Background and Objectives: Suspected bacterial infection is one of the leading presentations to the Emergency Department (ED) and is still associated with considerable morbidity and mortality. There is increasing evidence that biological sex may influence host immune responses, disease manifestations, therapeutic requirements, and clinical outcomes in infectious diseases. However, sex-specific differences among patients clinically managed for suspected bacterial infection in ED remain incompletely defined. This study, therefore, aimed to assess demographic characteristics, clinical presentation, and clinical management as well as short-term outcomes related to sex among these patients. Materials and Methods: This retrospective single-center observational study included consecutive adults presenting with suspected bacterial infection to the ED between 1 June and 31 August 2025. Demographic, clinical, laboratory, treatment, infection-source, and outcome data were extracted from medical records. Between-group comparisons were followed by planned age-adjusted analyses and multivariable logistic regression. Results: A total of 213 patients were included, comprising 100 women (46.9%) and 113 men (53.1%). Women were older than men (median 77.0 vs. 67.0 years, p < 0.001), had lower diastolic blood pressure (70 vs. 75 mmHg, p = 0.004), and lower hemoglobin concentrations (11.79 vs. 12.45 g/dL, p = 0.004). Cardiovascular disease was more frequent among women than men (72.0% vs. 52.2%, p = 0.003), although this difference was attenuated and no longer significant after adjustment for age. A documented urinary source of infection was more frequent among women (51.0% vs. 34.5%, p = 0.015) and remained significantly associated with female sex after age adjustment (OR 2.14, 95% CI 1.20–3.81, p = 0.010; Benjamini–Hochberg-adjusted p = 0.039). No significant difference was detected in Emergency Department treatment: supplemental oxygen, vasopressors and broad-spectrum antibiotics were given with similar frequency to women and men (all p ≥ 0.139). Direct intensive care unit (ICU) admission from the ED occurred in 14 of 100 women (14.0%) and 21 of 113 men (18.6%; OR 0.71, 95% CI 0.34–1.49), and in-hospital mortality in 7 women (7.0%) and 9 men (8.0%; OR 0.87, 95% CI 0.31–2.43). After adjustment, female sex was not independently associated with direct ICU admission (OR 0.64, 95% CI 0.29–1.39; p = 0.257) or in-hospital mortality (OR 0.80, 95% CI 0.27–2.35; p = 0.690). Conclusions: In this single-center retrospective cohort of adults clinically managed for suspected bacterial infection in the emergency department, women were older and more frequently had a documented urinary source of infection. After adjustment for age, female sex remained associated with a documented urinary source of infection. The study did not provide precise evidence that sex was independently associated with direct ICU admission or in-hospital mortality; however, the confidence intervals were wide and clinically relevant differences cannot be excluded. Larger prospective multicenter studies with standardized diagnostic criteria, microbiological confirmation, and adequate outcome-event numbers are needed.

Intrauterine contraception has changed over the past decade through longer validated duration, lower-dose hormonal devices, redesigned copper devices, new indications, and better safety surveillance. This targeted scoping review (OSF registration 10.17605/OSF.IO/3GUQF) mapped English-language primary human studies published from 1 January 2016 to 5 September 2026 in journals indexed in the Science Citation Index Expanded (SCIE). A reproducible search targeted to the major device programs, randomized trials, and large surveillance cohorts identified 766 PubMed/MEDLINE records, with no additional unique records from Scopus or Web of Science; of the 624 unique records screened, 123 reports were assessed, and 114, from 66 distinct trials, cohorts, or data sources, were included and appraised with design-specific Joanna Briggs Institute (JBI) tools. Two single-arm programs and a 7-year randomized trial supported the efficacy of 52 mg levonorgestrel intrauterine devices (LNG-IUDs) through 8 years. Lower-dose LNG-IUDs eased placement but were associated with higher ectopic pregnancy rates in four Scandinavian analyses and with less antidepressant use than the 52 mg device. Smaller or size-matched copper devices improved continuation and reduced expulsion in randomized comparisons, whereas a low-copper nitinol device had a higher 5-year pregnancy rate than expected with TCu380A. Perforation was uncommon but more frequent after postpartum insertion and during breastfeeding; immediate postpartum insertion carried the highest expulsion risk. One randomized trial and its secondary analyses supported the 52 mg LNG-IUD for emergency contraception. Therapeutic evidence was strongest for heavy menstrual bleeding and endometrial hyperplasia, whereas intrauterine ball and precious metal designs showed no consistent benefit. Progress refined rather than replaced the T-shaped IUD.

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.

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.