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.

Asthma is a prevalent chronic disease, contributing significantly to the global burden of disease and economic costs. Despite advances in treatment, inadequate disease management and reliance on reliever medications lead to preventable deaths. Telemedicine, defined as the use of information and communication technology to improve healthcare access, has gained global attention, especially during the COVID-19 pandemic. This systematic review examines the effectiveness of home monitoring systems in managing severe asthma. A systematic literature search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library, focusing on studies from 2014 to 2024. Fourteen studies involving 9093 patients were analyzed. The results indicate that telemedicine, through tools such as mobile applications and portable spirometers, positively impacts asthma control, self-management, and quality of life. Home spirometry, in particular, shows strong agreement with clinic spirometry, offering a feasible alternative for continuous monitoring. Digital coaching and machine learning-based telemedicine applications also demonstrate significant potential in improving asthma outcomes. However, challenges such as technology accessibility, data privacy, and the need for standardized protocols remain. This review highlights the promise of telemedicine in asthma management and calls for further research to optimize its implementation and address existing barriers.

Background/Objectives: Obstructive sleep apnea (OSA) is a highly prevalent disorder that significantly impacts quality of life and daily functioning. While continuous positive airway pressure (CPAP) therapy is effective, long-term adherence remains a challenge. This single-arm observational study aimed to evaluate clinical outcomes and adherence patterns during telemedicine-supported CPAP therapy and identify distinct phenotypic response clusters in Romanian patients with OSA. Methods: This prospective observational study included 86 adults diagnosed with OSA, treated with ResMed Auto CPAP devices at “Victor Babeș” University Hospital in Timișoara, Romania. All patients were remotely monitored via the AirView™ platform and received monthly telephone interventions to promote adherence when necessary. Clinical outcomes were assessed through objective telemonitoring data. K-means clustering and t-distributed stochastic neighbor embedding (t-SNE) were employed to explore phenotypic response patterns. Results: During telemedicine-supported CPAP therapy, significant clinical improvements were observed. The apnea–hypopnea index (AHI) decreased from 42.0 ± 21.1 to 1.9 ± 1.3 events/hour. CPAP adherence improved from 75.5% to 90.5% over six months. Average daily usage increased from 348.4 ± 85.8 to 384.2 ± 65.2 min. However, post hoc analysis revealed significant concerns about the validity of self-reported psychological improvements. Self-esteem changes showed negligible correlation with objective clinical measures (r < 0.2, all p > 0.1), with only 3.3% of variance being explained by measurable therapeutic factors (R² = 0.033). Clustering analysis identified four distinct adherence and outcome profiles, yet paradoxically, patients with lower adherence showed greater self-esteem improvements, contradicting therapeutic causation. Conclusions: Telemedicine-supported CPAP therapy with structured monthly interventions was associated with substantial clinical improvements, including excellent AHI reduction (22-fold) and high adherence rates (+15% after 6 months). Data-driven phenotyping successfully identified distinct patient response profiles, supporting personalized management approaches. However, the single-arm design prevents definitive attribution of improvements to telemonitoring versus natural adaptation or placebo effects. Self-reported psychological outcomes showed concerning patterns suggesting predominant placebo responses rather than therapeutic benefits. While the overall findings demonstrate the potential value of structured telemonitoring for objective CPAP outcomes, controlled trials are essential to establishing true therapeutic efficacy and distinguishing intervention effects from measurement bias.

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.

Background: Pleural infection remains associated with substantial morbidity, mortality, and frequent treatment escalation. This systematic review and meta-analysis evaluated routinely available prognostic factors associated with adverse clinical outcomes in adults with pleural infection, including complicated parapneumonic effusion and pleural empyema. Methods: PubMed, Scopus, Web of Science Core Collection, and the Cochrane Library were searched from inception to 6 July 2026. Studies evaluating routinely available clinical, biochemical, microbiological, pleural fluid, radiological, or composite prognostic factors were included. Methodological quality was assessed using the Newcastle–Ottawa Scale (NOS). Comparable data were synthesized using random-effects meta-analysis. Results: Thirty studies involving 8443 participants were included. The evaluated outcomes comprised treatment failure, short-term mortality, need for surgery, intensive care unit admission, recurrence, readmission, and length of hospital stay. Five studies (877 participants) contributed to the RAPID score meta-analysis. High-risk RAPID classification was associated with greater short-term mortality than combined low- and intermediate-risk classification (RR 4.52, 95% CI 2.71–7.55; primary OR 6.09, 95% CI 3.25–11.38; I² = 0% for the OR analysis). In a limited meta-analysis of three studies (1239 participants), each 10-year increase in age was associated with higher odds of short-term mortality (OR 1.54, 95% CI 1.02–2.30; I² = 30.4%); however, mortality was assessed in hospital in two studies and at 90 days in one study. Additional prognostic factors associated with adverse outcomes included comorbidity burden, renal dysfunction, hypoalbuminemia, serial C-reactive protein trajectories, bacteremia, pleural fluid biochemical markers, pleural thickening, loculation, and delayed or ineffective drainage, although heterogeneous reporting precluded further quantitative synthesis. Conclusions: The RAPID score is the most consistently supported routinely available predictor of short-term mortality in adults with pleural infection. Increasing age may also be prognostic, but its pooled estimate is based on only three studies with different mortality windows and should be interpreted cautiously. Future prospective multicenter studies using standardized outcome definitions are needed to validate additional prognostic markers and improve risk-guided clinical decision-making.