Deep neck infection is a pathology at the border of two specialties, otorhinolaryngology and maxillofacial surgery, and represents a medico-surgical emergency. In terms of its evolution, it can extend to the level of the thorax and result in mediastinitis, with difficult evolution and poor prognosis. The aims of this scoping review are to present the etiology, bacteriology, clinical manifestations, and diagnostics, as well as treatment, in light of the research published in the last 5 years on deep neck infection associated with descending necrotizing mediastinitis. The most common primary sources of deep neck infection are odontogenic and tonsillar. The other sources that are involved in deep neck infection are salivary glands, foreign bodies, malignancies, and iatrogenic causes after endoscopic maneuvers. The bacteriologic aspect is polymorphic, including both aerobic and anaerobic species. Complications that may appear include jugular vein thrombosis, airway obstruction, acute respiratory distress syndrome, sepsis, and disseminated intravascular coagulation. Timely diagnosis is important for ensuring the positive evolution of a deep neck infection. A CT scan is important for characterizing the nature of a deep neck lesion and identifying the spaces involved, and this method represents the gold standard for diagnosis of these lesions. Following the establishment of a definitive diagnosis, antibiotic therapy is initiated empirically, and is modified according to bacteriological exam results. The administration of antibiotics is an essential part of the treatment strategy for patients with a deep neck infection. Based on CT results, different surgical methods are applied under general anesthesia. The surgical strategy involves opening and draining the cervical spaces and debriding the necrotic tissue. In the cases of odontogenic causes, drainage and extraction of the infected teeth are performed. It is especially important to follow up on the dynamic progression of the patient. In the management of a deep neck infection associated with descending necrotizing mediastinitis, a multidisciplinary team is necessary.

1. Background: Literature data on bacterial infections and their impact on the mortality rates of COVID-19 patients from Romania are scarce, while worldwide reports are contrasting. 2. Materials and Methods: We conducted a unicentric retrospective observational study that included 280 patients with SARS-CoV-2 infection, on whom we performed various microbiological determinations. Based on the administration or not of the antibiotic treatment, we divided the patients into two groups. First, we sought to investigate the rates and predictors of bacterial infections, the causative microbial strains, and the prescribed antibiotic treatment. Secondly, the study aimed to identify the risk factors associated with in-hospital death and evaluate the biomarkers’ performance for predicting short-term mortality. 3. Results: Bacterial co-infections or secondary infections were confirmed in 23 (8.2%) patients. Acinetobacter baumannii was the pathogen responsible for most of the confirmed bacterial infections. Almost three quarters of the patients (72.8%) received empiric antibiotic therapy. Multivariate logistic regression has shown leukocytosis and intensive care unit admission as risk factors for bacterial infections and C-reactive protein, together with the length of hospital stay, as mortality predictors. The ROC curves revealed an acceptable performance for the erythrocyte sedimentation rate (AUC: 0.781), and C-reactive protein (AUC: 0.797), but a poor performance for fibrinogen (AUC: 0.664) in predicting fatal events. 4. Conclusions: This study highlighted the somewhat paradoxical association of a low rate of confirmed infections with a high rate of empiric antibiotic therapy. A thorough assessment of the risk factors for bacterial infections, in addition to the acknowledgment of various mortality predictors, is crucial for identifying high-risk patients, thus allowing a timely therapeutic intervention, with a direct impact on improving patients’ prognosis.

Background/Objectives: Multidrug-resistant urinary tract infections (MDR UTIs) constitute an important public health problem, especially in pregnant patients. The aim of this retrospective study was to characterize the bacterial spectrum and the profile of microbial resistance in cases of UTIs occurring in pregnant women, as well as their impact on obstetrical and neonatal outcomes. Methods: A total of 371 pregnant patients with UTIs were included in the analysis and were segregated into the following groups based on the type of bacterial resistance to antibiotics: MDR UTIs (70 patients, group 1), UTIs resistant to one class of antibiotics (108 patients, group 2), UTIs resistant to two classes of antibiotics (102 patients, group 3), and sensitive UTIs (91 patients, group 4). We used descriptive statistics for characterizing and comparing the microbial spectrum and the clinical characteristics of the patients. A multinomial logistic regression model for evaluating the relationship between the type of urinary tract infection and adverse obstetric or neonatal outcomes was employed. Results: In the case of MDR UTIs, the bacterial spectrum mainly included Escherichia coli, Enterococcus faecalis, and Klebsiella species. We found almost universal resistance to ampicillin. Our data confirmed an increased risk of preterm birth, premature rupture of membranes, neonatal respiratory distress syndrome, and neonatal intensive care unit admission for patients with MDR infections. Conclusions: The increased incidence of pathogens resistant to commonly used antibiotic classes in pregnancy suggests the need for the development of local and national protocols that adapt therapeutic and prophylactic regimens to clinical realities.

Background and Objectives: Postoperative pancreatic fistula after cephalic pancreatoduodenectomy (CPD) is still the leading cause of postoperative morbidity, entailing long hospital stay and costs or even death. The aim of this study was to propose the use of morphologic parameters based on a preoperative multisequence computer tomography (CT) scan in predicting the clinically relevant postoperative pancreatic fistula (CRPF) and a risk score based on a multiple regression analysis. Materials and Methods: For 78 consecutive patients with CPD, we measured the following parameters on the preoperative CT scans: the density of the pancreas on the unenhanced, arterial, portal and delayed phases; the unenhanced density of the liver; the caliber of the main pancreatic duct (MPD); the preoperatively estimated pancreatic remnant volume (ERPV) and the total pancreatic volume. We assessed the correlation of the parameters with the clinically relevant pancreatic fistula using a univariate analysis and formulated a score using the strongest correlated parameters; the validity of the score was appreciated using logistic regression models and an ROC analysis. Results: When comparing the CRPF group (28.2%) to the non-CRPF group, we found significant differences of the values of unenhanced pancreatic density (UPD) (44.09 ± 6.8 HU vs. 50.4 ± 6.31 HU, p = 0.008), delayed density of the pancreas (48.67 ± 18.05 HU vs. 61.28 ± 16.55, p = 0.045), unenhanced density of the liver (UDL) (44.09 ± 6.8 HU vs. 50.54 ± 6.31 HU, p = 0.008), MPD (0.93 ± 0.35 mm vs. 3.14 ± 2.95 mm, p = 0.02) and ERPV (46.37 ± 10.39 cm³ vs. 34.87 ± 12.35 cm³, p = 0.01). Based on the odds ratio from the multiple regression analysis and after calculating the optimum cut-off values of the variables, we proposed two scores that both used the MPD and the ERPV and differing in the third variable, either including the UPD or the UDL, producing values for the area under the receiver operating characteristic curve (AUC) of 0.846 (95% CI 0.694–0.941) and 0.774 (95% CI 0.599–0.850), respectively. Conclusions: A preoperative CT scan can be a useful tool in predicting the risk of clinically relevant pancreatic fistula.

Functional Dyspepsia (FD) is a disorder of gut-brain interaction (DGBI) characterized by chronic symptoms without an organic cause. Diagnosis follows the Rome IV criteria, requiring symptoms for at least six months. FD affects up to 20% of the population, significantly impacting the quality of life and healthcare systems. Upper gastrointestinal endoscopy is often performed to rule out organic disorders but has limited utility in typical FD cases. FD’s etiology involves gastric motility alterations, dysbiosis, and immune and central nervous system dysfunction. This review summarizes FD diagnostic methods. A PubMed search was conducted using keywords: Functional Dyspepsia, Gastric Motility Assessment, ROME IV, and Gastric Emptying (GE). Relevant studies were manually reviewed, excluding those unrelated to FD or gastric motility assessment. Despite extensive research on organic gastrointestinal diseases, FD's pathophysiology remains unclear, necessitating further studies. Diagnostic methods include the rapid water and nutrient drink tests for assessing impaired gastric accommodation, hypersensitivity, and delayed gastric emptying. Drinking-ultrasonography and three-dimensional ultrasound evaluate gastric motor and sensory functions. MRI-based assessments provide detailed stomach volume and geometry insights. Gastric emptying scintigraphy and the 13C-gastric emptying breath test measure gastric emptying rates. High-resolution electrogastrography (HR-EGG) assesses gastric myoelectrical activity, while EndoFLIP measures sphincter function. Functional MRI and PET scans analyze brain activity related to FD symptoms. These methodologies enhance the understanding and management of FD by providing objective measures of gastric motility, accommodation, and sensory function. The integration of these advanced techniques into clinical practice holds the potential to move beyond symptom-based diagnosis, allowing for a more precise, individualized approach to treatment. Standardizing these diagnostic modalities will be crucial in optimizing patient care and alleviating the burden of FD on healthcare systems.

Background/Objectives: Neonatal early-onset sepsis (EOS) is a life-threatening condition, and numerous efforts have been invested in identifying the most promising biomarkers for its detection. In this prospective cohort study, we aimed to determine the diagnostic accuracy and optimal cut-off values of procalcitonin (PCT), presepsin, endocan, and interleukin (IL)-6 determined from the neonatal serum (0–12, 24–48, and 72–96 h), and umbilical blood cord for the diagnosis of EOS. Methods: A total of 122 patients were included in this study and were divided into two groups: group 1 (sepsis, n = 68 patients) and group 2 (without sepsis, n = 54 patients). Maternal and neonatal characteristics were assessed using descriptive statistics. Logistic regressions were used to evaluate the association between various biomarkers and the presence of EOS and to adjust for potential confounders. Using sensitivity analysis and Youden’s index from the ROC curve, the biomarkers’ diagnostic accuracy and optimal cut-off values were obtained. Results: PCT at 0–12 and 24–48 h of life exhibited the best diagnostic performance, with sensitivities (Ses) of 75% and 76.5% and specificities (Sps) above 74%. Presepsin demonstrated excellent performance at 24–48 h, with Ses of 68.42%, and Sps of 88.89%. IL-6 and endocan achieved modest results for the detection of EOS. Conclusions: PCT and presepsin measured at early neonatal timepoints demonstrated high diagnostic accuracy and favorable sensitivity–specificity balance for predicting EOS.