(1) Background: Severe COVID-19 frequently leads to intensive care unit-acquired weakness (ICU-AW), a complex neuromuscular syndrome that may result in enduring disability, delayed functional recovery, and extended mechanical ventilation. Conventional clinical assessment tools capture only a limited scope of this multifactorial condition and often fail to accurately depict the nonlinear dynamics of physiological deterioration and recovery observed in critically ill patients. (2) Methods: This study presents an integrative framework that combines Physical and Rehabilitation Medicine (PRM) with analytical tools derived from nonlinear dynamics and fractal physiology. A prospective observational design and a long-term clinical evaluation were used along with nonlinear signal analysis. Fractal complexity metrics, including Higuchi fractal dimension (HFD) and detrended fluctuation analysis (DFA), were utilized to characterize the dynamics of neuromuscular and cardiorespiratory signals during rehabilitation. Clinical outcomes included the Medical Research Council (MRC) muscle strength score, the Functional Status Score for the ICU (FSS-ICU), and measures of respiratory performance. (3) Results: Early PRM intervention was associated with a consistent increase in neuromuscular strength, functional mobility, and respiratory muscle performance. Fractal analysis showed that physiological complexity was restored at the same time, as shown by large increases in HFD and DFA values. The recovery paths were not linear, and clustering analysis identified three distinct recovery phenotypes. (4) Conclusions: The integration of fractal biomarkers and nonlinear modeling into ICU rehabilitation may enable early risk stratification, improve the monitoring of functional recovery, and strengthen personalized rehabilitation strategies for patients with ICU-acquired weakness following severe COVID-19.
Background: Behavioral addictions (BAs), including gambling disorder, gaming disorder, problematic pornography use, compulsive sexual behavior, and problematic internet use, have received increasing attention because of their potential impact on mental health, occupational functioning, and military readiness. Objectives: To identify military-specific risk factors, clinical and operational consequences, barriers to detection and treatment, and gaps in prevention strategies related to BAs among active-duty personnel and veterans, and to propose a framework for prevention and early intervention. Methods: A narrative evidence synthesis was conducted using studies evaluating BAs in military and veteran populations, and data were extracted regarding prevalence, risk factors, psychiatric comorbidities, functional outcomes, help-seeking barriers, and intervention approaches. Findings were analyzed thematically to identify common patterns across different BAs and to inform the development of a military-specific prevention framework. Results: Evidence consistently indicated that military personnel and veterans are at increased risk of confronting multiple vulnerability factors for BAs, including trauma exposure, deployment-related stress, social isolation, boredom, sleep disruption, risk- taking tendencies, and barriers to help-seeking. Gambling disorder and problematic gaming were the most extensively studied conditions and were associated with depression, anxiety, posttraumatic stress disorder, substance use disorders, suicidality, impaired occupational functioning, financial difficulties, and reduced operational readiness. Also, emerging evidence suggests similar associations for problematic pornography use, compulsive sexual behavior, and problematic internet use. Across studies, stigma, concerns about career repercussions, and limited awareness of available services represented important obstacles to treatment engagement. Conclusions: BAs represent an under-recognized challenge to military health and force readiness, while the available evidence supports implementing integrated prevention strategies that include routine screening, psychoeducation, commander training, confidential referral pathways, and early intervention programs. A comprehensive military-specific framework targeting behavioral addictions may improve individual well-being while reducing operational and organizational consequences.
Background. A novel framework to assess obesity and its complications involves the evaluation of fat-derived factors as potential biomarkers of the cardio-metabolic outcome and long-term management. In this exploratory study, we aimed to evaluate microarray-based circulating levels of adiponectin, adipsin, and AgRP in menopausal women with obesity. Methods. This is a pilot, bi-centric study according to a protocol based on Quantibody® Human Obesity Array 3 (RayBiotech, Norcross, GA, USA). Patients with obesity-associated complications (hypertension, diabetes, dyslipidaemia) were excluded. Results. In the study population (N = 24, median age of 60 years) adiponectin correlated with lipocalin-2 (r = 0.943, p = 0.0048) and plasminogen activation inhibitor-1 (r = 0.829, p = 0.0416). Adipsin correlated with inteleukin-8 (r = 0.786, p = 0.0362), and leptin (r = 0.832, p = 0.0008). Conclusion. Apparently healthy obese menopausal individuals present a landscape of circulating adipokines that might be placed in relationship with the inflammatory and coagulation panel, across a complex inter-play. In addition, agouti-related peptide, despite being a well- known central orexigenic factor, might serve as circulating biomarker, too, noting its correlations with interleukin-6 and glycaemia at 120 minute during oral glucose tolerance test.
Background: Severe SARS-CoV-2 infection often results in prolonged immobilization and intensive care unit–acquired weakness (ICUAW), contributing to delayed functional recovery. Early physical and rehabilitation medicine (PRM) interventions may mitigate neuromuscular decline, yet real-world data integrating kinesitherapy with proprioceptive focal stimulation (PFS) remain limited. This study evaluated the functional impact of early rehabilitation and the role of timing in rehabilitation among critically ill COVID-19 patients. Methods: A transversal observational cohort study included 148 adults with confirmed COVID-19 admitted to the ICU of the National Institute for Infectious Diseases “Prof. Dr. Matei Balș” (June 2020–June 2022). Individualized rehabilitation (kinesitherapy ± PFS) was initiated after hemodynamic stabilization. Outcomes included the Medical Research Council score, the ICU Mobility Scale, the Manchester Mobility Score, and the Glasgow Coma Scale. Statistical analyses used the chi-square, Mann–Whitney U, and Spearman's rank correlation tests. Results: One hundred and eight patients (73.0%) required mechanical ventilation. Intubation was strongly associated with muscular atrophy (p = 7.1×10⁻¹⁰) and lower ICU mobility (p = 1.56×10⁻¹¹). Delayed rehabilitation correlated moderately with poorer mobility at ICU discharge (ρ = −0.397). Conclusion: Early PRM is feasible and associated with better functional outcomes in severe COVID-19. Rehabilitation timing appears critical, particularly in mechanically ventilated patients.
(1) Background: The aim of this retrospective observational study was to evaluate the effects of sodium–glucose cotransporter-2 inhibitors (SGLT2i) therapy in patients with chronic kidney disease (CKD) who had been receiving renin–angiotensin– aldosterone system (RAAS) inhibitor (RAASi) treatment for at least one year. (2) Methods: The medical records of 73 patients with CKD, staged according to the KDIGO 2012 guidelines, were reviewed at the start of combined therapy (RAASi and SGLT2i), marked as T0, and again after six months (T1). Biochemical parameters assessed at both time points included urinary albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), urinary albumin, urinary proteinuria, serum creatinine, and hemoglobin. (3) Results: A significant reduction in UACR (p < 0.001) and 24-hour urine albumin excretion (p = 0.050) was observed. Urine protein/24h (p = 0.074) and serum creatinine (p = 0.391) showed decreasing trends, while eGFR increased (p = 0.154), although these changes did not reach statistical significance. Regarding UACR category migration, 25% of patients improved, 74% remained stable, and only 1% worsened. (4) Conclusions: After six months of combined SGLT2i and RAASi therapy, most patients showed stable or improved renal status, suggesting a nephroprotective effect of dual therapy in CKD.
Background: Repeated surveys are essential for tracking trends in smoking prevalence among physicians, especially pulmonologists, who play a pivotal role in cessation counseling. Methods: In 2024, we conducted a descriptive cross-sectional surveillance study during the Romanian National Congress of Pneumology. A total of 332 registered pulmonologists were invited, and 226 (68.1%) provided a complete 30-item online questionnaire. The survey assessed smoking behavior and smoking-cessation counseling practices among Romanian pulmonologists for smokers and users of alternative nicotine products. Results: In a 2024 survey, current smoking rates were 4.9% (11/226) for conventional cigarettes, 2.2% (5/226) for heated tobacco products (HTPs), and 0.9% (2/226) for electronic cigarettes (e-cigarettes). Counseling practices were strongest for the initial steps of the 5A model: 93.4% (211/226) consistently asked about smoking status, and 88.1% (199/226) advised cessation. However, fewer assessed readiness to quit (65%, 147/226), monitored long-term abstinence (66.4%, 150/226), or assisted through referral and treatment. Only 36.3% (82/226) referred patients to the national STOP SMOKING program, and just 15.9% (36/226) declared to recommend Quitline programs. Conclusions: Smoking prevalence among Romanian pulmonologists has declined substantially over the past two decades. Despite high adherence to asking and advising patients, significant gaps remain in assistance and follow-up. Strengthened training and system-level support are needed to optimize cessation counseling.
This study aimed to assess the validity and reliability of the Therapeutic Communication Questionnaire for nurses. This cross-sectional analytical research was conducted in Kashan in 2023. After the translation process, the questionnaire was distributed among the target community. The questionnaire was designed in electronic form (Porsline) and consisted of three sections: demographic information, the Therapeutic Communication Questionnaire for nurses with patients, and a questionnaire on barriers to effective (“nurse–patient”) communication. After completing the questionnaire, the data were entered into SPSS (version 16). Out of 347 participants, 123 (35.47%) were male, with a mean age of 27.07 ± 3.97 years, respectively. The Cronbach's alpha coefficient for the questionnaire was 0.89, and the test–retest reliability (intraclass correlation coefficient, ICC (3,1) was 0.80. The Bartlett's test value was 10368.72, which was statistically significant (P<0.001). The Kaiser-Meyer-Olkin Measure (KMO) index in the results analysis was 0.86. Exploratory factor analysis using principal axis factoring with Promax rotation, combined with scree plot and parallel analysis, supported a three-factor solution explaining 42.46% of the variance. (Only factors 1 and 2 had acceptable reliability.) The questionnaire shows good validity and reliability for Persian speakers. However, cultural differences must be considered, as attitudes influence the nature of communication.
This study explores behavioral and demographic predictors of sustainability engagement in sustainable food choices among Romanian adults, addressing a regional gap in Eastern European sustainability research, based on an online non-probability sample of 406 respondents collected through an online cross-sectional survey, with voluntary response and snowball sampling techniques, conducted between 15 October 2024 and 30 January 2025. From 527 initial responses, 121 questionnaires were excluded due to incomplete or inconsistent answers, resulting in a final analytic sample of 406 respondents. A modified version of the Food Choice Questionnaire (FCQ), termed the Consumers’ Engagement in Food Choices Questionnaire (CEFCQ), was employed to capture sustainability-related behaviors and attitudes. Four hypotheses were tested using multiple linear regression. While snowball sampling is appropriate for exploratory research, we acknowledge its limitations in terms of representativeness at the national level. The respondents haven’t received any incentives, and data privacy and confidentiality were guaranteed. A modified version of the Food Choice Questionnaire (FCQ) was employed to assess sustainability-related attitudes and behaviors, including food label awareness, shopping frequency, and food waste reduction practices. Drawing on existing literature, four hypotheses were formulated and tested using multiple linear regression analysis. Results indicate that label reading behavior and perceived importance of digitalization are positively associated with sustainability engagement, while shopping frequency is negatively associated. Educational attainment and digital marketplace engagement show no significant association after controlling for other variables. The model explains approximately 25% of the variance in sustainability engagement. Given the non-probabilistic sampling design and demographic skew toward female and highly educated respondents, findings are interpreted as exploratory. This study contributes region-specific evidence on sustainable food behavior in Romania and highlights the role of information-oriented behaviors over formal education in predicting sustainability engagement. Implications for consumer education, labeling policy, and targeted interventions aligned with the European Green Deal are discussed.
Burns that affect functional areas present unique challenges in terms of diagnosis and therapy due to their particular mobility and aesthetic importance. In this article, we summarize the current principles in the diagnosis, treatment, and rehabilitation of burns that affect these regions. In this regard, the recent medical literature (clinical evidence) was analyzed to outline management strategies specific to each region. Early and correct evaluation of lesions, along with individualized treatment are essential for maintaining mobility and preventing sequelae. The results obtained are applicable in both civilian and military environments. Superficial burns respond well to conservative care with dressings, splints, and physiotherapy on the one hand, and on the other hand, deep burns benefit from excision and early grafting, the standard modern procedure that shortens hospitalization and greatly improves results. Long-term recovery depends on scar modulation, reconstructive surgery, and multidisciplinary rehabilitation addressing both functional and psychological aspects. Treatment of the burns of functional areas requires prompt, tailored, and multidisciplinary management to restore function and minimize disability. Standardized treatment algorithms and expanded research on long-term rehabilitation remain essential for improving burn care outcomes.
Objective. In this retrospective study, we aimed to analyse bone profile in menopausal women who suffered a low-trauma fall and were found to have an osteoporotic fracture. Methods. This real-life setting included individuals with a fall within the last year before DXA scan [providing bone mineral density (BMD)/T-score], and excluded traumatic falls, prior anti-osteoporosis therapy, diagnosis of osteoporosis, cancers, and bone metabolic diseases. Results. 5-year age-group analysis was statistically significantly different (N=48, p=0.017): in the 70-74 year interval, 75% were in group F (fracture +ve), in the 50-54 year interval, 83.33% were in group nonF (fracture-free). Mineral metabolism assays and bone turnover markers pinpointed a similar profile, except for DXA: femoral neck T-score was lower in group F versus nonF (-1.75±0.72 versus -1.17±0.91, p=0.029). Receiver operating characteristic curve of femoral neck T-score for predicting a fracture showed an area under the curve of 0.691 (p=0.031). Conclusion. Menopausal women with a 1-year fall history with fractures were older, had a longer menopause duration, and had lower femoral neck BMD than fracture-free women. Type 2 diabetes and hypertension had similar prevalence, as did the vitamin D profile and bone turnover markers. Individuals with vertebral fractures (most common types) showed a lower lumbar BMD versus those with non-vertebral fractures.
