Childbirth is a remarkable, life-changing process and is frequently regarded as an excruciating, physically and emotionally demanding experience that women endure. Labor pain management poses a significant challenge for obstetricians and expectant mothers. Although pharmacological pain management is the gold standard, it still imposes risks on the mother and baby. Recently, non-pharmacological pain management (NPPM) has emerged as a safe, effective option. Six databases were searched for articles published up to 2023 using specific related keywords and defined inclusion and exclusion criteria. The extraction and gathering of data was made so as to be categorized into physical, psychological, and complementary NPPM techniques. In light of the enormous development and diversity of NPPM techniques, the present review aims to examine contemporary NPPM knowledge and application, discussing efficacy, advantages, limitations, and potential adverse effects, with a specific focus on women’s individual requirements, to strengthen obstetricians’ knowledge in guiding decision-making for women in childbirth.

Background and Objectives: Romania faces one of the highest cervical cancer burdens in Europe though it is a preventable cancer through population screening by cytology and human papillomavirus (HPV) detection. Also, it has one of the highest incidences of human immunodeficiency virus (HIV) infection. HPV and HIV coinfection are frequently encountered. The aim of study was to establish the prevalence of HPV infection among HIV-positive women in Southeast Region of Romania, to genotype high risk HPV types -and to correlate the results with clinical data and cytological cervical lesions. Materials and Methods: 40 HIV-positive women were screened for HPV types and for cytological cervical lesions. The findings were evaluated in correlation with CD4 cell counts, HIV viral load, age at first sexual intercourse, number of sexual partners, vaginal candidiasis, and Gardnerella using statistical methods. Results: 19/40 (47.5%) women were positive for HPV types, 63.15% infected with single HPV type and 36.85% with multiple HPV types. The most frequent types were type: 31 (42.1%), 56 (31.57%), 53 (15.78%). On cytology, 34 (85%) women were found with NILM of which 38.23% were HPV-positive. Fifteen percent of women had abnormal cytology (three ASC-US, three LSIL), and all of them were HPV-positive. Through analyzing the value of CD4 count, women with CD4 count ≤ 200 cells/μL were found to be significantly more likely to be infected with HPV; meanwhile there was no correlation between the detection of HPV types and HIV viral load. Candida or Gardnerella were more often associated with HIV-positive women with HPV, than in women without HPV. Conclusions: Infection with HPV types is common among HIV-positive women in the Southeast Region of Romania and it is associated with age at the beginning of sexual life, number of sexual partners, CD4 value, vaginal candidiasis, and Gardnerella infection.

Background: Recent studies have shown that gut microbiota have important roles in different human diseases. There has been an ever-increasing application of high-throughput technologies for the characterization of microbial ecosystems. This led to an explosion of various molecular profiling data, and the analysis of such data has shown that machine-learning algorithms have been useful in identifying key molecular signatures. Results: In this review, we first analyze how dysbiosis of the intestinal microbiota relates to human disease and how possible modulation of the gut microbial ecosystem may be used for disease intervention. Further, we introduce categories and the workflows of different machine-learning approaches and how they perform integrative analysis of multi-omics data. Last, we review advances of machine learning in gut microbiome applications and discuss challenges it faces. Conclusions: We conclude that machine learning is indeed well suited for analyzing gut microbiome and that these approaches are beneficial for developing gut microbe-targeted therapies, helping in achieving personalized and precision medicine.

Abdominal pain in the right iliac fossa in women may be caused by a complicated ovarian cyst, adnexitis, and appendicitis. The paper analyses the characteristics of patients with right iliac fossa pain admitted during the Covid-19 pandemic. A retrospective analysis on 25 cases with abdominal pain in the right iliac fossa admitted to “St. Apostol Andrei” Emergency County Clinical Hospital Constanta, Romania between March 2020 and March 2021 was performed. In 52% of the cases, the symptomatology remitted with antispasmodics, 4 (16%) patients had cystic torsion and right adnexectomy (group A, without adnexa), 6 (24%) patients had ruptured cysts and right cystectomy, and 2 (8%) had immediate cystectomy together with appendectomy due to signs of peritoneal irritation (group B, adnexa retained). The age, the signs and the symptoms, as well as the inpatient diagnosis in group A were lower compared to patients in group B. The ovarian cyst can become a major surgical emergency if twisted or ruptured and it reaches an important vascular source, especially if it is associated with acute appendicitis, which often poses problems of differential diagnosis. The collaboration between gynecologists and surgeons is essential in the optimal therapeutic solution of these cases.

Background: This is a prospective study. Atrophic vulvovaginitis (VVA), a prevalent condition resulting from estrogen deficiency after the menopause, is characterized by symptoms such as vaginal dryness, itching, burning, dyspareunia, and urinary discomfort. Standard treatment involves systemic estrogen replacement therapy (HRT) and localized estrogen treatments, such as estriol. However, many women with moderate-to-severe VVA may not fully benefit from estrogen therapy alone. Non-hormonal adjunctive treatments, such as pelvic floor exercises (e.g., Kegel exercises), are being explored to enhance clinical outcomes. Objectives: This study investigates the combined effect of local estriol therapy and Kegel exercises in improving VVA symptoms in postmenopausal women. Methods: Fifty postmenopausal women diagnosed with VVA were enrolled and divided into three severity groups: mild, moderate, and severe. All participants received estriol therapy (0.5 mg vaginal tablets daily for 10 days each month) for the first three months. Following this, Kegel exercises were introduced for an additional three-month period, alongside continued estriol therapy. Symptom improvement was evaluated after six months, with outcomes categorized as complete remission, partial remission, or no remission. Results: Significant improvements in symptom remission were observed, particularly in the moderate and severe groups. In the mild VVA group, 81.82% achieved complete remission with combined therapy compared to 68.18% with estriol alone. In the severe group, complete remission was observed in 40% of patients receiving combined therapy compared to 20% with estriol therapy alone. These findings suggest that Kegel exercises enhance the effectiveness of estriol by improving local blood circulation, which facilitates better estrogen absorption and distribution. Conclusions: The addition of Kegel exercises to local estriol therapy significantly improves symptom remission rates, especially in moderate and severe VVA cases. This approach offers a promising strategy for managing postmenopausal VVA, particularly in cases that do not fully respond to estrogen therapy alone.

Background: This study aimed to assess the feasibility of conducting a prospective study to evaluate histological changes in skin and muscle tissues after two weeks of balneotherapeutic intervention, as described in Romanian medical regulations. Methods: Thirty-five patients participated in this study, thirty of whom received balneotherapy (a cold mud ointment or a mud pack, or a mud bath, and/or a salted water bath) and five received hydrotherapy (the witness plot). Inclusion and exclusion criteria were applied. Twenty-four hours after discharge, a tegument and muscle biopsy were performed, and fragments were histologically prepared. Results: In the blade evidence analysis, the increased caliber and number of open capillaries and the presence of angiogenesis vessels were statistically significant (p = 0.001 < α = 0.05) for the cold mud ointment and mud pack compared with the witness and mud bath plots. The number of angiogenesis blood vessels was higher in the dermis (p < 0.05 *) with the mud pack plot and in the muscle with the mud cold ointment (p < 0.05). The histological study showed that two weeks of therapeutic intervention produced evidence-based proof in the dermis and muscle tissues, which was persistent at least twenty-four hours after the completion of the balneal course. The results encourage the team to continue the histological approach using modern techniques.