Effects of Pulmonary Rehabilitation on Respiratory Function and Thickness of the Diaphragm in Patients with Post-COVID-19 Syndrome: A Randomized Clinical Trial.

BACKGROUND: Rehabilitation is an effective method for improving the overall health of patients who have experienced the long-term effects of COVID-19. METHODS: The double-blind, randomized prospective study assessed the effectiveness of a 6-week rehabilitation program among post-COVID-19 patients. A total of 59 patients under treatment following COVID-19 were randomly divided into two groups. Both groups completed the same six-week comprehensive exercise training program supported by a respiratory muscle trainer (Threshold IMT) during out-patient sessions. The control group performed placebo IMT. Respiratory muscle strength, chest wall expansion, spirometry, and diaphragm ultrasonography measurements were taken before and after the six weeks. RESULTS: The applied rehabilitation program improved respiratory muscle strength in both the study and control groups (p < 0.001). There was a significant chest circumference increase in the study group (p < 0.001). Spirometric parameters improved in both groups, with the study group showing a greater improvement: 8.02% in FEV1 (p < 0.001), 13.24% in FVC EX (p < 0.001) and 9.67% in PEF (p < 0.001). Rehabilitation also increased diaphragm thickness during maximum inhalation in both groups. CONCLUSIONS: Based on the study findings, the specialized outpatient rehabilitation program developed for post-COVID-19 patients has proven to be effective and safe.

Foot static disturbances and clinical features in overweight patients with rheumatoid arthritis.

Introduction: Rheumatoid arthritis (RA) is a chronic, inflammatory, connective tissue disease, leading to foot deformities, impairment of locomotive functions, and reducing patients' quality of life. Obesity prevalence is rising in early RA and is associated with worse disease activity, function and health-related quality of life, with a significant negative impact on achieving a low Disease Activity Score in 28 joints (DAS28). The aim of the study was to evaluate foot deformities in overweight RA patients according to the severity of the disease. Material and methods: The study was performed on 50 overweight women with RA. The control group consisted of 50 overweight women free of any disorders. Plantography examination was carried out by means of a CQ ST 2K podoscope. Rheumatoid arthritis disease activity was assessed by DAS28. Activity limitation was assessed using the Health Assessment Questionnaire (HAQ) and foot posture by the Foot Posture Index (FPI-6). Body composition analysis was performed using In Body 220. Results: Hallux valgus was the most frequent deformation in RA patients with overweight. Longitudinal flat foot was much more frequent in RA patients than transverse flat foot. A relationship between fat tissue mass and presence of transverse flat foot in RA patients with overweight was found. In this group DAS28, VAS, and Clarke's angle were correlated with increased value of HAQ. Conclusions: Plantar contourography showed a trend of an increase of α angle values and the Sztriter-Godunow index (KY) in overweight RA patients with increasing severity of radiological changes and DAS28, requiring use of proper prevention and therapeutic strategies of destructive changes.

Balance Disorders in People with History of COVID-19 in Light of Posturographic Tests.

Coronavirus disease-19 (COVID-19), resulting from infection with the SARS-CoV-2 virus, causes not only flu-like symptoms, such as fever, aches, or a dry cough, but also affects the sensory system, leading to a loss of smell and taste or to neurological deficits in the shape of balance disorders and dizziness. PURPOSE OF THE STUDY: Our research aimed to assess the prevalence of balance disorders in patients who had suffered COVID-19. MATERIAL AND METHODS: The study group consisted of 73 subjects with a history of SARS-CoV-2 infection. The control group consisted of 50 healthy people with similar demographics. A balance analysis was performed on a tensometric platform, using the Romberg test. RESULTS: Statistically significant differences between the results of the study group and the control group were obtained in the evaluation of the length of body sways and the area of gravity center, both with open and closed eyes, and in the case of maximum body sways with open eyes. CONCLUSIONS: Patients who have suffered COVID-19 may suffer from balance disorders detectable by posturographic tests.

What Influences Proprioceptive Impairments in Patients with Rheumatic Diseases? Analysis of Different Factors.

Rheumatic diseases lead to postural problems, which increase the risk of falls and lead to greater disability. The aim of the present work is to evaluate posture disorders in patients with osteoarthritis (OA) and rheumatoid arthritis (RA), as well as to evaluate the influence of other factors. A total of 71 subjects were enrolled in this study. Joint position sense (JPS) and the functional assessment of proprioception on a balance platform for both lower limbs were examined. The Average Trace Error (ATE), test time (t), and Average Platform Force Variation (AFV) were calculated. Additionally, an equilibrium test was carried out in the one-legged standing position (Single Leg Stance-SLS). The results were compared in several ways and revealed the following: (1) A JPS of 10° plantar flexion in RA obtained significantly worse results when repeating the movement than OA; the ATEs were significantly lower in RA; and RA needed more support during SLS assessment. (2) RA patients with higher DAS28 had statistically significantly higher values in JPS, with 5° plantar flexion and 10° dorsal flexion, SLS assessment, and stabilometric rates. A statistically significant correlation between DAS28 and RA was found in a JPS of 10° plantar flexion. The VAS ruler demonstrated a significant moderate correlation with t. (3) Patients who experienced at least one fall demonstrated higher JPS and t. Our study shows that proprioception is the most influenced by the nature of the disease and the level of disease activity. We can see that the stability and balance functions are also greatly influenced by the patient's falling experience and the level of pain. These findings may be useful in designing an optimal proprioception-enhancing movement training plan.

Exercise Training as a Non-Pharmacological Therapy for Patients with Pulmonary Arterial Hypertension: Home-Based Rehabilitation Program and Training Recommendations.

Pulmonary arterial hypertension (PAH) is a chronic and progressive disorder with a poor prognosis associated with non-specific symptoms, including general weakness, shortness of breath on exertion, and decreased muscle strength and endurance. Despite recent significant progress in the field of PAH therapy, many patients are still characterized by a dynamic course of the disease, a significant reduction in physical performance, a constantly deteriorating quality of life, and limited activity in everyday life. Thus, the main goal of PAH therapy is to ensure an acceptable level of quality of life as early as possible in the course of the disease, reduce the progression of symptoms and, if possible, improve the prognosis, which is still poor. The perception of the importance of activity and exercise has changed significantly in recent years, and rehabilitation dedicated to PAH patients is now considered to be one of the new adjuvant treatment options. Currently, there is insufficient data on what form, frequency, and intensity of exercise are required for the best results. Nevertheless, exercise training (ET) is necessary in order to reverse the accompanying PAH impairment of exercise capacity and, without additional clinical risk, to maximize the benefits of pharmacotherapy. This review summarizes the current state of knowledge on the rehabilitation of PAH patients and presents the available rehabilitation models. In addition, it includes a ready-to-use, illustrated, safe home rehabilitation program with recommendations for its use. Utilizing ET as an adjuvant treatment option to improve the functional capacity and quality of life of patients may enhance the clinical effectiveness of therapeutic management and contribute to the improvement of the quality of care for patients suffering from PAH. The beneficial effect of exercise training on the development of symptoms improves the clinical course of the disease, and a lower incidence of adverse events can lead to a reduction in health care expenditure.

Evaluation of the Effectiveness of Iontophoresis with Perskindol Gel in Patients with Osteoarthritis of the Knee Joints.

INTRODUCTION: Osteoarthritis (OA) is one of the most common causes of pain in the musculoskeletal system leading to disability. The basic principle of the therapy is the simultaneous use of pharmacological and non-pharmacological treatments. The aim of this study was to evaluate the effectiveness of galvanic and iontophoresis treatments with Perskindol Active Classic Gel (Perskindol) in patients with OA of the knee joints. Moreover, a comparative evaluation of the effectiveness of the application was performed depending on the selection of the active electrode. MATERIAL AND METHODS: The study included 100 patients with gonarthrosis, treated at the Rehabilitation Clinic of the Bialystok University Hospital. Three groups were randomly selected: in group I (n = 33), anodic galvanic treatment was applied, group II (n = 33) received iontophoresis with Perskindol gel from the negative pole ("-" iontophoresis), and group III (n = 34) received iontophoresis with Perskindol gel from the positive pole ("+" iontophoresis). The VAS, the Laitinen questionnaire, the Lequesne Index, the Lysholm questionnaire, and the SF-36v2 health survey were used for the clinical evaluation of the patients. RESULTS: In the group of patients who underwent iontophoresis with the use of Perskindol gel introduced from the positive pole, a statistically significant improvement was shown in all the assessed parameters in comparison to the patients who underwent anodic galvanic treatment. CONCLUSIONS: The most favorable effect of iontophoresis was observed in the case of iontophoresis with Perskindol gel introduced from the positive pole.

Static Foot Disturbances and the Quality of Life of Older Person with Rheumatoid Arthritis.

Disturbed static foot function is one of the main causes of impaired quality of life, which may be related to the frailty syndrome of older adult patients with Rheumatoid Arthitis (RA). The aim of the study was to evaluate the relationship between parameters of static foot function disturbances and quality of life of older adult patients with RA. The study was performed among 102 patients with RA diagnosed according to the American College of Rheumatology (ACR) and EULAR 2010 criteria. Patients were divided into four subgroups depending on radiological evaluation according to the Steinbrocker classification. Plantoconturography examination was conducted using a podoscope with a 3D scanner and software for computer foot examination CQ ST2K. Quality of life of patients with RA was evaluated using the Arthritis Impact Measurement Scales-2 (AIMS-2). A statistically significant relationship between AIMS-2 and parameters of static foot function disturbances was observed. The study revealed correlations between parameters of disturbed static foot function and RA severity in comparison to disease duration. Our results indicate a relationship between static foot function disturbances and quality of life of patients with RA, not only in the area of physical activity, but also in the social an emotional domain. Study results indicate that plantoconturography and assessment of quality of life using AIMS-2 could be useful as a diagnostic and prognostic tool in RA.

Effectiveness and safety of a simple home-based rehabilitation program in pulmonary arterial hypertension: an interventional pilot study.

BACKGROUND: Rehabilitation plays an important role in the management of patients with pulmonary arterial hypertension (PAH) and current guidelines recommend implementation of a monitored individualized exercise training program as adjuvant therapy for stable PAH patients on optimal medical treatment. An optimal rehabilitation model for this group of patients has not yet been established. This randomized prospective study assessed the effectiveness and safety of a 6-month home-based caregiver-supervised rehabilitation program among patients with pulmonary arterial hypertension. METHODS: A total of 39 patients with PAH were divided into two groups: intervention group (16 patients), subjected to a 6-month home-based physical training and respiratory rehabilitation program adapted to the clinical status of participants, and control group (23 patients) who did not perform physical training. The 6-min walk test (6MWT), measurement of respiratory muscle strength, quality of life assessment (SF-36, Fatigue Severity Scale - FSS) were performed before study commencement, and after 6 and 12 months. Adherence to exercise protocol and occurrence of adverse events were also assessed. RESULTS: Physical training significantly improved 6MWT distance (by 71.38 ± 83.4 m after 6 months (p = 0.004), which remained increased after 12 months (p = 0.043), and respiratory muscle strength after 6 and 12 months (p < 0.01). Significant improvement in quality of life was observed after the training period with the use of the SF-36 questionnaire (Physical Functioning, p < 0.001; Role Physical, p = 0.015; Vitality, p = 0.022; Role Emotional, p = 0.029; Physical Component Summary, p = 0.005), but it did not persist after study completion. Adherence to exercise protocol was on average 91.88 ± 14.1%. No serious adverse events were noted. CONCLUSION: According to study results, the home-based rehabilitation program dedicated to PAH patients is safe and effective. It improves functional parameters and quality of life. Strength of respiratory muscles and 6MWD remain increased 6 months after training cessation. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03780803 . Registered 12 December 2018.

Usefulness of high-speed digital imaging (HSDI) in the diagnosis of oedematous - hypertrophic changes of the larynx in people using voice occupationally.

INTRODUCTION: The aim of the study is the evaluation of the usefulness of High-Speed Digital Imaging (HSDI) in the diagnosis of organic dysphonia in a form of oedematous-hypertrophic changes of vocal fold mucosa, morphologically confirmed by Transmission Electron Microscopy (TEM) method in patients working with voice occupationally. MATERIAL AND METHODS: The group consisted of 30 patients working with voice occupationally with oedematous-hypertrophic changes of vocal fold mucosa. Parameters of vocal folds vibrations were evaluated using HSDI technique with a digital HS camera, HRES Endocam Richard Wolf GmbH. The image of vocal folds was recorded with a rate of 4000 frames per second. Postoperative material of the larynx was prepared in a routine way and observed in transmission electron microscope OPTON 900-PC. RESULTS: HSDI technique allows to assess the real vibrations of vocal folds and determine many parameters. The results of TEM in the postoperative material showed destruction of epithelial cells with severe vacuolar degeneration, the enlargement of intercellular spaces and a large number of blood vessels in the stroma, which indicates the presence of oedematous-hypertrophic changes of the larynx. DISCUSSION: The ultrastructural assessment confirm the particular usefulness of HSDI method in the diagnosis of organic dysphonia in a form of oedematous-hypertrophic changes. Key words: High-Speed Digital Imaging, oedematous-hypertrophic changes, vocal fold mucosa, larynx.

Clinical usefulness of videocapillaroscopy and selected endothelial cell activation markers in people with Type 1 diabetes mellitus complicated by microangiopathy.

PURPOSE: Microvascular abnormalities are one of the most important causes of persistent diabetic complications. The aim of our study was to compare microvascular changes examined by nailfold videocapillaroscopy (NVC) examination with serum concentrations of vascular endothelial growth factor (VEGF), soluble thrombomodulin (sTM) and endothelin-1 (ET-1) in people with Type 1 diabetes with and without microangiopathy. MATERIAL/METHODS: The study included 106 people with Type 1 diabetes and 40 healthy controls. All participants were evaluated by extensive clinical, laboratory and capillaroscopic studies. NVC was performed using a stereomicroscope SZ 4045 (Olympus, Germany). The intensity of morphological changes was graded from 0 to 3. Serum levels of VEGF, sTM and ET-1 were determined by an enzyme-linked immunosorbent assay (ELISA). RESULTS: Morphological changes were observed by NVC in 86 out of 106 (81%) people with Type 1 diabetes mellitus. Severe capillaroscopic changes (score 3) were seen in 32 out of 54 (59%) people with microangiopathy, but in only seven out of 52 (13%) individuals without microangiopathy. Higher serum concentration of VEGF (p<0.001), ET-1 (p<0.001) and sTM (p<0.05) were demonstrated in people with diabetes complicated with microangiopathy compared to healthy controls. Moreover, comparison between people with and without microangiopathic complications showed a significantly higher capillaroscopic score and sTM serum concentration in the group with retinopathy (p<0.001) nephropathy (p<0.001) and neuropathy (p<0.01). CONCLUSIONS: Our results suggest that abnormalities in NVC may reflect the extent of microvascular involvement and associated with higher VEGF, sTM and ET-1 serum levels, as well as with microangiopathic complications in diabetic people.

Evaluation of foot static disturbances in patients with rheumatic diseases.

OBJECTIVES: Rheumatic diseases such as osteoarthritis and rheumatoid arthritis constitute the most frequent pathological states leading to the development of foot deformities, which reduce quality of life and cause disability. The aim of the present study was to compare the results of plantoconturographic examinations, obtained by means of a computer podoscope, in osteoarthritis and rheumatoid arthritis patients. Special attention was paid to the differences in the values of each parameter determining the level of foot function. MATERIAL AND METHODS: The study was performed in 94 female patients divided into two groups according to the type of disease. There were 54 patients with rheumatoid arthritis and 40 with osteoarthritis. The control group consisted of 34 healthy women. The plantographic assessment of static foot structure was carried out by means of a device for computer-aided foot examination. RESULTS: A fallen transverse arch of the right foot was statistically much more frequent in the rheumatoid arthritis patients than in osteoarthritis patients or the control group (p < 0.005 and p < 0.05, respectively). Significant differences in the values of the Wejsflog index were observed in the case of left foot between rheumatoid arthritis patients and the control group (p < 0.05). Similarly, there were statistically significant differences in the values of the hallux valgus angle (α) for the right foot between rheumatoid arthritis and osteoarthritis patients or control group (in both cases p < 0.05). CONCLUSIONS: Rheumatic diseases predispose patients to disturbances of static foot function. The obtained results highlight the importance of diagnosing foot static disturbances in the prevention of destructive changes affecting the functioning of osteoarthritis and rheumatoid arthritis patients.

[High-speed digital imaging in the diagnosis of voice pathologies]. / Technika szybkiego filmu w sekwencji cyfrowej w diagnostyce patologii narzadu glosu.

Technique of high-speed digital imaging (HSDI) is unique technique, allowing for assessment of real vocal fold vibrations. AIM: The aim of the study is to present the usefulness of HSDI in the diagnosis of clinical type of dysphonia. MATERIALS AND METHODS: The study group was diagnosed at the Department of Clinical Phonoaudiology and Logopedics at the Medical University of Bialystok and treated at the Phoniatric Clinic in years 2012-2015. HSDI technique with a digital camera was used for visualization of the larynx. The rigid endoscope with 90° optics was used for visualizing the vocal folds vibrations during phonation of "e" vowel, at the rate of 4000 frames per second. Playback of recorded sequence set at 15 frames per second, what allowed to assess vocal folds vibrations in slow motion mode during over 8 minutes. Mucosal wave (MW), glottal closure, symmetry, regularity and synchrony of vocal fold vibration were analyzed. Digital kymography (DKG) of the larynx was made for analyzing the value of the Open Quotient (OQ) in the assessment of degree of glottal insufficiency. RESULTS: In the analyzed group of patients, the functional dysphonia was diagnosed in 71%, organic dysphonia in 29% patients. In 68%, glottal insufficiency was registered in the rear part at the glottis. The oedematous-hypertrophic changes were diagnosed in 21% of the cases, hypertrophic changes of larynx - in 6%, vocal fold polyps - in 3% and vocal fold nodules - in 2% of patients. CONCLUSIONS: Examination of the larynx by using HSDI technique is quick, non-invasive to patient. HSDI allows to objective assessment of the degree of severity of insufficiency of glottal closure, what is confirmed by the objective values of the OQ. Evaluation of MW allows for the differentiation of clinical type and severity of organic dysphonia.

Efficacy of daytime transcutaneous electrical stimulation of the genioglossus muscle in patients with obstructive sleep apnea syndrome: short report.

Obstructive sleep apnea syndrome (OSAS) is characterized by hypotonia of lingual and suprahyoid muscles. Genioglossus muscle is responsible for protrusion and depression of the tongue. Its dysfunction results in occlusion of the upper airways and greater incidence of apnea-hypopnea events during sleep. The aim of this prospective study was to compare the effects of daytime transcutaneous electrical stimulation of the genioglossus muscle and standard continuous positive airway pressure (CPAP) therapy on the quality of sleep, in patients with OSAS. During a 4-week study period, 19 patients with OSAS were subjected to daytime transcutaneous electrical stimulation of the genioglossus muscle before sleep and another 19 subjects underwent standard CPAP therapy. Polysomnography (apnea-hypopnea index, AHI), Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) were used to diagnose OSAS and to verify the efficacy of both treatments. Electrical stimulation treatment was reflected by a decrease in PSQI (p = 0.012) but did not influence ESS and AHI values (p > 0.05). In turn, CPAP therapy resulted in a significant decrease in ESS and AHI values (p < 0.001) but exerted no effect on PSQI (p = 0.089). Despite improvement of sleep quality, electrical stimulation does not seem to reduce AHI values in patients with OSAS. Daytime electrical stimulation can be considered as an adjunct treatment in OSAS. Future prospective studies should center on the identification of patients with OSAS who may benefit most from transcutaneous electrical stimulation.

[Excessive daytime sleepiness and risk for obstructive sleep apnea in the public transport drivers]. / Ocena wystepowania wzmozonej sennosci w ciagu dnia oraz ryzyka obturacyjnego bezdechu podczas snu u kierowców zawodowych komunikacji miejskiej.

BACKGROUND: Obstructive sleep apnea (OSA) is a set of symptoms related to the increased upper airways resistance during sleep (due to pharyngeal walls collapse) leading to intermittent airflow obstruction in the lungs. One of the most severe OSA symptoms is excessive daytime sleepiness. Sustained daytime sleepiness may impair cognitive functions and thus influence the everyday functioning of affected person. MATERIAL AND METHODS: The aim of the study was to prospectively assess excessive daytime sleepiness and the risk for OSA in municipal bus drivers. The study was performed in a group of 103 men. The anonymous survey comprised Epworth Sleepiness Scale (ESS) for daytime sleepiness assessment and STOP-Bang Questionnaire (SBQ) for OSA risk assessment. RESULTS: In 43 (42%) respondents OSA risk was assessed as low, while moderate and high risk was observed in 55 (53%) and 5 (5%) drivers, respectively. Severe daytime sleepiness correlated positively with ESS results (r = 0.32; p < 0.05). In drivers with high OSA risk revealed in SBQ no correlation with high ESS was observed. CONCLUSIONS: In drivers with moderate and high OSA risk a sleep medicine specialist consultation with a consecutive diagnostic procedures is necessary. STOP-Bang Questionnaire and ESS are the fast tools to identify patients at increased risk for OSA.

Application of plantography examination to the assessment of foot deformity in patients with rheumatoid arthritis.

INTRODUCTION: Rheumatoid arthritis (RA) is a chronic, inflammatory and multiple-system disorder of connective tissue. It frequently affects joints and periarticular structures of feet that constitute a significant supporting element underlying normal gait and motion of the body centre of gravity. The aim of the study was to evaluate foot deformities on the basis of plantography examination in RA patients according to the severity of the disease. MATERIAL AND METHODS: The study was performed on 54 RA patients. The control group consisted of 34 volunteers free of any disorders. Plantography examination was carried out by means of a CQ ST2K podoscope. The following parameters were applied to the assessment of the disturbances of foot statics: hallux valgus angle (α), Sztriter-Godunow index (KY), Wejsflog's index (Wwp) and Clarke's angle (CL). RESULTS: Markedly higher values of the α angle were noted in RA patients, reflecting the presence of hallux valgus. Moreover, values of the α angle were higher in patients in the third stage of radiological changes than those in the second one. On the other hand, values of Clarke's angle for the right foot were significantly higher in men in the second and third stage of RA compared to the control group. The most common deformities in RA patients include HV and transverse flat foot, more explicit in women in the third stage of RA. CONCLUSIONS: Plantography examination has been shown to constitute a useful diagnostic tool for assessment and monitoring of foot deformities in RA patients.

Parameters of the assessment of voice quality and clinical manifestation of rheumatoid arthritis.

PURPOSE: The aim of the study was to investigate the voice quality parameters in 72 rheumatoid arthritis (RA) patients and their relationships with the clinical manifestations and disease activity. The control group consisted of 30 healthy subjects. MATERIAL AND METHODS: All RA patients were evaluated by extensive clinical, laboratory and radiographic studies. The phoniatric assessment included the analysis of vocal folds vibrations by digital stroboscopy (DS) of the larynx using HRES ENDOCAM 5562 system, digital kymography (DKG) and High-Speed Digital Imaging (HSDI) technique. The acoustic voice analysis was conducted using DiagnoScope Specialist program. RESULTS: Voice quality disorders were registered in 32 (44.44%) RA patients and observed more frequently in patients with moderate and severe activity (DAS28≥3.2) than in mild RA. In digital stroboscopy, confirmed by digital kymography, the hypofunctional dysphonia was observed especially in patients with DAS28≥3.2. Outcomes of the subjective assessment of voice quality were in accordance with the objective parameters and acoustic voice examination. CONCLUSIONS: In RA patients the most frequent voice quality disorders with hypofunctional dysphonia were registered. The relationships between voice quality disorders, clinical activity and radiographic progression of RA patients were observed. Digital stroboscopy, digital kymography, High-Speed Digital Imaging and acoustic voice analysis used in the complex diagnosis of RA confirmed the presence of pathological changes in the larynx. There is a need of cooperation between rheumatologists and phoniatricians in the diagnosis and treatment of dysphonia in RA patients.

The influence of Multiwave Locked System (MLS) laser therapy on clinical features, microcirculatory abnormalities and selected modulators of angiogenesis in patients with Raynaud's phenomenon.

The aim of this study was to investigate the influence of the Multiwave Locked System (MLS) laser therapy on clinical features, microvascular changes in nailfold videocapillaroscopy (NVC) and circulating modulators releasing as a consequence of vascular endothelium injury such as vascular endothelial growth factor (VEGF) and angiopoietin 2 (Ang-2) in patients with primary and secondary Raynaud's phenomenon. Seventy-eight RP patients and 30 healthy volunteers were recruited into the study. All patients with RP received MLS laser irradiation for 3 weeks. Clinical, NVC and laboratory investigations were performed before and after the MLS laser therapy. The serum concentration of VEGF and Ang-2 were determined by an enzyme-linked immunosorbent assay (ELISA). After 3 weeks of MLS laser therapy, the clinical improvement manifested by decreasing of the number of RP attacks, mean duration of Raynaud's attack and pain intensity in RP patients was observed. After MLS laser therapy in 65% of patients with primary and in 35% with secondary RP, an increase in the loop number and/or a reduction in avascular areas in NVC were observed. In comparison with a control group, higher serum concentration of VEGF and Ang-2 in RP patients was demonstrated. After MLS laser therapy, a reduction of Ang-2 in both groups of RP patients was found. Our results suggest that NVC may reflect microvascular changes associated with clinical improvement after MLS laser therapy in patients with primary and secondary RP. Ang-2 serum levels may be a useful marker of microvascular abnormalities in RP patients treated with MLS laser therapy.

Incidence of Chlamydia trachomatis infection in patients with reactive arthritis.

OBJECTIVES: The aim of the study was to evaluate the incidence of Chlamydia trachomatis in patients with reactive arthritis (ReA) within the area of the Podlaskie province (north eastern Poland). MATERIAL AND METHODS: The study concerned 323 patients including 132 women and 191 men diagnosed with ReA. The material for C. trachomatis was collected from the urethra in men and the cervical canal in women. Also, every patient was tested for the presence of anti-C. trachomatis IgG class antibodies, while 121 individuals were additionally tested for IgA class antibodies. In the direct studies, the direct immunofluorescence (DIF) method or polymerase chain reaction (PCR) was used. The immunoenzymatic method was used to detect anti-C. trachomatis antibodies. The control group in the case of direct studies comprised 125 individuals, while in the case of serology research it included 127 (IgG) and 109 (IgA) persons. RESULTS: Chlamydia trachomatis infection in the urethral and cervical smears was found in 42 patients (13.0%) including 20 women (15.2%) and 22 men (11.5%). In the control group chlamydia was detected in 3 patients (2.4%) including 4% of women and 2% of men. IgA class antibodies were present in 10/121 (8.3%) patients, similarly in women and in men (8.2% and 8.3% respectively). In the control group the specific IgA class antibodies were found in 3/85 patients (3.5%). Anti-C. trachomatis IgG antibodies were found in 70/323 patients (21.7%), similarly in men and women. CONCLUSIONS: Chlamydia trachomatis is a common bacterial factor observed in the genitourinary system of patients with ReA. The outcomes of studies within the Podlaskie province indicate less frequent presence of chlamydial infection compared with Dolnoslaskie province.No correlations between detecting the presence of C. trachomatis in the urogenital tract and the presence of specific antibodies in the serum of ReA patients were observed.Concurrent direct studies of the urogenital tract and a serological blood test increase the chance of detecting C. trachomatis infection.

Raynaud's phenomenon: new aspects of pathogenesis and the role of nailfold videocapillaroscopy.

Raynaud's phenomenon (RP) refers to paroxysmal pallor or cyanosis of the digits of the hands or feet and, infrequently, the tips of the nose or ears (acral parts) owing to cold-induced vasoconstriction of the digital arteries, precapillary arterioles, and cutaneous arteriovenous shunts. Raynaud's phenomenon reflects an exaggeration of normal central and local vasomotor responses to cold or emotion. Raynaud's phenomenon has been classified as primary or secondary, depending on whether it occurs as an isolated condition or is associated mainly with a connective tissue disease. Dysregulation of autonomic and sensitive nerve fibers, functional and structural vessel changes, and intravascular alterations can be observed in the pathogenesis of RP. Nailfold videocapillaroscopy (NVC) is the best non-invasive and repetitive diagnostic technique for detecting morpho-functional changes in the microcirculation. Nailfold videocapillaroscopy is accepted in early diagnosis and monitoring of primary and secondary RP.

Visual assessment of voice disorders in patients with occupational dysphonia.

INTRODUCTION: In a group of persons using the voice occupationally, the frequent symptoms are hoarseness, voice fatigability and aphonia. Pathological changes in the larynx may have organic or functional character which require different methods of treatment and rehabilitation. Visualization of vibrations of the vocal folds is an essential condition for an appropriate assessment of the causes of dysphonia. OBJECTIVE: The purpose of the study is assessment of the usefulness of a high-speed imaging (HSI) system in the diagnosis of functional and organic dysphonia of occupational character, compared with digital kymography (DKG) and digital stroboscopy (DS) with a high resolution module. MATERIAL AND METHODS: The study group consisted of 64 patients with voice quality disorders with features of occupational dysphonia. The control group consisted of 15 patients with euphonic voice. Analysis of the voice quality parameters during phonation of the 'e' vowel was performed using HSI, DKG and stroboscopy of high resolution, by means of a digital HS camera (HRES Endocam, Richard Wolf GmbH, Knittlingen, Germany). Vocal folds vibrations were registered at the rate of 4,000 frames per second. RESULTS: HSI is the most reliable diagnostic tool giving the possibility of an analysis of the true vibrations of the vocal folds. It also enables an observation of the aperiodicity of vibrations of the vocal folds, while DS with high resolution allows diagnosis of the periodicity of the vibrations. CONCLUSIONS: HSI is particularly useful in the diagnosis of neurologically-based pathology of the voice (paralytic dysphonia) and organic dysphonia. The quickest method of diagnosing the phonatory paresis of the glottis is DKG. The advantage of both HSI and DKG is the non-invasiveness of examinations; however, their limitations are time-consuming and the high cost of equipment.