Low-level laser therapy for acute neck pain with radiculopathy: a double-blind placebo-controlled randomized study.

OBJECTIVE: The objective of the study was to investigate clinical effects of low-level laser therapy (LLLT) in patients with acute neck pain with radiculopathy. DESIGN: Double-blind, randomized, placebo-controlled study. SETTING: The study was carried out between January 2005 and September 2007 at the Clinic for Rehabilitation at the Medical School, University of Belgrade, Serbia. PATIENTS AND INTERVENTION: Sixty subjects received a course of 15 treatments over 3 weeks with active or an inactivated laser as a placebo procedure. LLLT was applied to the skin projection at the anatomical site of the spinal segment involved with the following parameters: wavelength 905 nm, frequency 5,000 Hz, power density of 12 mW/cm(2), and dose of 2 J/cm(2), treatment time 120 seconds, at whole doses 12 J/cm(2). OUTCOME MEASURES: The primary outcome measure was pain intensity as measured by a visual analog scale. Secondary outcome measures were neck movement, neck disability index, and quality of life. Measurements were taken before treatment and at the end of the 3-week treatment period. RESULTS: Statistically significant differences between groups were found for intensity of arm pain (P = 0.003, with high effect size d = 0.92) and for neck extension (P = 0.003 with high effect size d = 0.94). CONCLUSION: LLLT gave more effective short-term relief of arm pain and increased range of neck extension in patients with acute neck pain with radiculopathy in comparison to the placebo procedure.

Clinoptilolite for Treatment of Dyslipidemia: Preliminary Efficacy Study.

OBJECTIVES: A tribomechanically activated clinoptilolite (natural aluminosilicate mineral) has been used to increase growth in meat-producing animals, as an adjuvant in cancer therapy, and a heavy metal remover in humans. Because of its unique cation exchanging and chelating properties, we hypothesized that clinoptilolite may be beneficial for the treatment of dyslipidemia in the manner similar to bile acid sequestrants. Thus, specific aims of this pilot study were to orally administer clinoptilolite in different doses and granule size combinations to determine magnitude and time profile of changes in blood lipids. DESIGN: A phase I/IIa prospective, open-label, uncontrolled, dose/granule size-ranging study (treatment phase 8 weeks, follow-up 6 weeks). Blood lipids were examined every 2 weeks. SETTINGS: Outpatient clinic of a university-affiliated hospital. SUBJECTS: Forty-one subjects (all white, mean age 57.6 ± 6.8 years, 17 women) with blood lipids above the normative limits divided into three groups. INTERVENTION: A tribomechanically activated clinoptilolite was administered in three dose/grind combinations: 6 g/day of fine grind (6gF), 6 g/day of coarse grind (6gC), and 9 g/day of coarse grind (9gC). OUTCOME MEASURES: Blood concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), and triglycerides (TG). RESULTS: For the 3 groups combined, all lipid fractions significantly improved after 8 weeks of treatment (20-25%, p < 0.001), which reversed to baseline after 6 weeks of clinoptilolite withdrawal. Early (week 2) and the most pronounced decrease in TC and LDLc was observed in the 6gF group (19% and 23% in week 8, respectively), with no difference in HDLc and TG between the three dose/grind groups. No side effects were reported. CONCLUSIONS: These pilot results suggest that oral administration of clinoptilolite may improve lipid profile in individuals with dyslipidemia, which warrants further investigations.

Structured exercise program improves functional capacity and delays relapse in euthyroid patients with Graves' disease.

PURPOSE: To evaluate short- and long-term effects of structured exercise program in euthyroid patients with Graves' disease. METHODS: The study employed a retrospective case-control design. The exercise group (n = 62) underwent 3 weeks of structured exercise program consisting of daily walking, strengthening, and stretching exercises while the control group (n = 62) participated in leisure activities. Thyroid profile, aerobic capacity, and perceived fatigue were evaluated on in-patient admission and discharge. Time to discontinuation of anti-thyroid medication after discharge and time to relapse of symptoms were determined. RESULTS: The exercise group increased estimated peak oxygen consumption (significant group-by-time ANOVA interaction, P < 0.001), decreased serum thyroxin (P = 0.038), increased serum thyrotropin (P = 0.071), and reported less fatigue (Fisher's exact test, p < 0.001) from admission to discharge. The anti-thyroid medication was withdrawn within 6 months of discharge in significantly greater proportion of subjects in the exercise than control group (84% vs. 18%). Conversely, the rate of relapse within 12 months of medication withdrawal was smaller in the exercise (29%) than control group (72%). CONCLUSIONS: The results suggest that structured exercise program may normalize thyroid profile, improve aerobic capacity, and reduce fatigue on the short-term basis as well as reduce the need for anti-thyroid medication on the long-term basis.

Population genetic analyses of susceptibility to increased body weight.

INTRODUCTION: Obesity is a complex condition with multifactorial origin. Assuming that such a state is genetically controlled, the aim of our study was to evaluate the degree of genetic homozygosity among overweight and obese individuals by the homozygously recessive characteristics (HRC) test. MATERIAL AND METHODS: We analysed the presence, distribution and individual combination of 15 selected genetically controlled recessive phenotype traits in a sample of 140 individuals with increased body mass index (overweight individuals n = 100 and obese individuals n = 40) and a control group of normal weight individuals (n = 300). RESULTS: OBESE INDIVIDUALS HAVE SIGNIFICANTLY HIGHER MEAN VALUES FOR GENETIC HOMOZYGOSITY THAN THOSE WITH NORMAL WEIGHT (NORMAL WEIGHT: 3.61 ±1.48; obese: 4.13 ±1.47, p < 0.05) and difference in the presence of certain individual combinations of evaluated phenotype traits (Σχ(2) = 76.9; p < 0.01). There was no difference in average homozygosity of such genetic markers between groups of normal weight and overweight individuals (normal weight: 3.61 ±1.48; overweight: 3.93 ±1.51, p > 0.05) and between groups of overweight and obese individuals (overweight: 3.93 ±1.51; obese: 4.13 ±1.47, p > 0.05). There is no difference in the presence of certain individual combinations of evaluated phenotype traits between overweight and obese individuals (Σχ(2) = 20.6; p > 0.05). CONCLUSIONS: There is a populational genetic difference in the degree of genetic homozygosity and variability between the group of normal weight and group of obese individuals, indicating a possible genetic component. Overweight and obese individuals have a genetic predisposition, but different expression of genetic loads could be one of the possible explanations for different susceptibility to increase of fat mass and body mass index.

Acute low back pain with radiculopathy: a double-blind, randomized, placebo-controlled study.

OBJECTIVE: The aim of this study was to investigate the clinical effects of low-level laser therapy (LLLT) in patients with acute low back pain (LBP) with radiculopathy. BACKGROUND DATA: Acute LBP with radiculopathy is associated with pain and disability and the important pathogenic role of inflammation. LLLT has shown significant anti-inflammatory effects in many studies. MATERIALS AND METHODS: A randomized, double-blind, placebo-controlled trial was performed on 546 patients. Group A (182 patients) was treated with nimesulide 200 mg/day and additionally with active LLLT; group B (182 patients) was treated only with nimesulide; and group C (182 patients) was treated with nimesulide and placebo LLLT. LLLT was applied behind the involved spine segment using a stationary skin-contact method. Patients were treated 5 times weekly, for a total of 15 treatments, with the following parameters: wavelength 904 nm; frequency 5000 Hz; 100-mW average diode power; power density of 20 mW/cm(2) and dose of 3 J/cm(2); treatment time 150 sec at whole doses of 12 J/cm(2). The outcomes were pain intensity measured with a visual analog scale (VAS); lumbar movement, with a modified Schober test; pain disability, with Oswestry disability score; and quality of life, with a 12-item short-form health survey questionnaire (SF-12). Subjects were evaluated before and after treatment. Statistical analyses were done with SPSS 11.5. RESULTS: Statistically significant differences were found in all outcomes measured (p < 0.001), but were larger in group A than in B (p < 0.0005) and C (p < 0.0005). The results in group C were better than in group B (p < 0.0005). CONCLUSIONS: The results of this study show better improvement in acute LBP treated with LLLT used as additional therapy.

[Rehabilitation of children with apallic syndrome of traumatic or ischemic etiology].

INTRODUCTION: Apallic syndrome may be defined as the complete lack of cortical function - paragnosia and parapraxia. Vegetative functions and other sub cortical functions are maintained (sleep rhythm, suckling and swallowing reflex). The aim of the study was to investigate the recovery of children with Apallic syndrome depending on the etiology and differences among various modalities like self-care, motor control and speech during rehabilitation. MATERIAL AND METHODS: The study was conducted among eight children (mean age 9.4) (SD-2.6). Four had a post-traumatic and four Apallic syndrome of ischemic etiology. Friedman and Kruskal-Wallis tests were used for statistical analysis. RESULTS: There was no evident difference in recovery among children with Apallic syndrome of different etiology. In regard to self-care, motor control and speech, all children showed the same level of improvement during rehabilitation therapy. These results correspond with similar research findings. CONCLUSION: Rehabilitation is essential to aid recovery and it does not depend on the etiology. Recovery success is the same regardless of the chosen modality.

[Effects of physical training on the lipid profile of patients after myocardial infarction].

INTRODUCTION: Positive effects of physical training on blood lipoprotein have been clearly demonstrated and they are constituive elements in prevention and treatment of hyperlipoproteinemia. The aim of this study was to evaluate the effects of physical training (PT) on lipid risk factors in patients with myocardial infarction (MI) during posthospital rehabilitation (PHR) and prolonged rehabilitation (48 months). MATERIAL AND METHODS: The prospective clinical study included 230 patients after MI. Patients were divided into two groups: group A (180 patients) participated in organized PT (PHR and prolonged rehabilitation at home) that lasted 48&6.4 months and the control group (50 patients) without PT. The intensity of PT was recommended to be 70% of maximal heart rate obtained during the exercise test (ET). Evaluation of lipid profile was done after the last control (48+/-6.4 months after MI). Parameters in the control group were compared with the parameters in the examined group of patients. RESULTS: Hyperlipidemia, as a risk factor, was present in 39% of patients of group A and in 38% of patients ofthe control group just after MI. A statistically significant difference wasn't established in lipoprotein levels in examined groups of patients before MI (p>0.05). Prolonged PT leads to significant deacrese of total cholesterol (p< 0.01), LDL/cholesterol (p < 0.05) and triglycerides (p<0.01), but increase in HDL/holesterol (p 0.01), in patients after MI with organized rehabilitation in comparison with the control group. CONCLUSION: Prolonged PT has a beneficial effect on hyperlipoproteinemia inl patients after MI. We have to practice PT over the "threshold" of physical activities if we want to achieve optimal results.

[Functional outcome evaluation after total hip arthroplasty].

INTRODUCTION: Total hip arthroplasty improves the hip functional status and quality of life of operated patients. The surgery outcome is determined by several numerical methods. The aim of this study was to evaluate the hip functional status 1 and 5 years after total hip arthroplasty using a modified Harris hip score. MATERIAL AND METHODS: 75 patients with 78 primary total hip arthroplasties were included in the study. All patients underwent clinical evaluation 1 and 5 years after operation using our modified Harris hip score. From the original score 2 questions, that evaluated the range of motion (5 points) and deformity (4 points), were excluded, and 2 questions that assessed the hip function were added: rising from a chair after an hour of sitting (5 points) and bathing (4 points). Also, we added one question regarding patient's satisfaction after surgery. RESULTS: I and 5 years after the surgery, very good hip functional status was verified in 77% and 82.4% of patients respectively (excellent and good total Harris hip score). 92% of patients were satisfied with the outcome 1 and 5 years after the operation. CONCLUSION: Our modified Harris hip score can be used for long-term evaluation of patients after total hip arthroplasty.

[Quality of life in patients with subacute low back pain treated with physiotherapy rehabilitation].

INTRODUCTION: Low back pain is one of the most frequent health problems. The aim of the study was to investigate clinical effects of complex rehabilitation programs on quality of life of patients with subacute lumbar pain, and also to investigate the relationship between quality of life and the intensity of pain and local functional status of the lumbar spine. MATERIAL AND METHODS: The prospective study included 60 patients suffering from subacute low back pain with radiculopathy caused by lumbar disc syndrome, without any previous treatment, and who did not need surgery. In a single blind trial patients were divided into two groups. The first group (A group, n=30) was treated by low level laser therapy (wavelength 904 nm, frequency 4000 Hz, at dose 2J per point); the whole dose of 12J, then with TENS (frequency 80 Hz, 30 minutes, pulse duration 200 micros), with exercise, and simultaneously with conventional therapy with NSAIDs which inhibit COX-2 (meloxicam, 15 mg per day). Patients were treated 5 times a week, a total of 15 treatments. The second group (B group, n =30), was treated only by meloxicam (15 mg per day). The subjects were evaluated before the first treatment and three days after the last treatment (21st to 24th day). Data were analyzed using Student's t test and with analytic statistical methods. RESULTS: The mean Oswestry scores before and after therapy for group A have reduced from 25+/-2 to 16+/-3, with statistical significance (t= 8.84 p<0.001) and in group B from 24+/-2.5 to 22+/-2.5 (t=2.56 p<0.05). Statistical analysis has shown an increase of mean values for the 12-item health survey (SF-12) from 22.33+/-4.66 to 36.33+/-3.66 (t=9.12 p<0.001), in group A and from 23.66+/-3.66 to 30.33+/-4.66 (t=3.15 p <0.001) in group B. Mean values of intensity of pain in group A have been reduced from 82+/-6.50 to 46+/-5.50, (t=7.85, p<0.001) and from 80+/-5.50 to 62+/-6.50 in group B (t=5.65; p<0.001). No significant changes have been recorded in Schober measurement. The intensity of pain was in positive correlation with Oswestry score (Ft=7.84; p<0.001) in group A and also in group B (Ft=5.25: p<0.05), as for the 12-item health survey (SF-12) (Ft=8.34: p<0.001) in group A and in group B (Ft=5.98; p<0.05). Two measurements of quality of life have shown close relationship (Ft=5.45; p<0.05) in group A and group B (Ft=6.45: p<0.05). CONCLUSION: Results of this study showed that better results were achieved in group treated with complex rehabilitation methods in comparison with patients treated only with anti-inflammatory drugs. Also, the 12-item health survey (SF-12) has shown positive correlation with intensity of pain reduction and with Oswestry disability score and so it is valid for measuring the effectiveness of therapeutic modalities in subacute lumbar pain.

[The effects of balneotherapy on knee osteoarthritis].

INTRODUCTION: Effects of two types of balneotherapy on patients with knee osteoarthritis (OA) were compared. MATERIAL AND METHODS: 58 patients were included in the study and treated in the "Rusanda Spa" in Melenci. The patients were divided into two groups: group I (n=30) received a spa treatment and a mud pack per day, group II (n=28) received only two spa treatments per day. Thermal water components are: Na, Cl, Ca, HCO3, SO4 homeoterms (38 degrees C) and mud pack components are alkaline Na, Cl, Ca, HCO3, SO4. The effects of two traditional spa therapies were evaluated using Lequesne index. Secondary measures were pain intensity (visual analogue scale), 10 meters walking time, 3 squats and 10 stairs climbing time. RESULTS AND DISCUSSION: Improvements were found in Lequesne knee index. In group I it was higher (44%), than in group 11 (30.7%), p<0.001. Vascular pain has decreased in both groups (38.2% and 31.1%). In group I it was more significant (p=0.003). CONCLUSION: The results of secondary measures show a better improvement in the first, in regard to the second group. Both traditional spa therapies are good in treatment of functional status and pain in patients with OA. A combination of these two spa therapies is the best solution, but it is not clinically relevant.

Histopathology of chronic hepatitis C in relation to virus genotype.

BACKGROUND/AIM: The natural history of hepatitis C virus (HCV) infection is variable and the factors determining the course of the illness are unclear. There are geographical variations in the distribution of different HCV genotypes, and some of them are related to the specific infection routes. Regarding our country, the dominant genotype is genotype 1b. It is unclear and still remains a question whether the distinct histopathological manifestations are related to the particular genotypes of HCV. Thus, the aim of this study was to determine whether the distinct histopathological manifestations of HCV infection might be in relation to the individual virus genotype. METHODS: In this study we examined 126 patients with chronic HCV infection regarding the histopathological features, demographic data, and virus genotype. The observed groups of patients were predominantly infected with HCV genotypes 1b and 3a. RESULTS: In this study we found that the patients infected with HCV genotype 1b had more frequently moderate or severe necroinflammatory activity of the disease, significantly higher grading score as compared with other genotypes (p < 0.0001). A higher degree of fibrosis was, also, more common in the patients infected with genotype 1b of HCV as compared with other genotypes (p < 0.05). There were no significant correlations between the necroinflammatory activity of the disease and the stage of fibrosis in 1b, 4 and mixed genotypes. CONCLUSION: The present data support the hypothesis that distinct genotypes of HCV are associated with the particular histopathological manifestation of the disease.