CHSJ

Current issue

Current Health Sciences Journal

vol. 52 no. 2, 2026

1. The Role and Diagnostic Accuracy of Artificial Intelligence in Pulmonary Function Tests: A Systematic Review

T. ORPWOOD, I.L. SOICA

The rapid advancement of artificial intelligence (AI) has highlighted its potential as a supportive tool in pulmonary function test (PFT) interpretation given the inherent biological variation, inter-rater variability, lack of confidence in result interpretation and restricted access within resource-constrained settings. This study aims to systematically review the published literature on the diagnostic accuracy of AI-based interpretation of PFTs and evaluate its implications for current and future clinical practice in healthcare. After screening, forty-seven publications met the inclusion criteria and were analysed to create a narrative summary. Four main over-arching themes were identified from the available literature. AI appears to consistently outperform non-specialists in diagnostic accuracy of PFTs and showed a synergistic effect when used as an adjunct in both specialist and non-specialist settings. Using AI software also had greater diagnostic accuracy than clinicians when presented with suboptimal or limited clinical information and investigations. It was also observed that the implementation of AI can address the issue of inter-rater variability by giving more consultant interpretations. Chronic obstructive pulmonary disease diagnosis saw the greatest accuracy with other conditions such as obstructive sleep apnoea showing limited evidence for the introduction of AI as a diagnostic tool. The evidence suggests that AI has the potential to play a significant role in the future of healthcare but should be used as an adjunctive tool as opposed to an independent diagnostic decision maker. One such way it could be utilised is as a triage/screening tool to help bridge the gap between primary and secondary care.

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2. Evaluating the Role of Exosome Therapy in Reproductive Aging: A Narrative Review of Recent Advancements

E.S.A. MOGHADDAM, H.M. TALEBI

Introduction: Exosome therapy shows promise as a non-hormonal treatment to restore ovarian function and combat reproductive aging. This review aims to explore recent advances, mechanisms, and clinical potential of exosome therapy in reproductive aging. Methods: This narrative review explored advancements in exosome therapy for reproductive aging through a comprehensive literature search of PubMed, Embase, Google Scholar, and ClinicalKey, covering studies from 2015 to 2025. Using a structured search strategy with relevant MeSH terms and keywords. After applying inclusion and exclusion criteria focused on human studies with therapeutic relevance, 13 articles were selected. Key data were extracted and synthesized to highlight mechanisms, clinical potential, and future directions of exosome-based interventions in ovarian aging. Results: Thirteen human-focused studies were categorized into four themes: ovarian function restoration, exosomal biomarkers, therapeutic roles in reproductive diseases, and clinical applications. Exosomes especially MSC-derived enhanced ovarian regeneration through anti-apoptotic, anti-inflammatory, and metabolic pathways. Age-related changes in exosomal cargo showed strong diagnostic potential. Exosomes also demonstrated therapeutic effects in POI and PCOS and showed promise as low-immunogenic, cell-free nanocarriers for targeted reproductive-aging interventions. Conclusion: Exosome therapy is a promising, non-hormonal option for addressing reproductive aging, with potential for safe and effective clinical use.

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3. The Influence of Ageing, Sex and Cause of Death on the Myocardial Tissue Collagen Fibrillary Component Behaviour

L.E. CAMENIA, C. FLORESCU, M.S. SERBANESCU, I.E. PLESEA, R.M. PLESEA

Aim. The morphology and the function of human body are influenced by two main factors: the passing of the years and the increasing diversity of diseases with their subsequent lesions. The morphological structures of the heart are not exempt from the synergistic influence of these two major factors. The authors’ goal was to compare the variations of interstitial mature collagen fibers (COLF) amount-% between the different main regions of the heart wall during patients´ ageing, on one hand, and, depending on patients’ cause of death, on the other hand. Methods. Samples of myocardial tissue with no evident lesion, coming from 95 patients with different ages (0-24 years-AP_01, 25-44 years-AP_02, 45-64 years-AP_03 and >64 years-AP_04) deceased in hospital with different causes of death (vascular diseases-V_P, non-vascular diseases-NV_P, and suspect/violent cause of death-S/V_Dth) and autopsied, were collected from five epicardium-to-endocardium cross sections (left ventricle anterior wall-LV_AW, lateral wall-LV_LW and posterior wall-LV_PW, interventricular septum-IVS and right ventricle wall-RVW). Further, they were histologically processed and stained with Picro Syrius Red technique. COLF proportion was assessed, on virtual slides, with a a computer program designed specifically for this purpose. For statistical comparison of data, Kruskal-Wallis and Pearson correlation tests were used. Results. The COLF proportion had the smallest values in elderly and they increased markedly towards the younger periods of age. Then, the COLF proportion had the highest values in the RV_W (excepting the AP_04 period of life), and the lowest values in the IVS. In LV_W, COLF proportion had a general increasing trend from anterior to posterior regions in AP_01 and AP_03 periods of life and in males. In turn, it had decreasing trend from anterior to posterior regions in AP_02 and AP_04 periods of life and in females. The COLF proportion had the highest values in NV_P group in all cardiac main regions and the lowest values in V_P group (excepting LV), in both men and women. It had also the highest values in the RV_W and the lowest ones in IVS in all three diseases groups. In LV, COLF proportion had the highest values in NV_P group but the smallest ones in S-V_Dth group, in all main heart regions of this group. The COLF proportion had higher values in males than in females in all heart wall main regions in NV_P group and S-V_Dth group but vice versa in V_P group. Conclusions.

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4. Tobacco and Color Parameters of Lateral Incisors in Young Adults

M. MOCIU, G. RAFTU, S.G. BUSTIUC, C.G. PUSCASU, C. BARTOK-NICOLAE, E.C. SIN, A. CARAIANE

This study aims to identify the disparities in tooth color between young adult consumers and non-consumers of tobacco and/or nicotine products. The study population included healthy young individuals aged 18 to 30 years. Participants were instructed to refrain from smoking for at least 2 hours before to the study session, avoid dental hygiene for a minimum of 2 hours before the session, and abstain from eating and drinking for at least 2 hours preceding the study period. A total 58 young adults participated in this study, consisting of 29 tobacco and/or nicotine users and 29 non-users. The mean lightness±standard deviation for the cervical region of tooth 1.2 was 82.25±2.841145, whereas for tooth 2.2 it was 80.55±3.625857, both derived from non-consumers in the same location. A notable disparity was observed in the a* value for teeth 1.2 in the cervical region when comparing non-consumers to users (p=0.033176). A substantial difference was noted in the central area of tooth 2.2 when comparing non-consumers to smokers (p=0.013802) for the a* values. Understanding the reasons for tooth color changes is important for early detection and accurate assessment of future treatment outcomes.

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5. Admission Acute Brain Dysfunction and In-ICU Mortality in a Single-Center Pre-Vaccination Romanian COVID-19 Cohort: A Retrospective Observational Analysis

A.I. NEACSU, A.D. ROTARU-ZAVALEANU, M.B. NOVAC, L. RADU, E. OSIAC

Background: Critically ill COVID-19 patients frequently develop organ dysfunction and acute brain dysfunction with features overlapping sepsis-associated encephalopathy (SAE). Real-world cohorts from Eastern European intensive care during the pre-vaccination period are scarce. Methods: We retrospectively analysed 389 consecutive adults with RT-PCR-confirmed SARS-CoV-2 admitted to a single regional Romanian tertiary ICU during 2020-2021, entirely preceding population-level vaccination. Organ dysfunction was defined as admission SOFA?2, and acute brain dysfunction was op-erationalised from admission Glasgow Coma Scale and neurological SOFA (the acute brain dysfunction [ABD] proxy). Associations with in-ICU mortality were examined descriptively, with pre-specified sensitivity analyses restricted to non-ventilated pa-tients to address sedation confounding. Results: In-ICU mortality was 65.8%. The ABD proxy was present in 49.6% of the cohort; mortality was 96.9% in ABD-proxy-positive patients versus 45.9% in those with preserved consciousness, an absolute difference of 51.0 percentage points, which was of similar magnitude (49.4 points) in non-ventilated patients, arguing against sedation as the sole explanation. Higher inflammatory markers accompanied the ABD proxy, and the association between admission acute brain dys-function and mortality was consistent across analyses. Conclusions: Admission acute brain dysfunction was strongly associated with in-ICU mortality, and this association persisted in non-ventilated patients. The findings are descriptive associations within an extreme, single-center pre-vaccination cohort under surge conditions; they are not causal, and should not be generalised to vaccinated or contemporary critical care.

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6. From Data to Decision: Interpretable and Reliable Heart Disease Risk Prediction

A.I. SPINU, R.C. IVANESCU, C.R. DANCIULESCU, D.R. STANESCU

Background: Heart disease is the leading cause of morbidity and mortality worldwide, highlighting the need for accurate and clinically meaningful risk prediction tool. Methodology: A retrospective analysis was performed on a dataset of 918 patients with complete clinical information. The relationship between variables and disease presence were explored using correlation and dependence measure. To prediction was made using logistic regression, linear discriminant analysis, and generalized additive models. The performances were evaluated using cross-validation, discrimination metrics, and calibration analysis. Results: Functional and exercise-related variables, particularly Oldpeak, maximum heart rate, chest pain type, and ST slope showed the strongest correlation with disease presence. All models achieved AUROC values higher than 0.91. Logistic regression and generalized additive models performed similarly, with no statistically significant difference between them. Calibration analysis showed a good agreement between predicted and observed probabilities. Conclusion: Heart disease prediction can be achieved with high accuracy using clinically accessible variables and interpretable models. Our findings suggest that simpler approaches remain suitable for practical clinical applications, while preserving transparency and usability.

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7. Pulmonary Function in Adults with Severe Eosinophilic Asthma Using Biologicals: A Case-Control Study

A. DOS SANTOS BESERRA, J. RIBEIRO BORGES, I. DA NOBREGA FERREIRA, M.P. CABRAL SANTOS, T.T. MAFORT, T.PRUDENTE BARTHOLO, A.J. LOPES

The era of biologics has revolutionized the treatment of severe eosinophilic asthma (SEA). Although biologics appear to control SEA, pulmonary function is still poorly assessed with effective techniques. This study aimed to compare pulmonary function between adults living with severe asthma (alwSEA) with and without the use of biologics through a comprehensive approach to measuring pulmonary function, including assessments of pulmonary mechanics, static lung volumes, and small airways. Methodology: This is a cross-sectional study in which 15 alwSEA using biologics (biological group-BG) and 17 alwSEA using conventional therapy (control group-CG) were evaluated. These individuals underwent spirometry, body plethysmography, and respiratory oscillometry. In addition, they underwent the Asthma Control Test and the Asthma Quality of Life Questionnaire. Results: The sample was predominantly female, with 14 women (93.3%) in the BG and 16 (94.1%) in the CG. The groups differed significantly in age, with the BG being younger than the CG [52 (47-61) vs. 60 (54-66) years, p=0.045]. The BG presented significantly higher values of forced expiratory volume in the first second [1.77 (1.45-1.91) vs. 1.27 (1.18-1.47) L, p=0.005]. The CG presented a higher residual volume to total lung capacity ratio [141 (128-157) vs. 108 (89-117) % predicted, p<0.001]. Respiratory system resistance at 20 Hz was higher in the CG [170 (137-216.5) vs. 131.5 (110.8-179.2) % predicted, p=0.038]. Conclusions: In alwSEA, biologics appear to improve not only volumes and flows, but also air trapping. Furthermore, biologics appear to act on central airway resistance.

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8. The Assessment of T-Lymphocytes In Gastric Adenocarcinomas

R.A. PISICA-ILINCA, L. STANCA, M.V. ZORILA, A.E. STEPAN

Gastric adenocarcinomas (GAC) are common cancers in pathology, which pose real problems in practice due to heterogeneity, response to treatment and prognosis. New therapeutic approaches in GAC are aimed at activating the immune system by unblocking or modulating it. In this study, we analyzed the density and distribution of intra- and peritumoral CD4 and CD8 lymphocytes, by immunohistochemistry, in relation to the main prognostic parameters of GAC. CD4 and CD8 lymphocytes were superior in the tumor compartments in the case of discohesive and mixed GAC. They also predominated in discohesive GAC with signet ring cells at the intratumoral level and in those without other specifications at the peritumoral level. CD4 and CD8 were superior in high-grade GAC, in stages II/III and with lymphovascular invasion, more frequently peritumoral. The study indicated differences in the distribution of CD4 and CD8 T lymphocytes that may be useful for improving patient stratification for personalized targeted therapy of GAC.

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9. The Need of Support and Guidance Among Hospitalized Patients

D. KAKKAVAS, D. MASTROGIANNIS, A.STAMOU, A. MAGGITA, V.I TSOULOU, A. TSAMI, M. POLIKANDRIOTI

Background: Hospitalization is a common and stressful experience that often leads to emotional distress, including anxiety and uncertainty, highlighting the need for comprehensive psychological support. It can negatively affect patients' well-being and their ability to cope with illness, underscoring the importance of addressing patients' emotional and psychosocial needs. Objective: To explore the need of support and guidance among hospitalized patients and associated factors. Methods: In the present cross-sectional study, 121 hospitalized patients were enrolled. Data collection was carried out by interview method, using the scale “Needs of hospitalized patients with coronary artery disease scale”, which included patient characteristics. In the present study, the subscale “need for support and guidance” was explored. The level of statistical significance was set to p<0.05. Results: Age (p=0.001), marital status (p=0.001), occupation (p=0.003), the presence of comorbidity (p=0.001), urinary catheter use (p=0.001), previous hospitalization (p=0.001), and uncertainty regarding care after discharge (p=0.001), were found to be statistically significantly associated with need for support and guidance. Conclusion: Demographic and clinical characteristics are associated with the importance of support and guidance among hospitalized patients. In depth understanding of this need is expected to contribute to implementation of effective patient-centered care.

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10. Diagnostic Performance of Diffusion-Weighted MRI and ADC Values in Differentiating Atypical Leiomyomas from Uterine Sarcomas

R.A. RIZESCU, I.A. SALCIANU, A. IONESCU, G.E IANA, A.M. BRATU, I.A. GHEONEA

Background: Leiomyomas are the most common benign uterine tumors, whereas uterine sarcomas are rare malignant neoplasms associated with high morbidity and mortality. Differentiation using imaging remains challenging because of overlapping radiologic features. Purpose: To evaluate magnetic resonance imaging (MRI) characteristics of atypical leiomyomas and uterine sarcomas, with emphasis on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values. Materials and Methods: In this retrospective study, 22 patients with histopathologically confirmed uterine leiomyoma or sarcoma underwent MRI for atypical or suspicious uterine lesions. MRI assessment included T2-weighted imaging, DWI with ADC maps, and fat-suppressed T1-weighted sequences before and after gadolinium administration. Results: Thirteen atypical leiomyomas (59%) and nine sarcomas (41%) were analyzed. Mean patient age was similar between groups. Abnormal vaginal bleeding was more frequent in sarcomas (89% vs. 38%). Sarcomas more commonly showed irregular margins (89% vs. 69%) and T2 hyperintensity (89% vs. 15%). Heterogeneous enhancement and cystic or hemorrhagic changes occurred in both tumor types, while extrauterine disease was observed only in sarcomas. All sarcomas demonstrated high DWI signal intensity exceeding that of the endometrium, whereas most leiomyomas showed intermediate signal intensity. Mean ADC values were significantly lower in sarcomas (0.813 × 10?³mm²/s) than in leiomyomas (1.050 × 10?³ mm²/s), with an optimal cutoff of 0.892 × 10?³mm²/s. Conclusion: MRI, particularly DWI and ADC analysis, provides valuable differentiation between atypical leiomyomas and uterine sarcomas, with sarcomas demonstrating higher DWI signal intensity and significantly lower ADC values.

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11. Clinicopathological Features and Statistical Associations in Squamous Cell Carcinoma of the Lip

I.C. VILCEA, B.C. ANDREIANA, C. MARGARITESCU, M.M.FLORESCU, A.M. BADIU, O.I. CREU, I.A. MURARU, A.M. VILCEA, L.E. STOICA, R.N. CIUREA

Background: Lip squamous cell carcinoma (SCC) is frequently associated with chronic ultraviolet exposure and actinic cheilitis. Although prognosis is generally favorable, clinicopathological parameters may correlate with tumor characteristics and risk-related patterns. Materials and Methods: A retrospective study was conducted on 21 cases of lip SCC diagnosed at the County Clinical Emergency Hospital of Craiova between January 2021 and June 2025. Epidemiological and clinical variables (age, sex, area of residence, tumor site and size, macroscopic appearance) and histopathological parameters (subtype, grade, tumor extension, resection margin status, depth of invasion, perineural and vascular invasion) were evaluated. Associations were tested using the Chi-square (?²) tests in IBM SPSS software. Results: The mean age was 74.2±10.88 years, with male predominance (71.4%) and rural residence 71.4% of patients. Most tumors were located on the lower lip (90.4%). Keratinizing SCC was the most frequent histological subtype (61.9%), and well to moderately differentiated tumors (G1-G2) predominated. Muscular invasion was identified in 71.4% of cases, and pT3 was the most frequent (71.4%). Actinic cheilitis was present in all cases. Statistically significant associations were observed between gender and histological grade, tumor site and differentiation, and between histological subtype and degree of differentiation (p<0.05). Conclusions: Lip SCC predominantly affects elderly male patients and most frequently involves the lower lip. Tumor localization, depth of invasion, and histological grade showed relevant associations with the aggressiveness of lip SCC.

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12. From Classroom to Clinic: A Qualitative Study on Newly Graduated Nurses’ Transition to Practice

H. JAFARIMANESH, M. ZAKERIMOGHADAM, S. GHIYASVANDIAN

Background: The global nursing shortage and high turnover rates among newly graduated nurses (NGNs) pose significant challenges to their transition into professional roles. Understanding NGNs’ experiences is crucial for identifying the factors contributing to turnover and developing targeted strategies that facilitate their integration into clinical practice, ultimately promoting long-term retention. While extensive research has explored this transition in developed countries, there remains a notable gap in studies focusing on NGNs’ experiences in developing nations. This study aims to explore the lived experiences of NGNs during their transition to clinical practice (TCP), offering valuable insights to inform policy development and improve support mechanisms in healthcare settings. Design: This study employed a qualitative inductive content analysis approach to explore NGNs’ transition experiences. Conducted in three hospitals affiliated with Tehran University of Medical Sciences, the study recruited 21 NGNs with less than one year of work experience through purposive sampling. Data were gathered via semi-structured face-to-face interviews and analyzed using the Graneheim and Lundman framework. To ensure the trustworthiness of findings, Lincoln and Guba’s criteria were rigorously applied. Data management and analysis were facilitated by MAXQDA (version 20). Results: Three main categories emerged from the data analysis: magnetic experiences, non-magnetic experiences, and transition period outcomes. Conclusion: The findings underscore the complex and multifaceted nature of NGNs’ transition experiences, encompassing both magnetic (supportive) and non-magnetic (challenging) factors that significantly influence patient care quality, job satisfaction, and retention decisions. These findings align with transition theory and transition shock models, emphasizing the urgent need for structured, evidence-based support programs to optimize the transition process. This study provides critical insights for designing targeted interventions, fostering attractive work environments, and enhancing nursing workforce retention strategies.

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13. Observational Assessment of the Effect of Sleep Bruxism on Oxyhaemoglobin Saturation: A Preliminary Study

M. PALINKAS, S. SIESSERE, S.C. HALLAK REGALO

Objectives: Sleep bruxism, characterized by involuntary muscle activity and classified into phasic and tonic patterns, warrants analysis with respect to physiological parameters, as this could aid in understanding its broader health implications. This observational study aimed to compare oxyhaemoglobin saturation between subjects with and without sleep bruxism. Material and Methods: Ninety subjects aged between 18 and 45 years, with natural permanent dentition, normal occlusion, no temporomandibular dysfunction, and no obstructive sleep apnoea, were selected and divided into two homogeneous groups regarding age, sex, weight, and height. The sleep bruxism group comprised 29 women and 16 men (mean age 30.5±6.8), as did the control group (mean age 29.4±7.9). All subjects underwent an overnight PSG session, with the diagnosis of sleep bruxism established according to the criteria of the American Academy of Sleep Medicine. Minimum, mean, and maximum oxyhaemoglobin saturation levels were evaluated using pulse oximetry. Data were analyzed using Student's t-test (p<0.05). Results: Comparisons between the groups revealed significant differences in the maximum oxyhaemoglobin saturation index (p=0.04). The sleep bruxism group showed a lower maximum oxyhaemoglobin saturation index compared to the control group. No significant differences were observed for minimum or mean oxyhaemoglobin saturation. Conclusion: Sleep bruxism was associated with a lower maximum oxyhaemoglobin saturation compared with controls. Although the observed difference was small and remained within normal physiological limits, these findings suggest a possible relationship between sleep bruxism and oxygenation dynamics during sleep that warrants further investigation.

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14. Cutaneous Tuberculosis in a 22-Day-Old Neonate: A Diagnostic Challenge and Case Report

A. IMRAN, S.W.F. SHAHA, S.A.R. SHAH, M. RAFIQUE, H. RAJA

Background: Cutaneous tuberculosis (CTB) is a rare extrapulmonary manifestation of tuberculosis, particularly in neonates. Its diagnosis is often challenging due to non-specific presentations that can mimic common conditions. Clinical Description: We report the case of a 22-day-old male neonate who presented to the emergency room with fever and a scalp swelling following a reported fall from bed. Initial assessment suggested a subcutaneous abscess. The patient did not respond to multiple courses of intravenous antibiotics. A blood culture grew Burkholderia species, but targeted therapy also failed. Incision and drainage were performed, and pus GeneXpert testing was positive for Mycobacterium tuberculosis, despite a negative tuberculin skin test and clear chest X-ray. A final diagnosis of cutaneous tuberculosis (tuberculous chancre) was established. Management & Outcome: Anti-tuberculosis therapy (ATT) was initiated, leading to the complete resolution of the swelling and full recovery. Conclusion: This case underscores the diagnostic challenges of neonatal CTB. It highlights the importance of considering tuberculosis in the differential diagnosis of non-resolving abscesses in infants, especially in endemic areas, and demonstrates the critical role of molecular diagnostics like GeneXpert in achieving a timely diagnosis.

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15. Cardiac Resynchronization Therapy Optimization in a Patient with Left Ventricular Non-Compaction Cardiomyopathy and Morbid Obesity

A. FARHANGEE, I. MINDRILA

Left ventricular non-compaction cardiomyopathy (LVNC) is a rare myocardial disorder associated with heart failure and arrhythmias. Cardiac resynchronisation therapy (CRT) is an established treatment in patients with electrical dyssynchrony; however, achieving optimal response remains challenging in complex clinical scenarios. We report a 51-year-old male with LVNC, severe left ventricular dysfunction, morbid obesity, and recurrent atrial and ventricular arrhythmias. Despite initial improvement following CRT-D implan-tation, the patient developed progressive heart failure and recurrent ventricular tachycardia with high atrial arrhythmia burden, resulting in ineffective biventricular pacing. Following unsuccessful device optimisation strategies, a multidisciplinary decision was made to proceed with atrioventricular node ablation. This resulted in marked clinical and echocardiographic improvement, including recovery of left ventricular ejection fraction and symptomatic status. This case highlights the importance of ensuring adequate CRT delivery and demonstrates the pivot-al role of atrioventricular node ablation in patients with refractory atrial arrhythmias and suboptimal CRT response.

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