Acute myocardial infarction (AMI) is a multifactorial condition and a leading cause of morbidity and mortality worldwide. This study aimed to assess the distribution of clinical and demographic characteristics among AMI patients and compare these findings with data from the RO-STEMI program for the Romanian population. We performed a case-control analysis of 138 patients presenting with chest pain at the Emergency Department of “Dr. Carol Davila” Central Military Emergency University Hospital between November 2021 and April 2022. The AMI group (n = 69) included patients with STEMI-specific ECG changes and elevated cardiac biomarkers, while the control group (n = 69) was represented by patients with chest pain but normal ECG and biomarkers. Men with AMI were 8.66 years younger than women, exceeding the 6.51-year difference reported by RO-STEMI. Hypertension and dyslipidemia were strongly associated with AMI (OR = 8.20 and OR = 7.36, p < 0.0001). During the pandemic, early presentation (<6 h) decreased by 15%, while arrivals within 6–12 h increased by 19.02%. Primary percutaneous coronary intervention was performed in 81.16% of cases versus 12.94% previously. Killip class and reduced left ventricular ejection fraction correlated with mortality and hospitalization duration. These findings indicate significant changes in AMI onset age, treatment strategies, and presentation delays compared to pre-pandemic data.
Background: This narrative review explores the multidimensional impact of Mental Health Literacy (MHL) among military personnel, a population frequently exposed to high-stress environments and associated psychological risks. It aims to synthesize evidence on how MHL influences various individual, organizational, and social outcomes. Methods: A narrative review was conducted by analyzing relevant peer-reviewed articles published between 2015 and 2025. Comprehensive searches were performed across major databases, including PubMed, Web of Science, Scopus, the Scientific Information Database (SID), and MagIran. From an initial pool of 43 records, 8 duplicates were removed, leaving 35 articles for screening. After full-text assessment, 7 studies met the inclusion criteria. The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)reporting guidelines, and the methodological quality of the included studies was appraised using the Mixed Methods Appraisal Tool (MMAT). Results: The results demonstrate that the impact of MHL in military personnel spans five core dimensions: (1) Education and Awareness, (2) Prevention and Treatment, (3) Performance Improvement, (4) Leadership and Social Support, and (5) Societal and Family Impact. Enhanced MHL not only reduces stigma and promotes help-seeking behavior but also improves stress management, early crisis identification, and timely intervention, contributing to overall psychological resilience. Conclusions: Strengthening MHL is essential for improving the quality of life, operational performance, and psychological well-being of military personnel. Commanders and military managers should prioritize developing and implementing targeted educational programs and interventions to foster mental health awareness and resilience.
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.
Military mass-casualty (MASCAL) incidents impose severe constraints on analgesia delivery due to rapid triage, limited monitoring capacity, and heterogeneous provider qualifications. This review aimed to map current evidence on battlefield analgesics and identify options suitable for high-throughput MASCAL conditions. A scoping review was conducted following PRISMA-ScR methodology, including a systematic PubMed/MEDLINE search (2017-2023), dual-review screening, predefined eligibility criteria, and structured data extraction. Sixty-six articles met the inclusion criteria. Evidence indicates that transmucosal opioids – oral transmucosal fentanyl citrate (OTFC) and the sufentanil sublingual tablet (SST) – provide rapid, effective analgesia but require continuous observation, airway-rescue competence, and governance controls, which may limit their safe use in large-scale MASCAL operations. Ketamine demonstrates the most favorable operational profile, combining reliable analgesia with preserved airway reflexes, cardiovascular stability, flexible dosing routes, and minimal monitoring requirements. Cannabinoid preparations and α2- agonists lack sufficient evidence for acute trauma analgesia and present pharmacologic or safety limitations that preclude routine prehospital use. Based on these findings, we propose a triage-linked analgesia framework that aligns agent selection with provider level, monitoring capacity, and evacuation timelines. Overall, ketamine emerges as the primary analgesic option for MASCAL incidents, whereas transmucosal opioids should be reserved for trained personnel operating under protocolized oversight.
(1) Introduction: Artificial intelligence (AI) is transforming healthcare and has particular relevance in military medicine, where austere environments, uncertainty, and time-critical decisions are common; (2) Methods: A literature review was conducted in PubMed/MEDLINE, Scopus, and Web of Science, covering studies published between 2000 and 2026. Relevant articles on AI in military medicine were identified and grouped into three domains: clinical, operational, and educational; (3) Results: Forty-one studies were included. In the clinical domain, AI supports decision-making, trauma care, medical imaging, and mental health, including early detection of post-traumatic stress disorder (PTSD). Operational applications include physiological monitoring, triage optimization, and medical evacuation. In education, AI enhances medical simulation and adaptive learning. Key limitations include poor data quality and availability, algorithmic bias, and limited validation in real operational settings; (4) Conclusions: AI can substantially improve military medical practice by increasing diagnostic accuracy, supporting rapid decisions, and improving operational efficiency. However, implementation requires rigorous clinical validation, transparent and reliable systems, and careful attention to ethical and organizational issues. AI should be used as a complementary tool that supports, rather than replaces, clinical judgment.
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.
Background: Digital transformation in cardiology is reshaping diagnosis, monitoring, and therapy through connected devices, digital biomarkers, telemedicine, and artificial intelligence. This paper synthesizes recent advances and emphasizes the shift from episodic assessment to continuous surveillance and personalized predictive care. Methods: The article included 81 studies published between 2015 and 2026, identified in PubMed, Google Scholar, and ScienceDirect, encompassing clinical trials, meta- analyses, observational studies, and reviews focused upon continuous cardiovascular monitoring, remote care, and AI-supported analysis. According to the selection criteria, studies with weak methodology or limited clinical relevance were removed. Results: Continuous monitoring enables early detection of physiological changes, individualized prevention, reduces hospitalizations, and supports cost efficiency and the expansion of remote services. Artificial intelligence and multimodal analytics facilitate dynamic risk stratification, clinical decision support, and the development of cardiovascular digital twin models for precision medicine. Implementation remains constrained by requirements for robust validation, potential algorithmic bias, data protection and cybersecurity concerns, and regulatory or acceptance barriers. Conclusions: Digital cardiology enables anticipatory, patient- centered healthcare based on continuous monitoring and AI as core clinical tools, promoting integrated patient–hospital–home ecosystems, real-time therapeutic guidance, and sustained cardiovascular prevention. The priorities defined by these directions are subjects for further research and healthcare development worldwide in the next decades. improves
(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.
(1) Background and aim: Multimodal treatment is the current standard approach for managing lymphedema, with the goal of normalizing or reducing volume discrepancies, improving function, and enhancing appearance. However, following the reduction of the solid component and enhancement of lymph flow through physiological procedures involving supermicrosurgery, residual areas of fibrosis or lipodystrophy may persist, causing dissatisfaction for both the patient and the physician. (2) Methods: We present a three-case series of lymphedema, two affecting the upper limb and one affecting a lower limb, all previously treated with lymphaticovenular anastomosis (LVA) and/or debulking liposuction, which resulted in satisfactory overall volume reduction of the limbs, but with persistent swelling of the dorsum of the hand and forefoot, respectively. All patients were subsequently treated with a combination of bioengineered enzymatic cocktail (BEC). (3) Results: All three patients demonstrated stable reduction of swelling in the affected areas at one-month follow-up, with improved quality of life and function, which was maintained at six months followup. (4) Conclusion: These preliminary observations suggest that multi-enzyme cocktails warrant investigation as adjuncts for localized, post-surgical residual lymphedema, particularly for distal, anatomically challenging regions, such as the hand, foot, and digits, where surgical options are limited.
Introduction. Management of moderate-severe psoriasis is challenging in the presence of severe systemic comorbidities, such as HIV infection, recent history of cancer, latent tuberculosis infection, or advanced liver disease. These patients are almost invariably excluded from randomized clinical trials, an aspect that limits the availability of standardized therapeutic options. Material and methods. This narrative review summarizes the current literature on immunomodulatory therapeutic strategies in patients with psoriasis and severe systemic comorbidities, integrating existing evidence in the literature with relevant clinical observations from real-world practice. Results. Available data suggest that therapeutic decisions should be individualized according to the type of comorbidities and severity of the disease. In well-controlled HIV infection, conservative strategies may be preferred. In patients with a history of cancer, systemic therapies may be used with caution and in interdisciplinary collaboration. In latent tuberculosis infection, prophylaxis is necessary, but isoniazid-induced hepatotoxicity is an important limitation. In liver disease, biological therapies may constitute a safer alternative to conventional systemic therapy. Conclusion. In this context, patients with psoriasis and severe associated systemic comorbidities require a personalized, multidisciplinary approach and close monitoring. Real-world data play an essential role in guiding therapeutic decisions in this patient population.
