Background: Acute chest pain is a common cause for presentation to the emergency department (ED), where rapid identification of patients at high risk for acute coronary syndrome is essential. The HEART score combines medical history, electrocardiogram, age, risk factors, and troponin levels to provide structured risk stratification. However, evidence regarding the HEART score in COVID-19 survivors presenting with acute chest pain remains limited. This study examined the distribution of HEART scores and their associations with decisions made in the emergency department, hospital management, rises in cardiac troponin levels, coronary revascularization, and in-hospital mortality. Materials and Methods: In this single-center retrospective observational study, 400 consecutive adult COVID-19 survivors who presented to the ED with acute non-traumatic chest pain were included. HEART scores were retrospectively calculated from routinely available clinical and laboratory data, and patients were categorized as low (0–3), moderate (4–6), or high risk (7–10). Results: The median HEART score was 2 (IQR 0–5); 264 patients (66.0%) were classified as low risk, 50 (12.5%) as moderate risk and 86 (21.5%) as high risk. The distribution of the total score was bimodal, with 128 patients (32.0%) scoring zero and 78 (19.5%) scoring 8–10. Cardiac troponin was above the upper reference limit at presentation or at one hour in 96 patients (24.0%): 3 of 264 low-risk patients (1.1%), 7 of 50 moderate-risk patients (14.0%) and all 86 high-risk patients (100%). Eighty-three patients (20.8%) were admitted to hospital, almost all from the high-risk category (82 of 86, 95.3%), compared with 1 of 50 moderate-risk patients (2.0%) and no low-risk patient. All 51 revascularisation procedures (46 percutaneous coronary interventions and 5 coronary artery bypass grafts) and all five in-hospital deaths (1.2% of the cohort) occurred among high-risk patients. In an exploratory, hypothesis-generating multivariable analysis of troponin elevation, older age (adjusted odds ratio 2.38 per decade, 95% CI 1.88–3.09) and smoking (4.10, 2.12–8.06) were associated with elevation and female sex was inversely so (0.22, 0.11–0.41); renal function was not available for adjustment. Conclusions: HEART score categories were associated with ED disposition and in-hospital management in this retrospective cohort of COVID-19 survivors presenting with acute chest pain. High-risk patients accounted for nearly all hospital admissions, coronary revascularizations, and in-hospital deaths. However, systematic post-discharge follow-up was not available; therefore, 30-day or 6-week MACE could not be assessed, and the prognostic performance of the HEART score or the safety of HEART-based discharge cannot be determined. These findings should therefore be interpreted as descriptive associations reflecting real-world clinical practice and warrant confirmation in prospective studies with systematic follow-up.

Background and Objectives: Sepsis-associated organ dysfunction is accompanied by complex inflammatory, metabolic, hematological, and renal alterations. However, the relationships between routinely available biomarkers and organ dysfunction remain incompletely characterized across different clinical populations. This study aimed to investigate baseline and longitudinal biomarker–organ dysfunction associations in two independent neonatal and adult sepsis cohorts recruited from different hospitals. Cross-cohort observations were intended to be descriptive, without attributing differences to age-related biological mechanisms. Materials and Methods: This exploratory, retrospective, two-center observational study included 120 neonates and 120 adults with sepsis who were consecutively identified between January 2021 and December 2025. Organ dysfunction was assessed using the neonatal Sequential Organ Failure Assessment (nSOFA) score in neonates and the Sequential Organ Failure Assessment (SOFA) score in adults. Baseline and longitudinal associations involving C-reactive protein, lactate, leukocyte subsets, neutrophil-to-lymphocyte ratio (NLR), platelet count, and creatinine were evaluated separately within each cohort using unadjusted Spearman’s rank correlations. Longitudinal changes were assessed from baseline to day 3 in neonates and from admission to 48 h in adults. Results: In unadjusted analyses, baseline creatinine was positively associated with organ dysfunction in neonates and adults, while platelet counts were inversely associated with nSOFA and SOFA. After adjustment for gestational and postnatal age, neonatal creatinine and lactate remained associated with nSOFA, whereas platelet count did not. After adjustment for CKD, adult creatinine and NLR remained associated with SOFA, whereas platelet count did not. In longitudinal analyses adjusted for baseline severity and baseline biomarker value, only the neonatal Δlactate–ΔnSOFA association remained below the FDR threshold in the adjusted longitudinal analyses. Conclusions: Several principal baseline associations persisted after targeted covariate adjustment, but the platelet associations did not. Only the neonatal lactate–nSOFA association remained statistically significant in adjusted longitudinal analyses. The remaining reported associations are unadjusted and should not be interpreted as causal or as evidence of independent prognostic value.

Background/Objectives: Romania reports among the highest rates of carbapenem-resistant Gram-negative bacteria in the European Union, but patient-level data on healthcare-associated infections (HAIs) are scarce. We characterised carbapenem resistance, in-hospital outcomes, and carbapenem prescribing in a 24-month HAI cohort. Methods: This was a retrospective study of 315 patients with microbiologically confirmed HAI (2024–2025) at a tertiary infectious diseases hospital, contributing 243 Gram-negative isolates. Carbapenem resistance was determined by the hospital laboratory; extensively drug-resistant (XDR) status, defined as susceptibility to no more than two of the antimicrobial classes tested, was assigned under the hospital surveillance protocol. Risk-factor analysis was exploratory. Results: Of 243 Gram-negative isolates, 162 (66.7%) were carbapenem-resistant and 150 of these (92.6%) were designated XDR. Resistance reached 90.6% in Klebsiella pneumoniae and 83.0% in Acinetobacter baumannii, against 33.3% in Pseudomonas aeruginosa and 0% in Escherichia coli, and occurred at every infection site. No routinely recorded characteristic distinguished resistant from susceptible infection after adjustment (area under the curve 0.62). In-hospital death was associated with intensive care transfer (adjusted odds ratio 6.92, 95% confidence interval 3.33–14.38) but not with carbapenem resistance (1.14, 0.52–2.50). Of 92 carbapenem recipients, 54 (58.7%) had a carbapenem-resistant isolate, against which carbapenems are inactive, and 12 (13.0%) had a Gram-negative isolate that was neither carbapenem-resistant nor extended-spectrum β-lactamase-producing. Conclusions: At this centre, carbapenem resistance in Gram-negative HAI is endemic, could not be predicted from the routinely recorded characteristics examined, and exceeds European surveillance figures only among the Enterobacterales. No independent association with mortality was detected, although the susceptible comparison group was small. The XDR proportion was assigned under the hospital surveillance protocol and is not directly comparable with category-based estimates. Because antibiotic exposure was recorded without timing relative to culture sampling, these data support prospective audit of carbapenem prescribing rather than demonstrating missed de-escalation.

Background/Objectives: Distinguishing perforated from non-perforated appendicitis preoperatively is difficult, and routine scores diagnose appendicitis rather than grade severity. We examined whether two inflammatory markers and one sonographic sign, combined in a model, discriminate between perforated and non-perforated appendicitis, and how this compares with a bedside score. Methods: Retrospective single-center cohort of 142 children aged 3–17 years undergoing initially attempted laparoscopic appendectomy (October 2022–December 2023). Log-transformed neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) were prespecified; sonographic free peritoneal fluid was selected from four signs using the outcome, and reported in-sample performance is an upper bound. Predictors were fitted by Firth penalized logistic regression with bootstrap validation. Results: Perforation occurred in 27 patients (19.0%). All three were independent predictors (odds ratios: CRP 2.583, NLR 3.045, free peritoneal fluid 3.638). The area under the curve was 0.900 (0.890 optimism-corrected). At the Youden-optimal threshold, sensitivity was 96.3% and negative predictive value 98.9%. The Pediatric Appendicitis Score reached 0.855 (difference not significant, p = 0.375); at matched sensitivity its specificity was 38.9% versus 74.8%. Conclusions: The model’s potential value lies in excluding perforation rather than establishing it, and applies after the decision to operate has been taken, informing antibiotic selection, operative urgency and family counselling rather than the indication for surgery. Overall discrimination did not differ significantly from the Pediatric Appendicitis Score, the advantage lying in the operating point rather than in the area under the curve. These findings are hypothesis-generating and require external validation.

Background: An age of 45 years is often used to guide endometrial assessment in abnormal uterine bleeding (AUB), but age is only one component of clinical risk. We described the relationship between age and histopathological yield among premenopausal women who had undergone endometrial sampling. Methods: This single-centre retrospective cross-sectional study analysed the index sampling episodes of 824 women with AUB documented as premenopausal or perimenopausal (January 2022–May 2026). The clinically more consequential endpoint was endometrial intraepithelial neoplasia (EIN)/atypical hyperplasia or carcinoma; the primary statistical outcome was a broader composite that also included hyperplasia without atypia. Modified Poisson regression estimated the adjusted association between age ≥45 years and the primary outcome. Discrimination of age alone and of an exploratory model using variables available before biopsy was compared in 776 complete cases with bootstrap internal validation. Results: EIN/carcinoma occurred in 4/361 (1.1%) women aged <45 years and 25/463 (5.4%) aged ≥45 years (crude RR 4.87, 95% CI 1.71–13.88). The broad outcome occurred in 24/361 (6.6%) and 57/463 (12.3%), respectively (absolute difference 5.7 percentage points, 95% CI 1.6–9.6; adjusted RR 1.62, 95% CI 1.01–2.61; p = 0.047). Results were similar across sensitivity analyses (adjusted RRs 1.52–1.68). With age coded as ≥45 years in both models, the optimism-corrected AUC was 0.686 for the exploratory pre-biopsy model and 0.575 for age alone (difference 0.111, 95% CI 0.060–0.196). Conclusions: Among premenopausal women selected for endometrial sampling, histopathological yield increased with age, and most EIN/carcinoma cases occurred at age ≥45 years, but the adjusted association for the broad outcome was imprecise, and age alone had limited discrimination. Model performance was assessed only internally and only in sampled women; this study cannot establish a biopsy rule for all women with AUB because women not sampled were not observed.

Background: Biostatistical competence is essential to evidence-based clinical reasoning, yet biostatistics is often taught as a stand-alone course. This scoping review mapped how biostatistics is taught and assessed in medical and health professions education and when learning outcomes are measured relative to instruction. Methods: Following JBI methodology and PRISMA-ScR, we searched PubMed, Web of Science, and Scopus for English-language studies published from 2015 onward (final search 2 October 2026) and charted instructional approaches, digital tools, assessment instruments, and the timing of outcome measurement. Results: Eighty-six studies were included, with 45 of them in medicine. Non-randomized controlled (21) and cross-sectional (20) designs predominated, and most studies measured end-of-course performance, perceptions, or attitudes with locally developed instruments. Of 15 controlled digital versus non-digital comparisons, 7 reported results favoring the digital format, and 6 reported no statistically significant difference. These comparisons were not critically appraised. Nine studies measured an outcome after instruction ended, mostly within three months. Only four reassessed the same learners, and no study followed learners into clinical practice. Conclusions: Biostatistics is taught and examined extensively, but the included studies rarely measured retention, and none assessed application in clinical practice. Validated measures of applied statistical reasoning and longitudinal designs are needed.