(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: 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.
The idea of using mobile hospitals - a fully functional hospital is a system with a high degree of complexity - in case of a pandemic crisis, is not new, but shows how much they are needed. Solutions belonging to the category of mobile architecture are increasingly common, technical and logistic difficulties are solved in more perfect way. This applies mostly to objects with simple layouts and functional relationships, with relatively little technical equipment. In the case of healthcare facilities there are several factors increasing the difficulty: multitude of functional connections, sanitary requirements, technical equipment, and internal infrastructure. The Romanian military and civilian specialists from Bucharest Central Military Emergency University Hospital (SUUMC) showed that is possible to build a hospital as a modular and mobile structure in order to fight COVID 19, but the strategic actions and the effort needed to organize and run mobile hospital far exceeds the expenditure, protocols and specialized M.D.s necessary to run the stationary hospital.
The pandemic called COVID-19 disease has an exponential course since the first cases were reported showing in 9th of May, 2020, more than 4 million cases of COVID-19. United States and European Council (EC), together with other European Union institutions, were closely monitoring the situation in order to take quick action. Objective: The aim of this article is to analyze the response to COVID 19 pandemic outbreak in term of strategy and money flow of Romanian health system in order to identify the strength and weakness and prepare for other similar provocative challenges. Global and national strategy: United States Government is delivering a comprehensive package of services to support international partners around the world in combatting this disease adding American expertise for global benefit, saving lives by improving international partners abilities to respond to the COVID-19, and reducing secondary impacts. Meanwhile European Union is focused on 6 major coordinates limit the spread of the virus, ensure and provide medical supplies, decrease negative economic impact, support jobs, promoting research and help European citizens to repatriate. Despite all negative elements a proper and relatively quick response of Romanian Public Health System was noticed and the taken measures were harmonized and synchronized with the European coordinates, prioritize initiatives, build an action plan, establish a communication plan, workforce optimization and management strategy. Conclusion: Global shock needs global response, with little or no government interventions, economic costs will be huge.
Purpose: This study is carried out to evaluate the diagnostic value of using common features of computed tomography (CT) imaging in COVID-19 disease, and to assess the relationship between blood oxygen saturation level and severity of CT findings. Materials and Methods: In this retrospective study, the chest CT of 173 test-confirmed COVID-19 patients have been evaluated to determine the patterns of involvement in multiple phases of illness. Then, the correlation between the severity of lung involvement and oxygen saturation levels has been assessed. Results: The chest CT results show that 87.6% of patients had GGO, which was the most common pattern in our findings. 83.8% of patients had bilateral lung involvement with the dominant multifocal and peripheral distribution. peribronchovascular involvement was also a common finding in our study (47.2 %). we found predominantly peribronchovascular view in 3 patients (1.7%), pleural effusion in 4 patients (2.3%), lymphadenopathy in 10 patients (5.8%), the tree in the bud in one patient (0.6%), and nodules in 4 patients (2.3%). We also found that GGO is the most common pattern during the early phase of the disease (97.4% of early phase cases). However, in the intermediate and late phases, consolidation and crazy paving patterns are more common. Moreover, our findings indicate that there is a significant relationship between oxygen saturation level and Total Severity Score, with the exclusion of the young adult patients (20-40 years). Conclusion: Relying on chest CT-scan findings apart from the oxygen saturation level is sufficient for the diagnosis and management of patients with COVID-19 pneumonia.
Introduction: Public interest in burnout has grown recently in developed countries, as has media coverage. Burnout has been a topic of scientific research in recent years for psychologists and sociologists alike. They have published numerous articles on the identification and classification of burnout syndrome. The medical staff is quite exposed to burnout because they often experience strong emotions such as the desire to treat or save their patients, fear of failure, occasional failures in the treatment of diseases. Materials and methods: This study aims to highlight the impact of the burnout syndrome in the Emergency Department of the Central Military Emergency Hospital during the COVID-19 pandemic, by conducting a comparative study based on the results of a questionnaire applied to the medical staff before and during the COVID-19 pandemic. Results: The study interviewed 65 participants aged between 20 and 60 years. They had to anonymously answer 16 questions marked with scores from 1 to 4. Comparing the results highlighted by the questionnaire, applied before the COVID-19 period, with those obtained in the questionnaire applied between May and June 2020, we noticed an increase in the level of burnout in all categories interviewed during the pandemic. Conclusions: In conclusion, the high level of contagiousness and the lack of a vaccine or treatment against SARS-CoV2 infection are additional concerns for burnout syndrome among healthcare professionals.
Isolation and quarantine during the Covid-19 pandemic affected the lifestyle and daily functioning of the population around the world, leading to social, psychological, and economic changes which further multiplied the stress related to the threat of coronavirus contagion by adding financial, relational, academic, professional and mental health vulnerabilities. To assess the impact of isolation and quarantine over the quality of life in the Romanian population, we conducted a Web-based survey focused on the evaluation of stress level, perception of lifestyle changes, communication patterns, mental health, major concerns, perception of one’s future, but also on the preferred coping strategies that people have used to deal with the isolation stress. The answers were collected during one month and the results for the first 2 weeks of quarantine/isolation were compared with the results after one month of such regimen. Several recommendations based on the survey results analysis were formulated regarding possible strategies for decreasing the impact of stress factors over the general population and specific, vulnerable groups.
Introduction: Intensive care facilities may play an important role in reducing corona mortality. This study aimed to assess the epidemiological features, treatments, and prognosis of corona patients that admitted to the Intensive Care Unit (ICU) of Baqiyatallah Hospital. Methods: All patients with a corona that admitted to the ICU of Baqiyatallah Hospital from March 5 to May 20, 2020, were included. The epidemiological characteristics, pharmacological, non-pharmacological, and supportive therapies and prognosis were assessed. Underlying diseases, smoking, and severity of lung involvement based on CT scan findings (mild, moderate, severe) and length of hospital stay in the ICU were recorded in a questionnaire. Non-invasive ventilation (NIV) or tracheal intubation, ventilator ventilation, and duration of endotracheal intubation, if needed, were recorded in the questionnaire. Meanwhile, whether tracheostomy was performed, the time of the procedure, and its duration were also recorded. Results: Overall, 82 patients were included in the study that 68 (82.9%) of them were males. The mean age was 57.96±14.08 years. The mortality rate was 53 cases (64.6%). There were 57 subjects (73.1%) at a severe lung involvement and 21 subjects (26.9%) at a moderate lung involvement. There was a significant relationship between severity of lung involvement and mortality (Odds ratio= 14.3, P<0.001). There was a significant relationship between mortality and Armadile use (Odds ratio= 2.9, P=0.04). There was a significant relationship between mortality and tracheal intubation (Odds ratio= 27.2, P<0.001). There was no significant difference between mortality and discharge of patients regarding the intubation period (P=0.26). There was not a significant relationship between tracheostomy, NIV, and mortality status in the patients (P=0.14 and 0.33 respectively). Also, there was no significant difference between mortality and discharge of patients regarding tracheostomy and NIV period (P=0.51 and 0.17). There was no significant difference in age between severe and moderate lung involvement cases (P=0.63). There was a significant difference in the duration of ICU hospitalization between severe and moderate lung involvement cases (P=0.004). Conclusion: The results showed none of the factors of age, sex, underlying diseases other than hypertension, pharmacological methods other than Armadile, and non-pharmacological methods such as hemoperfusion, plasmapheresis, IVIG, hyperimmune plasma injection, and stem cell as well as Ozone therapy does not affect corona patient’s mortality. Only the severity of lung involvement leading to endotracheal intubation and mechanical ventilation is related to patients’ mortality
Psoriasis is a chronic inflammatory disease, with multisystemic implications and genetic predisposition, characterized by the development of erythematous, scaling plaques on the skin. Management of moderate to severe psoriasis vulgaris may involve a biological treatment that suppresses the immune system. Because of this, the patients with psoriasis on an immunosuppressive treatment are theoretically at an increased risk of infections, including SARS-CoV- 2 infection. SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) is responsible for the current pandemic. In Romania, COVID-19 (Coronavirus Disease 19) was first reported on February 26, 2020, by confirming the first patient with SARS-CoV-2 by RT-PCR method. COVID-19 progression was divided into three phases: early infection, pulmonary phase, and hyperinflammatory phase. Although the inhibition of pro-inflammatory cytokines by biologic therapy is detrimental in the viral phase, it seems to be beneficial in the hyperinflammatory phase, by protecting the patients with psoriasis in progressing towards extra-pulmonary manifestations and death. Analyzing the evolution of the 8 cases of patients from our dermatology department – Colentina Clinical Hospital, with generalized psoriasis vulgaris on biologic immunosuppressive treatment and SARS-CoV-2 infection, we observed that they did not develop a more severe form of COVID-19 than the general population. Patients on biologic immunosuppressive treatment are more susceptible to the development of infections, including by SARS-CoV-2, but it was found that the biologic therapy can protect against a more severe type of COVID-19.
The novel coronavirus, identified in December 2019, has caused a pandemic that will remain in the medical literature as SARS-CoV-2, the etiological agent of the Covid-19 disease. It was initially stated that this disease would not be more serious than the flu, in terms of prevalence, frequency of complications and mortality. Although in the country of origin the epidemic was only local, the virus spread successively to other countries, until it quickly spread to all inhabited continents and was declared a pandemic. Being a new disease and a new virus, the world panicked. The World Health Organization released guidelines to member countries, which they have implemented. Because the disease sped out of control, it became not only a health crisis but also a socio-economic one. A year later, we are still facing this disease, about which we have learned a lot but not yet all that is necessary and so the time has come for a certain summing up. The Covid-19 pandemic is a reality of current times, the year 2020 being portrayed as the “COVID year”. The international scientific community has shown that, when needed, it can collaborate beyond classical barriers. Statistics show that the virus is not very aggressive, the disease is not very serious but there are also serious, sometimes fatal complications to which appropriate measures must be applied. The risk of serious illness and life-threatening complications is statistically reduced over time, the disease being less severe now than at the beginning, so it is on a downward slope.
