This systematic review evaluates the clinical outcomes and molecular predictors of response to pembrolizumab in patients with advanced and metastatic cervical cancer. We adhered to the PRISMA guidelines for systematic reviews, conducting a database search in PubMed, Scopus, and Embase. The eligibility criteria centered on clinical outcomes, including the overall survival (OS), progression-free survival (PFS), and immune-related biomarkers post-pembrolizumab therapy. We included both prospective and retrospective studies that detailed clinical outcomes and molecular characteristics predictive of therapeutic response. Our search yielded six studies involving 846 patients treated with pembrolizumab from 2017 to 2022. The meta-analysis of these studies showed that pembrolizumab, used as monotherapy or in combination with chemotherapy, extended the OS by a weighted median of 10.35 months and the PFS by 8.50 months. The treatment demonstrated a pooled objective response rate (ORR) of 22.39%, although the I² test result of 67.49% showed a high heterogeneity among the studies. Notably, patients with high PD-L1 expression (CPS ≥ 10) experienced improved outcomes in terms of the PFS and OS. The most common complications were fatigue, diarrhea, and immune-related adverse events. Pembrolizumab significantly enhances clinical outcomes in metastatic cervical cancer, particularly among patients with high PD-L1 expression. The drug maintains a good safety profile, reinforcing its treatment potential for patients with advanced and metastatic cervical cancer. Future studies should explore long-term effects and strategies to integrate pembrolizumab optimally into current treatment regimens, aiming to maximize patient benefits and effectively manage side effects.

Objectives: Pelvic organ prolapse (POP) is a common condition affecting women, often requiring surgical intervention. Laparoscopic pectopexy has gained popularity, but there is ongoing debate about the efficacy and safety of mesh versus thread as fixation materials. This study aims to compare the outcomes of these two techniques, focusing on cure, recurrence and postoperative complication rates. Methods: A prospective analysis was conducted on patients undergoing laparoscopic pectopexy for POP. This prospective study included 78 patients diagnosed with pelvic organ prolapse stage II–IV according to the POP-Q system. Thirty-six (46.15%) underwent laparoscopic pectopexy with mesh and forty-two patients (53.84%) underwent the laparoscopic pectopexy procedure with thread. Data on cure rates, recurrence, mild asymptomatic cystocele and chronic pain were analyzed. Statistical significance was assessed using chi-squared and Fisher’s exact tests. Results: The cure rate was high in both group: 94.4% in the Mesh group and 100% in the thread group. Recurrence of vaginal apex prolapse occurred in 5.56% of the Mesh group, while no recurrence was observed in the thread group. Chronic pain was reported in 11.11% of the Mesh group but was absent in the thread group (p < 0.05). The overall rate for cystocele across all participants was 44.87% (40.48% of patients in the thread group experienced mild asymptomatic cystocele, compared to 50% in the Mesh group). No intraoperative complications were reported in either group. Conclusions: Thread-based laparoscopic pectopexy demonstrates equivalent or superior outcomes compared to mesh, with a high cure rate, no recurrence rate and no chronic pain. These findings support the use of thread as a safer alternative, aligning with FDA guidelines on mesh usage.

Background and Objectives: Our aim was to perform a retrospective analysis of the volume of cervical screening tests, the number of patients treated with an excision method, and the incidence of invasive and non-invasive cervical during a pandemic and pre-pandemic period of 24 months. Materials and Methods: The study compared 404 patients who underwent cervical cone biopsy for cervical cancer. The study examined patients’ specimens based on histopathological characteristics and categorized cervical lesions based on pap smear. Results: There was a statistically significant age difference between the two study periods. The mean difference was 32 years before the pandemic and 35 years during the pandemic (p-value > 0.05). The biggest patient loss ratio identified by age group was in the 50–59-year group, with a 14.53% loss in the pre-pandemic period and a 9.1% loss in the pandemic period. In the pandemic period, patients from rural areas presented in the clinical trial with a lower rate of 39.52% (83 patients) vs. 60.47% (127 patients) in urban areas. A higher percentage of patients experiencing cervicorrhagia as a clinical manifestation in the pandemic period vs. the pre-pandemic period, with an increase in more severe lesions in the pandemic period, had a statistical significance of 8% more newly diagnosed compared to the pre-pandemic period. Conclusions: The addressability of the patients during the COVID period was not affected in a drastic way in our study. We encountered a decrease in appointments in the age group of 50–59 years and a decrease in patients with rural residence. In our study, we found an increase in cervical bleeding as a reason for consultation in the pandemic period with a higher lesion degree, both on a pap smear and on a cervical biopsy.

Background/Objectives: When the squamocolumnar junction is not fully visible (type 3 transformation zone), colposcopy-directed biopsy may under-sample endocervical disease. Endocervical curettage (ECC) is recommended in selected settings, but its incremental diagnostic yield in this setting, and whether this yield is concentrated in women with HPV16/18, remains clinically debated. Methods: We performed a retrospective cohort study of women referred to colposcopy because of HPV16/18 positivity regardless of cytology, persistent non-16/18 high-risk HPV positivity, and non-16/18 high-risk HPV positivity with abnormal cytology. Persistent non-16/18 high-risk HPV positivity was defined as repeated positivity on two tests performed at least 6 months apart. Eligible women had type 3 transformation zone documented and underwent paired ectocervical biopsy plus ECC at the same visit; biopsy was obtained in all women, including targeted sampling of the most abnormal ectocervical area when no discrete lesion was evident. Women were stratified by HPV genotype into HPV16/18 and non-16/18 high-risk HPV groups. The primary outcome was index high-grade cervical lesion, defined histologically as CIN2, CIN3, or carcinoma in situ; invasive cervical cancer was excluded. The added diagnostic yield of ECC was defined as ECC-only CIN2+, that is, CIN2+ detected on ECC when biopsy was <CIN2. Results: The cohort included 690 women (HPV16/18: 310; non-16/18 high-risk HPV: 380). Baseline cytology was negative for intraepithelial lesion or malignancy in 116 individuals (16.8%), ASC-US in 155 (22.5%), LSIL in 205 (29.7%), and ASC-H/HSIL in 214 (31.0%). On index composite histology, 122/690 (17.7%) had CIN2, 198/690 (28.7%) had CIN3, and 11/690 (1.6%) had carcinoma in situ. ECC identified CIN2+ not detected by biopsy in 19/690 (2.8%) cases, representing 19/331 (5.7%) of all CIN2+ diagnoses. ECC-only CIN2+ was more frequent in HPV16/18 than non-16/18 high-risk HPV (4.5% vs. 1.3%, p = 0.017). In multivariable analysis, HPV16/18 was associated with increased odds of ECC-only CIN2+ (aOR 3.22, 95% CI 1.10–9.44). No invasive cervical cancers were included in the analytic cohort. Conclusions: In type 3 transformation zone colposcopy, ECC adds a modest incremental yield for CIN2+ detection, with higher yield in HPV16/18-positive women. These findings support a risk-weighted approach to ECC rather than universal routine sampling.

Background and Objectives: Pleural infection is heterogeneous, and the clinical meaning of a positive pleural culture remains uncertain. We compared adults with positive and negative aerobic pleural-fluid cultures and examined associations with major in-hospital events. Materials and Methods: This retrospective, single-center, case-ascertained cohort included adults hospitalized with bacterial pleural infection in Western Romania during 2017–2025. The primary analytic cohort was restricted to patients whose first clinically relevant pleural specimen had an interpretable aerobic culture. Pleural fluid (PF)-positive and PF-negative status was defined exclusively by that result; unperformed tests and operative specimens were not used for classification. The composite outcome comprised in-hospital death, intensive-care unit (ICU) admission/transfer, or thoracic surgery/surgical transfer. Prespecified covariates were entered simultaneously in logistic regression. Results: Of 317 included patients, 276 had an interpretable aerobic pleural culture: 127 (46.0%) were PF-positive and 149 (54.0%) were PF-negative. PF-positive patients were more often institutionalized, had chronic kidney disease, nosocomial infection, frank empyema, and lower pleural-fluid pH and glucose. Streptococci predominated in community-acquired infection, whereas Gram-negative organisms and multidrug-resistant phenotypes were more frequent in healthcare-associated/nosocomial episodes. The composite occurred in 60/127 (47.2%) PF-positive and 51/149 (34.2%) PF-negative patients (OR 1.72, 95% CI 1.06–2.80). The adjusted PF-positive estimate remained imprecise (aOR 1.60, 95% CI 0.94–2.74; p = 0.084), whereas healthcare-associated/nosocomial acquisition was associated with the composite (aOR 1.76, 95% CI 1.03–3.00; p = 0.038). In a sensitivity analysis restricted to 249 patients whose pleural sampling preceded all recorded outcome components, the adjusted association remained imprecise (aOR 1.54, 95% CI 0.86–2.76). Conclusions: A positive aerobic pleural culture identified a distinct high-risk phenotype and influenced antimicrobial management, but its independent association with the heterogeneous in-hospital composite remained uncertain. Acquisition setting and local resistance ecology should guide empirical therapy, and outcome timing should be reported explicitly in future studies.

Objective: The aim of our study was to perform a retrospective analysis of the volume of cervical screening tests, the number of patients treated with an excision method, and the incidence of invasive and non-invasive cervical during a pandemic and pre-pandemic period of 24 months. Results: There was a statistically significant age difference between the two study periods, both by the average age of patients and by age group. The mean difference was 32 years before the pan-demic and 35 years during the pandemic (p-value >0.05). The majority of patients presenting for investigations before and during the pandemic were in the 30-39-year-old age group (31.95%, respectively; 34.2% (p-value = 0.003). The biggest patient loss ratio identified by age group was in the 50–59 years: 14,53% in the pre-pandemic period and 9,1% in the pandemic period. In the pan-demic period, patients from rural areas presented in the clinical trial with a lower rate of 39.52% (83 patients) vs. 60.47% (127 patients) in urban areas. A higher percentage of patients experiencing cervicorrhagia as a clinical manifestation in the pandemic period vs. the prepandemic period, with an increase in more severe lesions in the pandemic period, has a statistical significance of 8% more newly diagnosed compared to the pre-pandemic period. Conclusion: The addressability of the patients during the COVID period was not affected in a drastic way in our study. We encountered a decrease in appointments in the age group 50–59 years and a decrease in patients with rural residence. In our study, we found an increase in cervicorrhagia as a reason for consultation in the pandemic period with a higher lesion degree, both on a pap smear and on a cervical biopsy.