6 articles
Currently, extensive research has shown that almost all published prediction models are poorly studied and have significant limitations, leading to their predictive performance often being overestimated. Additionally, there is still no universally accepted scoring system, primarily due to the need for adaptation to heterogeneous patient samples (including patient numbers, clinical profiles, and risk factors) and/or ongoing differences in the organization of healthcare systems across various countries.
This is a narrative literature review. A bibliographic search was conducted in the PubMed, Hinari, SpringerLink, National Center for Biotechnology Information, and Medline databases. Articles published between 2000 and 2024 were selected based on keyword combinations such as "artificial intelligence", "prediction model", "algorithm", "machine learning", and "COVID-19". Information on machine learning predictive models was selected and processed to identify characteristics that can be used to predict diagnosis, severity, length of hospital stay, ICU admission, treatment, vaccination, and mortality in COVID-19 patients. After processing the data according to the search criteria, 125 full-text articles were identified. The final bibliography includes 52 relevant sources, which were considered representative of the literature on this synthesis article topic.
Artificial intelligence techniques are increasingly being used to predict outcomes in COVID-19 patients, particularly in estimating mortality among individuals infected with SARS-CoV-2, which can rapidly and effectively support clinical decision-making. According to the analysis of multiple studies, strong predictors of mortality in COVID-19 patients include advanced age, male gender, comorbidities, reduced levels of calcium, albumin, red blood cells, and oxygen saturation, as well as lymphopenia, elevated blood urea nitrogen, creatinine, lactate dehydrogenase, D-dimers, neutrophils, interleukin-6, procalcitonin, bilirubin, ferritin, aspartate aminotransferase, and troponin.
Artificial intelligence techniques provide potential advantages over conventional assessment methods. The information obtained from machine learning and deep learning algorithms, including easily accessible and interpretable data, can assist healthcare workers in making accurate decisions for the appropriate and timely care of COVID- 19 patients. This can improve patient outcomes, reduce the burden on healthcare systems, and ultimately decrease mortality rates.
Ozone therapy can be used as a monotherapy or as an adjunctive treatment to standard COVID-19 treatment protocols. Current evidence indicates that this approach may improve clinical outcomes, paraclinical markers, and reduce radiological signs of inflammation, with no side effects.
he study included 100 consecutive patients aged 18 and older with COVID-19, admitted to the Intensive Care Unit at the Institute of Emergency Medicine. Patients were randomly divided into two groups: 50 patients underwent treatment according to the National Clinical Protocol along with major ozonated autohemotherapy (the study group), while the other 50 patients were treated only according to the National Clinical Protocol (the control group).
Although the initial oxygenation index (PaO2/FiO2) values were similar in both study groups, a dynamic analysis revealed a clear efficacy of ozone therapy. By the end of the first-week treatment, the mean oxygenation index in the ozone-treated group was significantly higher than in the standard treatment group: 296.8±105.1 mm Hg versus 232.8±110.6 mm Hg (p<0.01). The use of oxygen therapy (70.0% vs. 78.0%), non-invasive ventilation (70.0% vs. 76.0%), and invasive mechanical ventilation (22.0% vs. 38.0%) tended to be lower in the ozone group, though this difference was not statistically significant (p>0.05). Both treatment groups showed a significant clinical improvement, with 54.0% of COVID-19 patients in the ozone group and 50.0% in the conventional treatment group achieving a two-point reduction in clinical severity score (p>0.05).
The mean oxygenation index significantly increased in the study patient group (246.86±30.3 mm Hg on day 1 and 296.75±105.1 mm Hg on day 7 of treatment; p<0.01) and remained unchanged in the control group (235.86±33.4 mm Hg on day 1 and 232.82±110.6 mm Hg on day 7 of treatment; p>0.05). Although the mortality rate was lower among COVID-19 patients treated with ozone therapy (24.0%) compared to those receiving standard treatment (34.0%), this difference did not achieve any statistical significance.
During COVID-19 pandemic, non-invasive ventilation (NIV) was widely used during COVID-19 Pandemic. The factors predicting NIV failure in COVID-19 patients remain debatable. The goal of this research is to identify the parameters that may correlate NIV failure.
A retrospective analysis of COVID-19 patients’ data, who were admitted to ICU of the Institute of Emergency Medicine, Chisinau, during July-October 2020 and connected to NIV. The study analyzed the demographics, laboratory and respiratory parameters (at admission, at NIV initiation, 24-48h and 72-96h of NIV) and their relation with NIV failure. For continuous variables, the established confidence interval was 95%. The Kruskal-Wallis H test was used for continuous variables and the Fisher’s exact test or chi-squared test was used for category data.
In study were included 154 patients. NIV failed in 52 patients. In NIV failure group were registered a higher rate of hypertension (88% vs 74%, p = 0.033), delirium (60% vs 20%, p=0.001) and need for sedation (83% vs 48, p=0.001). The urea levels were lower in NIV success group at admission, at NIV initiation and at 24-48h of NIV. The neutrophil/ lymphocyte ratio was higher in NIV failure group at NIV initiation; at 24-48h and 72-96h of NIV. NIV failure group had a higher level of WBC count and C-reactive protein at 24-48h and 72-96h as well as D-dimer at 72-96h of NIV. The ROX index was higher in NIV success group from NIV initiation and through 72h of NIV.
The presence of abnormal values of neutrophil/lymphocyte ratio, urea, lymphocytes, WBC count, C-reactive protein, D-dimer and ROX index during non-invasive ventilation, as well as association of delirium and need for sedation, can be suggestive and informative for high risk of NIV failure in COVID-19 patients. Continuous measurement of these parameters may help the clinicians to decide the optimal timing of conversion to invasive ventilation.
Evaluation of patient volemia arriving at a medical service today still represents a challenge for specialists, especially in those who need surgical and anesthetic intervention. One of the most common systemic side effect to anesthesia is hypotension. Spinal Anesthesia-Induced Hypotension (SAIH) because of sympathetic blockade is most frequently cited as a complication of subarachnoid anesthesia, its severity being influenced by the patient's volemic state. The aim of this literature review is to analyze if „routine” preanesthetic preloading reduces the incidence of SAIH in patients undergoing spinal anesthesia, also to emphasize the efficacy of preanesthetic assessment of the IVC/Ao (Inferior Vena Cava/Abdominal Aorta) Index measured by ultrasound in determination of patients’ volemia.
Narrative literature review. Bibliographic search in the PubMed, NCBI and Google Academic databases, using the keywords: „hypotension inferior vena cava”, „hypotension spinal anesthesia”, „inferior vena cava/aorta diameter”, „preloading hypotension”, which were combined with each other. The final bibliography included 40 references.
The principles of perianesthetic volemia management and prevention of arterial hypotension after the administration of the spinal block were detected in different groups of patients: the elderly, adult patients, anesthesiologic assistance in obstetrics and in various types of surgical interventions. Hypotension incidence data in patients with and without preanesthetic volume repletion were detected. At the same time, the effectiveness of the ultrasonographic assessment of IVC/Ao index in assessing patient's volume status was determined. The information was analyzed and synthesized in the article.
The effectiveness of routine preloading in reducing the incidence of arterial hypotension after spinal anesthesia did not prove its benefits in normovolemic patients, and ultrasonographic assessment of the IVC/Ao Index in assessing the volume status appears to be a simple, rapid, non-invasive, cost-effective volume assessment, which does not require the presence of a specialized imagist, being practically devoid of contraindications.
Oxygen-ozone therapy stands as a medically endorsed practice confirmed by numerous international clinical studies. Various authors have illustrated the beneficial clinical outcomes of ozone therapy in terms of its capacity to regulate redox balance, cellular inflammatory responses, and adaptation to ischemia/reperfusion processes. Ozone therapy extends to encompass a range of viral infections, inflammatory disorders, and degenerative ailments, used as both monotherapy and as an adjunct to unified conventional therapies.
Narrative literature review study. Bibliographic search was conducted using the PubMed, Hinari, and SpringerLink databases, as well as the National Center of Biotechnology Information and Medline. Articles published between 1990 and 2022 were selected using various combinations of keywords, including “ozone”, “ozone therapy”, “mechanisms of ozone action”, “biological effects of ozone”, “antioxidant effect”, “anti-inflammatory effect” and “immunomodulatory effect.” Information regarding ozone's mechanisms of action was identified and processed. Following the database information processing and search criteria, a total of 475 full-text articles were found. The final bibliography consists of 52 relevant sources that were deemed representative of the materials published on the topic of this synthesis article.
The effects of ozone on oxygen metabolism are explained by changes in the rheological properties of blood, including inhibition of erythrocyte aggregation and stimulation of 2,3-diphosphoglycerate in erythrocytes, favoring the transport and delivery of oxygen to tissues while facilitating the substantial elimination of nitric oxide and increasing blood flow. Intracellular triatomic oxygen enhances the oxidative carboxylation of pyruvate, stimulating ATP production, which also contributes to reducing peripheral vascular resistance.
Ozone generates a moderate oxidative stress. Yet, it can set off several beneficial biochemical mechanisms that reactivate both the intra- and extracellular antioxidant systems and reverse chronic oxidative stress in various inflammatory and degenerative processes. Ozone induces a mild activation of the immune system by triggering neutrophil activation and stimulating the synthesis of certain cytokines (IL-2, TNF-α, IL-6, and IFN-γ), thereby initiating a complete cascade of immune responses. Ozone therapy yields the following biological reactions: optimization of blood circulation and oxygen delivery to ischemic tissue, regulation of cellular antioxidant enzymes, initiation of a slight immune system activation, and enhancing the release of growth factors.
Technological advances and the ageing population have increased the demand for complex diagnostic procedures and minimally invasive surgery. As a result, there is an increasing demand to anaesthetize patients undergoing procedures outside the operating room. Due to increased anesthetic safety, with the development of modern monitoring methods, new drugs, anesthesia protocols it has been possible t