between common radiographic parameters and OA severity in Eastern European clinical populations remain limited. This study aimed to evaluate the associations between radiographic OA severity and coronal alignment, patellar height, and chondrocalcinosis in a Romanian clinical cohort. Materials and Methods: This single-center cross-sectional study included adult patients undergoing knee radiography for knee-related symptoms and/or functional assessment at a rehabilitation hospital between 2023 and 2025. Radiographs were obtained in the supine, non-weight-bearing position and included anteroposterior and lateral views. OA severity was graded using the Kellgren–Lawrence (KL) classification. Coronal alignment was assessed using the femorotibial angle, patellar height using the Insall–Salvati ratio (ISR), and chondrocalcinosis was recorded as present or absent. Associations between radiographic parameters and KL grade were analyzed using non-parametric statistics. Receiver operating characteristic (ROC) analyses were performed for exploratory assessment of limited separation between distributions. Results: Moderate to severe OA (KL ≥ 3) was present in 49% of patients. KL grade showed a moderate positive correlation with age (r = 0.50, p < 0.001) and differed significantly across coronal alignment categories (p < 0.001). Varus/valgus and pathological alignment classifications demonstrated moderate sensitivity (0.69–0.85) and variable specificity (0.52–0.85) for higher KL grades. ROC analyses of continuous alignment and ISR measures yielded area under the curve values ranging from approximately 0.65 to 0.68, indicating limited separation between distributions. Radiographically detected chondrocalcinosis was present in 5.3% of patients and showed no significant association with OA severity, and neither did patellar height. Conclusions: In this single-center Romanian clinical cohort, radiographic OA severity was associated with coronal plane alignment but not with patellar height or chondrocalcinosis. Alignment measures demonstrated limited discriminative ability and should be interpreted as complementary rather than diagnostic indicators of OA severity. These findings provide descriptive radiographic data from an Eastern European clinical population and highlight the need for longitudinal and population-based studies incorporating mechanical axis assessment and functional outcomes. Full article

Background and Objectives: Anatomical staging alone insufficiently explains survival heterogeneity in patients with resected non-small cell lung cancer (NSCLC). Although inflammation-based biomarkers have demonstrated prognostic value, the clinical relevance of erythrocyte-derived indices—particularly mean corpuscular volume (MCV)—remains poorly characterized in this setting. This study evaluated the prognostic significance of preoperative MCV and examined whether its integration with the Noble and Underwood (NUn) score improves survival prediction. Methods: We retrospectively analyzed patients with stage I–IIIA NSCLC who underwent complete surgical resection. Associations between clinicopathological variables and overall survival (OS) were assessed using Cox proportional hazards models. Prognostic performance was evaluated using the concordance index and the integrated time-dependent area under the curve. Continuous variables were modeled on their original scale without dichotomization. Results: Model comparison using the Akaike Information Criterion indicated that incorporation of the composite NUn–MCV index into the intermediate model—comprising age, basal metabolic rate, American Society of Anesthesiologists physical status, pleural invasion, and pathological stage—provided a superior model fit compared with inclusion of the NUn score and MCV as separate covariates. On this basis, the composite NUn–MCV model was selected as the full model. Across all evaluations, the full model demonstrated consistently greater discriminative ability for survival prediction than both the intermediate model and the baseline model based solely on pathological stage. Conclusions: Preoperative MCV independently predicts OS in patients with resected stage I–IIIA NSCLC. Integration of MCV with the NUn score into a composite index provides incremental prognostic value beyond anatomical staging and established clinical factors, supporting its use as a complementary tool for postoperative risk stratification. Full article

Sudden unexplained cardiac death (SUCD) is unpredictable, causing major emotional, economic, and productivity loss. In young, apparently healthy individuals, it remains one of the most challenging causes of mortality to understand mechanistically, and no validated molecular biomarkers are currently available to support investigation of subclinical cardiac electrical vulnerability. Conventional clinical assessment tools such as electrocardiography, echocardiography, and genetic testing often fail to detect early molecular disturbances that precede electrical or structural cardiac abnormalities. Recent evidence suggests that oxidative stress and redox imbalance play a crucial mechanistic role in cardiac electrical instability, modulating ion channel function, calcium handling, mitochondrial signaling, and intercellular coupling. This literature review explores the emerging role of salivary redox biomarkers as a non-invasive research framework for exploring redox-related mechanisms relevant to cardiac electrophysiology, introducing the concept of a “Salivary Redoxome”—an integrated oxidative–antioxidative profile measurable in saliva that may reflect systemic redox homeostasis in an exploratory context, without implying myocardial specificity. Key antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), together with oxidative damage indices such as malondialdehyde (MDA) and total antioxidant capacity (TAC), are discussed for their theoretical mechanistic relevance, biological plausibility, and current limitations. Methodological considerations, sources of pre-analytical variability, and challenges related to biomarker specificity and validation are also addressed to contextualize the current evidence base. At present, no direct clinical evidence links salivary oxidative stress markers to sudden unexplained cardiac death or to electrophysiological arrhythmic risk, and their proposed relevance is therefore exploratory and hypothesis-generating. This review positions salivary redox profiling as a research approach rather than a clinical screening, predictive, or preventive tool, and outlines a future research agenda aimed at systematic validation in well-designed prospective studies. Full article

Background: Diabetic foot ulceration represents one of the most severe diabetic complications, with 50–60% progressing to diabetic foot infection (DFI). All diabetic wounds and diseases originate from peripheral vasculopathy and neuropathy, which are caused by oxidative stress and inflammatory processes. We investigated the utility of neutrophil-to-lymphocyte ratio (NLR) and CRP-to-albumin ratio (CAR) as cost-effective inflammatory biomarkers in DFI. Methods: The study included 58 DFI patients and 45 healthy controls. Disease severity was assessed using PEDIS staging. Routine laboratory parameters, NLR, derived NLR (d-NLR), and CAR were measured and compared. Results: In DFI patients, statistically significant increases (p < 0.001) were observed in NLR (3.12 vs. 1.99, p < 0.001), d-NLR (2.13 vs. 1.49, p = 0.003), CAR (0.91 vs. 0.03, p < 0.001), CRP (30.5 vs. 1.3 mg/L, p < 0.001) and PCT (0.1 vs. 0.02 μg/L, p < 0.001) values compared to the control group. Strong correlations existed between NLR, CAR and disease severity markers (CRP, PCT, HbA1c, osteomyelitis, PEDIS stage). ROC analysis revealed excellent discriminatory power for CAR (AUC = 0.915), PCT (AUC = 0.952), and CRP (AUC = 0.902), while NLR showed moderate performance (AUC = 0.702). Conclusions: NLR/CAR demonstrate excellent discrimination vs. healthy controls (AUC 0.915/0.702). The proposed workflow (NLR screening → CAR severity → PCT confirmation) requires prospective validation against with guidelines. Full article