Chronic wounds, such as diabetic foot ulcers, pressure sores, and venous leg ulcers, represent a significant and growing challenge for global healthcare systems—not only due to their clinical complexity but also because of their profound economic implications. This paper investigates the direct and indirect costs associated with chronic wound management, emphasizing the disproportionate resource burden they place on health services, particularly in aging populations and individuals with comorbidities. By integrating global statistics with focused case studies from Romania, the analysis reveals that while wound dressings comprise a small portion of care expenses, the majority of costs stem from hospital stays, nursing care, and treatment of infections. The paper further explores the societal costs of productivity loss and welfare dependence, especially in low- and middle-income countries. Additionally, it examines the role of modern wound therapies—such as negative pressure systems and antimicrobial dressings—as well as AI-driven tools in improving clinical outcomes and enabling cost-effective care delivery. The Romanian healthcare context is analyzed as a case study to illustrate disparities in cost allocation and access to advanced treatments. Policy recommendations underscore the importance of early intervention, multidisciplinary management, and adoption of emerging technologies to ensure sustainable and equitable care models for chronic wound patients globally.

Colorectal cancer (CRC) remains a major global health burden, necessitating continuous advancements in diagnostic methodologies. Traditional screening techniques, including barium enema and fecal occult blood tests, have been progressively replaced by more precise modalities, such as colonoscopy, liquid biopsy, and artificial intelligence (AI)-assisted imaging. Objective: This review explores the evolution of CRC diagnostic tools, from conventional imaging methods to cutting-edge AI-driven approaches, emphasizing their clinical utility, cost-effectiveness, and integration into multidisciplinary healthcare settings. Methods: A comprehensive literature search was conducted using the PubMed, Medline, and Scopus databases, selecting studies that evaluate various CRC diagnostic tools, including endoscopic advancements, liquid biopsy applications, and AI-assisted imaging techniques. Key inclusion criteria include studies on diagnostic accuracy, sensitivity, specificity, clinical outcomes, and economic feasibility. Results: AI-assisted colonoscopy has demonstrated superior adenoma detection rates (ADR), reduced interobserver variability, and enhanced real-time lesion classification, offering a cost-effective alternative to liquid biopsy, particularly in high-volume healthcare institutions. While liquid biopsy provides a non-invasive means of molecular profiling, it remains cost-intensive and requires frequent testing, making it more suitable for post-treatment surveillance and high-risk patient monitoring. Conclusions: The future of CRC diagnostics lies in a hybrid model, leveraging AI-assisted endoscopic precision with molecular insights from liquid biopsy. This integration is expected to revolutionize early detection, risk stratification, and personalized treatment approaches, ultimately improving patient outcomes and healthcare efficiency.

The gallbladder pathology is mainly represented by cholelithiasis, treated with cholecystectomy, one of the most commonly performed surgical procedures, continues to raise some challenges. Despite the advancements in surgical techniques, especially in those patients presenting some particularities, such as cirrhotic patients or those with sclero-atrophic or acute gangrenous cholecystitis, difficulties continue to arise. This review, including an evaluation of the literature from the last 20 years, aims to explore the pathophysiological mechanisms and surgical approaches for these high-risk conditions. Emphasis is placed on tailoring management strategies in order to reduce complications and improve outcomes, offering insights for optimizing care in difficult cholecystectomies.

Background: Anastomotic leakage (AL) remains one of the most feared complications after colorectal surgery. This study aimed to identify preoperative risk factors for AL using a five-year dataset from two Romanian surgical clinics. Materials and Methods: A retrospective cohort of 155 patients undergoing colorectal resection with primary anastomosis (105 from “Colentina” Hospital and 50 from “Dr. I. Cantacuzino” Hospital) was analyzed. Preoperative demographic, clinical, and laboratory data were extracted and assessed using univariate and multivariable logistic regression. Statistical analyses were performed using IBM SPSS. Results: The overall AL rate was 10.3%. Multivariable analysis identified high ASA class (OR 17.6; p = 0.001), emergency surgery (OR 32.2; p = 0.0007), and heavy alcohol use (OR 15.3; p = 0.004) as independent predictors of leakage. While low preoperative albumin and smoking were associated with leakage in a bivariate analysis, these did not remain significant after adjustment. Notably, all laboratory markers were based on preoperative values, distinguishing our approach from prior studies that commonly evaluated postoperative biomarkers. No statistically significant effect was found for neoadjuvant chemotherapy or radiotherapy after controlling for other covariates. Conclusions: High ASA score, alcohol abuse, and emergency surgery were the strongest independent predictors of AL in our cohort. The lack of predictive power of certain widely reported factors, such as low albumin, may reflect our dataset’s focus on preoperative optimization. These findings support the use of individualized risk assessment and reinforce the role of preoperative preparation in reducing leak incidence in colorectal surgery.

Objectives: Acute obstructive pyelonephritis (AOP) is a urological emergency that combines bacterial infection with upper urinary tract obstruction. This retrospective study focuses on the microbial etiology and causes of obstruction, clinical manifestations, antibacterial therapy, drainage type, and outcomes in patients diagnosed with AOP at a tertiary urology center between 1 January 2020 and 30 December 2024. Methods: One hundred patients with a mean age of 61.30 years were included in this retrospective study, which examines demographic data, comorbidities, clinical features, pathogens involved, antimicrobial regimens, and hospital outcomes. Results: Urolithiasis was the most frequent cause of obstruction (62%), followed by ureteral stenosis (14%) and tumors (11%). AOPs were mainly produced by Escherichia coli (58%), followed by Klebsiella spp. (21%); 18% of all identified bacteria were ESBL-producing Gram-negative bacilli, and 29% were MDR bacteria. The most used IV antibiotics were fluoroquinolones (52%), followed by cephalosporins (19%) and carbapenems (18%). Carbapenems were administered to all patients with AOP caused by ESBL-producing pathogens and to 62% of those with MDR bacteria. The duration of antibiotic therapy was individualized based on clinical response. Switch to oral administration was made after 4.3 ± 1.5 days, and the antibiotic treatment lasted 10.8 ± 3.2 days. Conclusions: The results of the present study support integrating evidence-based guidelines with regional patterns of bacterial susceptibility to optimize therapeutic approaches and reduce severe outcomes in patients with AOP, most of whom have multiple comorbidities.

Background: Anastomotic leakage (AL) remains one of the most feared complications after colorectal surgery. This study aims to identify preoperative risk factors for AL using a five-year dataset from two Romanian surgical clinics. Matherial and Methods: A retrospective cohort of 155 patients undergoing colorectal resection with primary anastomosis (105 from “Colentina” Hospital and 50 from “Dr. I. Cantacuzino” Hospi-tal) was analyzed. Preoperative demographic, clinical, and laboratory data were ex-tracted and assessed using univariate and multivariable logistic regression. Statistical analyses were performed using IBM SPSS. Results: The overall AL rate was 10.3%. Multivariable analysis identified high ASA class (OR 17.6; p = 0.001), emergency sur-gery (OR 32.2; p = 0.0007), and heavy alcohol use (OR 15.3; p = 0.004) as independent predictors of leakage. While low preoperative albumin and smoking were associated with leakage in bivariate analysis, these did not remain significant after adjustment. Notably, all laboratory markers were based on preoperative values, distinguishing our approach from prior studies that commonly evaluate postoperative biomarkers. No statistically significant effect was found for neoadjuvant chemotherapy or radiother-apy after controlling for other covariates. Conclusions: High ASA score, alcohol abuse, and emergency surgery were the strongest independent predictors of AL in our cohort. The lack of predictive power of certain widely reported factors, such as low albumin, may reflect our dataset’s focus on preoperative optimization. These findings support the use of individualized risk assessment and reinforce the role of preoperative prepa-ration in reducing leak incidence in colorectal surgery.