Background: In 2012 the National Screening Program for all women between 25 and 64 years of age was launched in Romania. Public awareness is an important factor in the success of a screening program. For this reason, we intended to assess the perception and the level of awareness of Romanian women regarding the Pap test in the prevention of cervical cancer. Methods: A cross-sectional study was conducted among 454 women from rural and urban areas. For our study, we used a questionnaire covering general characteristics, awareness, knowledge and practices regarding cervical cancer and Pap smear. Results: 431 participants (95%) had heard of cervical cancer and Pap smear but only 71.8% knew the exact role of it. Bivariate analysis showed that knowledge about the importance of the Pap smear, early detection and treatment of early-stage cervical cancer was reduced among women with low socio-economic status, mainly living in rural area. The most frequent reasons for avoiding Pap smear screening were: lack of money, embarrassment or fear of gynaecological consultation and pain, the feeling that they don't need it, misconceptions about cervical cancer, fatalistic attitude, perceived low susceptibility to cervical cancer. Conclusions: Because the uptake and the success of cervical cancer screening are determined by women's knowledge and awareness of Pap smear, it is critical to improve these perceptions in the near future especially in rural area characterized by a low socio-economic status.

Background/Objectives: This study evaluated the diagnostic accuracy of cervical cytology, CINtec^® (p16/Ki-67 dual staining), and PD-L1 immunohistochemistry, individually and in combination with high-risk HPV (HR-HPV) testing, for identifying histologically confirmed cervical lesions ranging from CIN1 to invasive carcinoma. Methods: We conducted a prospective cross-sectional study including 114 patients who underwent cervical cytology, CINtec^®, PD-L1 staining, HPV genotyping, and histopathologic confirmation at a tertiary clinical center between September 2024 and September 2025. Sensitivity, specificity, PPV, NPV, and ROC performance were calculated for each test across lesion categories. Multivariable logistic regression models incorporating HR-HPV status were used to assess added predictive value. Results: All tests showed poor performance for CIN1 (cytology AUC 0.488; CINtec^® 0.374; PD-L1 0.366). Diagnostic accuracy improved markedly with lesion severity. For CIN3, CINtec^® demonstrated the highest discriminative ability (AUC 0.826), with cytology and PD-L1 also performing well (AUC 0.820 and 0.753). Cytology achieved the strongest ROC performance for CIN2+ (AUC 0.937), CIN3+ (0.913), and invasive carcinoma (0.887). PD-L1 consistently showed lower accuracy across categories. Cytology + HR-HPV demonstrated the highest AUC across all lesion categories. Conclusions: Cytology and CINtec^® exhibited strong diagnostic accuracy for high-grade lesions, while PD-L1 showed limited utility as an independent screening marker. Combining cytology with HR-HPV testing enhanced predictive performance across all lesion categories. These findings support the continued use of cytology-based triage and highlight CINtec^® as a valuable adjunct for high-grade disease detection. Because this study used a high-prevalence referral cohort, specificity may be overestimated and not representative of population-based screening.

Heiner syndrome (HS), although rare in pediatric practice, can cause cough, wheezing, and only in rare cases hemoptysis. HS should be considered in any child presenting these respiratory symptoms and radiological evidence of alveolar infiltrates, especially when accompanied by signs of food allergy—most notably cow's milk protein allergy, although other foods may also be involved. The use of probiotics should be evaluated with caution in these children. We report a case of a 1-year and 6-month-old female patient who presented at the Pneumology Clinic with a 1-day history of blood-tinged sputum. Although she had a known history of cow's milk protein allergy and well-controlled asthma, the occurrence of hemoptysis, even in small quantities, raised concerns for the family. A second episode of hemoptysis appeared when she consumed egg and probiotics. After correlating the patient's medical history with clinical, laboratory, and imaging findings, a diagnosis of HS was established. The patient received emergency treatment followed by bronchodilators, corticosteroid therapy, and a restricted diet for cow's milk protein and egg. The patient's condition improved immediately after treatment and remained stable at the 5-month follow-up. The differential diagnosis with idiopathic pulmonary hemosiderosis must not be overlooked, due to its more severe clinical course and higher risk of complications.

Among uterus-preserving treatments for presumed fibroids, only myomectomy yields a specimen. Occult uterine sarcoma is uncommon, but leiomyosarcoma is clinically aggressive and seldom recognised before treatment. This narrative review examines what pretreatment assessment can and cannot establish. Literature from PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library was synthesised narratively. Reported frequencies of unexpected sarcoma differ between clinical populations, mostly from 0.1% to 0.4%, and rise with age. Other predisposing factors are imprecisely quantified; genome-wide association data do not discriminate sarcoma from leiomyoma. Separate meta-analyses, largely of retrospective, enriched studies, report higher accuracy for magnetic resonance imaging (MRI), including diffusion-weighted sequences, than for ultrasound, by indirect comparison. Serum markers, composite scores and circulating nucleic acids remain supportive or investigational; directed biopsy lacks validation in unselected populations. In all-sarcoma scenarios, published likelihood ratios indicate that a negative MRI lowers, but does not eliminate, the probability of sarcoma; an exploratory, assumption-dependent reconstruction from a consecutive cohort illustrates their uncertain transportability. No available test reliably excludes sarcoma; after specimen-free therapy, a missed sarcoma may remain unrecognised until reassessment. We propose a conceptual framework, not a validated decision rule, that considers absolute residual risk alongside the specimen status of the chosen treatment.

Background: The deep-intronic variant 3849+10kbC>T preserves residual CFTR function and is recurrently associated with pancreatic sufficiency, normal or borderline sweat chloride and diagnosis beyond early childhood. A co-occurring poly-T 5T allele adds a second layer of uncertainty: its penetrance depends on the TG repeat carried in cis, and its contribution to the phenotype can be weighed only once its phase relative to the second variant has been established. Case Presentation: A boy with recurrent respiratory infections from the age of three was diagnosed with cystic fibrosis at 12 years, in 2018—four years before newborn screening became national policy in Romania. Two sweat conductivity measurements, 125 and 80 mmol/L NaCl-equivalent, together with targeted CFTR analysis identifying 3849+10kbC>T and a 5T allele, established the diagnosis. Phase was not determined—parental samples were not obtained and no allele-specific or long-range analysis was performed—so the two findings are reported as co-occurring rather than as demonstrably in trans. His elder brother, who had recurrent spontaneous pneumothorax and two negative sweat tests, was never genotyped because the test was not reimbursed. Bilateral bronchiectasis and chronic airway infection followed; inhaled colistimethate eradicated Pseudomonas aeruginosa, whereas Staphylococcus aureus persisted despite successive antibiogram-guided regimens. Access to elexacaftor/tezacaftor/ivacaftor was granted in January 2026 on the basis of the genotype. Conclusions: Molecular characterisation contributed to a diagnosis that rested on the combination of clinical phenotype, abnormal sweat conductivity, and CFTR analysis, and was, eight years later, the sole criterion for access to modulator therapy; phase and TG-repeat length remain undetermined. No follow-up data are available, therapy having been authorised but not yet started at the time of writing.

Background/Objectives: Emerging evidence links vaginal microbiome dysbiosis with HPV persistence and CIN progression, but whether microbiome markers provide incremental prognostic value beyond molecular triage assays remains unclear. This study aimed to evaluate whether Lactobacillus depletion and Shannon diversity improve prediction of biopsy-confirmed CIN2+ and CIN3+ outcomes beyond CINtec and HPV-16 genotyping. Methods: This was a secondary analysis of a cross-sectional study including 82 women undergoing cervical screening or follow-up for abnormal cytology. Associations with CIN2+, CIN3+, and CINtec positivity were estimated using modified Poisson regression. Multiplicative interaction between HPV-16 and Lactobacillus depletion was formally tested. Incremental discriminative performance was assessed using area under the receiver operating characteristic curve (AUC), DeLong’s test, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results: HPV-16 was the strongest predictor of CIN2+ (PR = 6.08, p < 0.001) and CIN3+ (PR = 5.53, p = 0.001). A significant sub-multiplicative interaction indicated that Lactobacillus depletion carried its strongest prognostic signal in HPV-16-negative women (CIN3+: PR_interaction = 0.04, p = 0.003). Adding microbiome markers to CINtec + HPV-16 significantly improved CIN2+ discrimination (ΔAUC = 0.034, p = 0.031), driven by correct downward reclassification of non-events (NRI_non-events = 0.833). When added to HPV-16 + age, IDI for CIN2+ reached 0.092 (p = 0.004). Conclusions: Vaginal microbiome markers, particularly Lactobacillus depletion, provide statistically significant incremental discriminative value for CIN2+ beyond CINtec p16/Ki-67 dual staining and HPV-16 genotyping. Microbiome-based triage may be most impactful in HPV-16-negative women.