Background: Emergency medicine in Romania has developed fast since inception. The need for faster diagnostic capabilities due to the high workload pre- and in-hospital made point-of-care ultrasound (POCUS) a logical next step. The advantages of POCUS are well known, but implementation presents challenges. Our goal was to study how a straightforward method of implementation would work locally. Methods: Two prospective observational studies were conducted at 6 months (prehospital) and 4 months (in-hospital). The protocol used was extended focused assessment sonography in trauma (eFAST), and the shock index (SI) was used to stratify patients. Voluntary sampling was conducted by emergency physicians. The primary outcomes were patient numbers, type of case use, results, and accuracy. Results: The prehospital study registered 34 patients: 41% traumas, 35% cardiac arrest, 18% shock, and 6% acute respiratory distress. The in-hospital study patients were 78: 36% traumas, 6% cardiac arrests, 41% shock, and 17% acute respiratory distress. A total of 88.5% of the cases were confirmed with definitive imagistic findings. Conclusion: The studies mark an increase in POCUS usage and use in complicated cases. Providing supervision and feedback into clinical practice resulted in a further increase in POCUS usage, the second study having an 88.5% accuracy when compared to the final diagnostic proving the increased efficiency of a longitudinal training approach.

Background and Objectives: The incidence and prevalence of cancers are increasing worldwide, with special emphasis placed on prevention, early detection, and the development of new therapeutic strategies that strongly impact patient outcomes. Limited data are available about emergency care’s role in treating patients with cancer. This study aims to determine the burden of end-stage and first-time diagnosis of cancer on emergency care in a high-turnover emergency care center. Materials and Methods: A retrospective observational study was conducted to identify patients requesting emergent aid for cancer-related symptoms in the Emergency Department of “St. Spiridon” Hospital from Iasi (Romania) between 1 October 2022 and 30 September 2023. The proportion and demographic characteristics of end-stage patients and those who received a first-time diagnosis during the emergency visit were evaluated. Risk analysis was performed to understand these patients’ care needs (such as medical care, surgical care, specialty consults, intensive care, ward admission, and other hospital transfers) and immediate care outcomes (such as in-hospital mortality and home discharge). Results: 2318 patients with cancer requested emergent care (patient presentation rate of 3.08%), of which 444 (19.15%) were diagnosed for the first time, and 616 (26.57%) were at the end-stage. First-time diagnosed patients had a significantly different distribution of cancer types (p < 0.001), were more likely to need any form of medical care, to require a specialty consultation, or to be admitted to a ward (OR 2.65, 95% CI: 2.12–3.32; p < 0.001; OR 3.28, 95% CI: 2.48–4.35, p < 0.001; OR 2.09, 95% CI: 1.70–2.59; p < 0.001, respectively) but were less severe, while end-stage patients were more likely to address repeatedly to the emergency room (OR 1.86, 95% CI: 1.32–2.59; p = 0.001) and had higher odds of needing intensive care, assisted ventilation and death (OR-4.63, 95% CI: 1.10–19.45, p = 0.04; OR 2.59, 95% CI: 1.57–4.28; p < 0.001, and OR 4.06, 95% CI: 1.73–9.54; p = 0.001, respectively). Conclusions: The emergency department often carries the weight of diagnosing patients with cancer and treating patients with end-stage disease. These data highlight the importance of prehospital care, particularly for cancer screening and palliative care, and the importance of fostering multidisciplinary collaboration in the emergency room with oncologists, geriatricians, and palliative care specialists to improve patient outcomes.

Background: Out-of-hospital cardiac arrest (OHCA) remains a major public health challenge in Romania. Although trained first-responder systems have improved prehospital response in other European settings, Romania lacks a structured national framework. This study assessed the knowledge, attitudes, perceived preparedness, and willingness of Inspectorate for Emergency Situations (ISU) personnel to participate as community first responders outside working hours. Methods: A national cross-sectional survey was conducted using a structured online questionnaire distributed to operational ISU personnel. The final sample included 1537 participants from five professional categories: firefighter officers with paramedic training, firefighter sub-officers with paramedic training, firefighter officers, firefighter sub-officers, and other personnel. Multivariable binary logistic regression was used to identify factors associated with high enthusiasm and desire for additional training. Results: More than 70% of respondents supported the integration of firefighter-paramedics into a community first-responder system, and over 75% expressed willingness to participate. Significant differences were observed between professional categories in demographic, professional, and first responder-related variables. In multivariable analysis, firefighter officers with and without paramedic training, as well as other personnel, had higher odds of high enthusiasm compared with firefighter sub-officers without paramedic training. Desire for additional training was independently associated with female sex and firefighter officer status, with or without paramedic training. Conclusions: Romanian ISU personnel showed favorable self-reported attitudes and high willingness to participate in a structured OHCA first-responder system. However, these findings reflect perceived motivation rather than operational feasibility, competence, or improved patient outcomes. Implementation would require standardized training, legal clarification, dispatch integration, adequate AED access, supervision, audit systems, and prospective evaluation using patient-level OHCA outcomes.

Background/Objectives: Obstructive ureterolithiasis complicated by infection may progress rapidly to systemic deterioration, while microbiological confirmation is generally unavailable during initial assessment. This study evaluated the association of admission procalcitonin (PCT), National Early Warning Score 2 (NEWS2), and routine urinary parameters with positive upper urinary tract culture in patients requiring urgent urinary decompression. Methods: This retrospective single-center observational study included 240 adults admitted with obstructive ureterolithiasis who underwent upper urinary tract decompression by ureteral stenting or percutaneous nephrostomy. Demographic, clinical, laboratory, and urinary parameters obtained at admission were compared according to upper urinary tract culture status. Factors associated with culture positivity were assessed using univariable and multivariable logistic regression. Four clinically defined models were compared: a reference model containing WBC, CRP, urinary nitrites, and proteinuria; models separately adding PCT or NEWS2; and a complete model containing both. Discrimination was compared using AUCs and the DeLong test, while model fit was assessed using likelihood-ratio tests. Internal validation was performed using 1000 bootstrap resamples. Results: Positive upper urinary tract cultures were identified in 86 patients (35.8%). In the complete model, PCT per doubling (aOR 1.820; 95% CI 1.502–2.205; p < 0.001) and NEWS2 (aOR 1.167; 95% CI 1.014–1.344; p = 0.031) remained independently associated with culture positivity. The reference model had an AUC of 0.691. Adding PCT increased the AUC to 0.831 (ΔAUC 0.140; p < 0.001), whereas adding NEWS2 alone resulted in an AUC of 0.720 (ΔAUC 0.029; p = 0.085). The complete model achieved an apparent AUC of 0.839 and an optimism-corrected AUC of 0.821. After PCT was included, NEWS2 improved overall model fit (p = 0.029) and produced an additional increase in AUC (ΔAUC 0.007; p = 0.448). Conclusions: Admission PCT and NEWS2 were independently associated with positive upper urinary tract culture The combined model showed good discrimination, although external validation is required before clinical application. Urinary nitrite positivity retained an independent association only in the exploratory cut-off-based analysis.

(1) Background: Pesticide poisoning is an inherent risk associated with the widespread use of pesticides in agriculture, and treatment largely depends on the type of pesticide involved. Thus, this retrospective study aimed to evaluate the clinical manifestation, symptoms associated, and treatment administered to patients with acute pesticide poisoning admitted to the Emergency Department of “Sf. Spiridon” Clinical Emergency Hospital in Iasi, Romania, and to investigate potential associations between pesticide type, clinical status and therapeutic management. (2) Methods: A sample of 46 patients presenting in the emergency unit with pesticide poisoning was assessed regarding clinical presentation and treatment received. (3) Results: Most poisoning cases were caused by insecticides (78.3%), followed by herbicides (21.7%). The predominant route of exposure was through ingestion (47.8%), followed by inhalation (21.7%). Gastrointestinal symptoms were the most frequent across all patients, while neurologic symptoms were frequent across the insecticide group. The median number of medications or procedures administered per patient was 3.0 in the insecticide group and 4.5 in the herbicide group. A non-significant trend toward more intensive treatment was observed in herbicide poisoning. Significant differences were found in the use of corticosteroids and calcium, with higher usage among herbicide patients. (4) Conclusions: These results reflect the heterogeneity of the clinical presentation depending on the pesticide, showcasing the need for individualised therapeutic approaches.

Background: Nephrolithiasis frequently coexists with type 2 diabetes, obesity, gout, chronic kidney disease, and other cardiometabolic disorders. Sodium–glucose cotransporter 2 (SGLT2) inhibitors may influence stone formation through effects on glucosuria, natriuresis, urine volume, urinary citrate, pH, urate handling, and relative supersaturation. This review aimed to examine the current mechanistic, biochemical, and clinical evidence linking SGLT2 inhibition to nephrolithiasis, with particular attention to its relevance for urological practice. Methods: A clinically oriented narrative review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. The final search was performed on 1 July 2026. A total of 15 studies were included. Randomised trials, pooled and post hoc analyses, observational and comparative-effectiveness studies, meta-analyses, human mechanistic studies, and relevant experimental investigations were considered. Evidence was synthesised narratively according to biological mechanisms, urinary chemistry and relative supersaturation, randomised evidence, and observational clinical outcomes. Clinical stone events were analysed separately from surrogate urinary endpoints. Results: SGLT2 inhibition is associated with reproducible increases in urinary citrate and variable effects on urine volume, urinary pH, and the excretion of calcium, phosphate, and urate. Short-term mechanistic studies suggest reductions in calcium phosphate supersaturation and, in selected uric acid stone formers, uric acid supersaturation, whereas effects on calcium oxalate supersaturation remain inconsistent. Observational studies and secondary analyses of randomised trials generally indicate fewer nephrolithiasis events among SGLT2 inhibitor users; however, most outcomes were based on adverse-event reporting or administrative codes and lacked stone composition, standardised imaging, urinary phenotyping, and recurrence adjudication. Conclusions: SGLT2 inhibitors may favourably modify selected lithogenic pathways, but their effects appear phenotype-dependent and have not yet been shown to directly prevent stone recurrence. They should not be initiated solely for the prevention of nephrolithiasis. In patients with established cardiovascular, renal, or metabolic indications, their potential urinary effects may represent an additional benefit. Dedicated long-term randomised studies with stone-specific endpoints are required.