ChatGPT in the development of medical questionnaires. The example of the low back pain.

In the last year, Chat Generative Pre-Trained Transformer (ChatGPT), a web software based on artificial intelligence has been showing high potential in every field of knowledge. In the medical area, its possible application is an object of many studies with promising results. We performed the current study to investigate the possible usefulness of ChatGPT in assessing low back pain. We asked ChatGPT to generate a questionnaire about this clinical condition and we compared the obtained questions and results with the ones obtained by other validated questionnaires: Oswestry Disability Index, Quebec Back Pain Disability Scale, Roland-Morris Disability Questionnaire, and Numeric Rating Scale for pain. We enrolled 20 subjects with low back pain and we found important consistencies among the validated questionnaires. The ChatGPT questionnaire showed an acceptable significant correlation only with Oswestry Disability Index and Quebec Back Pain Disability Scale. ChatGPT showed some peculiarities, especially in the assessment of quality of life and medical consultation and treatments. Our study shows that ChatGPT can help evaluate patients, including multilevel perspectives. However, its power is limited, and further research and validation are required.

Nutritional management of individuals with SARS-CoV-2 infection during rehabilitation.

The combination of poor dietary intake and increased healthcare needs predisposes COVID-19 patients to malnutrition and sarcopenia. The scope of this narrative review is tο present epidemiology and etiology of malnutrition and sarcopenia in COVID-19 patients, their consequences as well as the content and delivery mode of optimum nutritional services for malnourished/sarcopenic COVID-19 patients in the rehabilitation setting. This narrative review also summarizes nutritional recommendations, consensus statements and treatment pathways developed by scientific societies for COVID-19 patients. COVID-19 patients are prone to malnutrition and sarcopenia due to inactivity, comorbidities, cytokine response, nutritional deficiencies, anosmia, loss of taste, anorexia and treatment with dexamethasone. Thus, all COVID-19 patients, including those who are overweight or obese, should be regularly screened for malnutrition and sarcopenia at admission to the rehabilitation setting, using a validated tool to identify those with (or at risk of) malnutrition. As a consequence of malnutrition and sarcopenia, COVID-19 patients demonstrate diminished immune potential, lower respiratory function, swallowing dysfunction, and low resilience to metabolic stress. COVID-19 patients have increased energy (27-30 kcal/day) and protein needs (1-1.5 g/kg body weight/day). Personalized nutritional education and counseling, food fortification with energy dense and/or protein rich whole foods or with powdered supplements and use of high protein, energy dense oral nutritional supplements are recommended.

Does group-based high-intensity aerobic interval training improve the inflammatory status in patients with chronic heart failure?

BACKGROUND: Chronic heart failure (CHF) is a multifaceted syndrome associated with endothelial dysfunction and increased inflammation. Despite the existing controversies regarding the appropriate training modality, it is widely accepted that supervised cardiac rehabilitation (CR) interventions lead to proinflammatory biomarkers reduction and cellular adhesion molecules in patients with CHF. AIM: The aim of the study was to quantify the effects of 12-week group-based high-intensity aerobic interval training (HIAIT)/modified group-based HIAIT intervention (m-Ullevaal) vs. moderate continuous training (MICT) on serum levels of proinflammatory biomarkers. DESIGN: Single-blind, two-arm, prospective randomized controlled trial conducted on CHF outpatients performing group-based CR interventions throughout a 12-week period. SETTING: The setting of the study was the Medical Center of Outpatient Rehabilitation and Sports Medicine, Plovdiv, Bulgaria. POPULATION: The population included a total of 120 outpatients of both genders, mean age of 63.73±6.68 years, with stable CHF (NYHA classes II to IIIB, were randomly assigned to HIAIT/ m-Ullevaal (N.=60) or to MICT (N.=60) group. METHODS: Functional exercise capacity (FEC) of the eligible subjects was evaluated through 6-minute walk test (6MWT) and peak oxygen uptake. Blood samples were drawn at baseline, after 12 weeks follow-up for analyses of C-reactive protein (CRP), tumor necrosis factor-α (TNFα) and cellular adhesion molecules (CAM). RESULTS: Significant decreases in the serum levels of CRP (P=0.029), TNF-α (P=0.036), and vascular cell adhesion molecule-1 (VCAM-1) (P=0.040), were observed after 48 training sessions in the group-based HIAIT/m-Ullevaal intervention, except for intercellular adhesion molecule-1 (ICAM-1), which was higher in the MICT (P=0.034). FEC was significantly inversely related to CRP (r=-0.72, P<0.05), and the levels of VCAM-1 (r=-0.68, P<0.05). CONCLUSIONS: Both group-based CR interventions (HIAIT/m-Ullevaal and MICT) significantly reduced the serum levels of CRP, TNF- α, ICAM-1 and VCAM in patients with CHF. However, selected proinflammatory biomarkers changes and CAMs favorably decreased in the group-based HIAIT/m-Ullevaal intervention. The responses on serum levels of proinflammatory biomarkers and CAMs are dependent upon the type, intensity, and CR intervention duration. CLINICAL REHABILITATION IMPACT: The group-based high-intensity aerobic interval training reduces significantly the proinflammatory biomarkers and cellular adhesion molecules in patients with chronic heart failure.

Compassionate Drug Use - Time Arising for a New Law in Bulgaria in the Era of COVID-19.

INTRODUCTION: Despite clinical trials, there are still no approved specific therapies or any vaccine against COVID-19. The only option available is using investigational drugs for compassionate use. The update of the existing regulation regarding compassionate use is to ensure the effective and sustainable development of health policies and technologies over the COVID-19 pandemic and beyond. AIM: The present short communication aimed to highlight the need for early and expanded access to investigational drugs for compassionate use as well as a call for an update of the existing regulation in Bulgaria concerning compassionate use in the era of COVID-19. MATERIALS AND METHODS: In EU and Bulgaria as well, the legal framework for compassionate use was introduced by Article 83 (1) of Regulation (EC) No 726/2004 of the European Parliament and of the Council; in principle, Regulations of the European Parliament and of the Council are mandatory for all Member States. Remdesivir appears to have a favorable clinical and safety profile, as reported in a case involving patients with severe COVID-19 through a compassionate use programme. RESULTS: The overall probability of clinical improvement observed in 36 of 53 COVID-19 patients received intravenous remdesivir as part of a compassionate use programme was 68% (95% CI 40% to 80%). Thirty two patients (60%) demonstrated at least one adverse event, twelve 12 patients (23%) experienced serious adverse events and seven patients (13%) died. CONCLUSION: The global pandemic mandates Bulgarian Drug Agency for a reasonable update of the existing national regulation concerning compassionate use and off-label therapies. In the era of COVID-19, it is important for Bulgarian patients to have early and expanded access to investigational drugs for compassionate use.

Group-based cardiac rehabilitation interventions. A challenge for physical and rehabilitation medicine physicians: a randomized controlled trial.

BACKGROUND: In recent decades, many studies are focused on different training modalities comparison in patients with cardiac diseases. High intensity aerobic interval training (HIAIT) has been considered as an alternative approach to moderate-intensity continuous training (MICT) in rehabilitation of patients with chronic heart failure (CHF). AIM: To highlight the superiority of the modified group-based HIAIT intervention (m-Ullevaal) compared to the moderate-intensity continuous training (MICT), also to encourage physical and rehabilitation medicine (PRM) physicians to apply the m-Ullevaal intervention in routine cardiac rehabilitation (CR) practice. DESIGN: А single-blind, prospective randomized controlled trial. SETTING: Medical Center of Rehabilitation and Sports Medicine, Plovdiv, Bulgaria outpatients were enrolled. POPULATION: One hundred and twenty subjects of both genders, mean age of 63.73±6.68 years, with stable CHF, NYHA classes II to IIIB, were randomly assigned to m-Ullevaal group (N.=60) or to MICT (N.=60) group. Both CR protocols were conducted throughout a 12-week period. METHODS: Functional exercise capacity (FEC), assessed with six-minute walk test, and peak oxygen uptake (VO2peak), left ventricular ejection fraction (LVEF), m-Borg's perceived exertion scale (mBPES), and quality of life (QoL) were outcome measures evaluated. RESULTS: Significant improvement in FEC (P<0.001), LVEF (P<0.001), mBPES and QoL (P<0.001), was observed 12 weeks after both CR interventions (T2). However, the participants performed m-Ullevaal protocol achieved a greater improvement compared to those performed MICT (P<0.001). CONCLUSIONS: The m-Ullevaal protocol seems to be more beneficial and more effective compared to MICT. PRM physicians can efficiently apply the m-Ullevaal protocol in CHF patients rehabilitation. CLINICAL REHABILITATION IMPACT: Group-based HIAIT interventions can be widely applied by PRM physicians in CHF patients rehabilitation.

Percutaneous endoscopic ventral facetectomy: An innovative substitute of open decompression surgery for lateral recess stenosis surgical treatment?

BACKGROUND: Percutaneous transforaminal endoscopic surgery (PTES) constitutes an innovative method principally recruited for the treatment of lumbar disc herniation. Indication spectrum of PTES is constantly widened in current years. Hence, PTES has been proposed to represent a satisfactory alternative for the treatment of lateral recess stenosis (LRS), being defined as percutaneous endoscopic ventral facetectomy (PEVF) in these cases. The aim of this original study is to determine, for the first time in the literature, the outcomes of PEVF, especially in otherwise healthy nonelderly patients with LRS, alongside with special focus in health-related quality of life (HRQoL) assessment. MATERIALS AND METHODS: Eighty-five otherwise healthy individuals from 58 to 64 years were diagnosed with LRS, being subjected to successful PEVF. Patients were prospectively evaluated in 6 weeks, in 3, 6, and 12 months, and in 2 years postoperatively. Visual analog scales (VASs) were separately utilized for leg and low back pain evaluation (VAS-LP and VAS-BP, respectively), whereas Short Form-36 (SF-36) questionnaire was sequentially implemented for HRQoL assessment. RESULTS: All indexes of SF-36 as well as VAS-LP featured maximal amelioration in 6 weeks postoperatively, with subsequent further enhancement until 3 months and successor stabilization until 2 years. In contrast, VAS-BP presented minimal quantitative amelioration in 6 weeks, featuring no additional alterations. Values of all indexes in all follow-up intervals were demonstrated to be statistically significant in comparison with preoperative values (P < 0.05). No remarkable differentiation was observed between distinct parameters of SF-36. CONCLUSIONS: PEVF implementation in nonelderly patients with LRS was displayed to be safe and effective, providing alongside considerable improvement in HRQoL 2 years postoperatively.

Oblong Sesamoid Bone Appearance into the Nuchal Ligament. A Case Report.

Radio-opaque formations behind the spinous processes of the cervical spine are really rare. They were described in 1929 for the first time. Sesamoid ossicles are found close to a bone or a joint and are usually small. Some sesamoids form part of normal human anatomy, while others are normal anatomical variants. We report a case of a 73-year-old Caucasian male who visited the outpatient clinic complaining about chronic cervical pain. An oblong sesamoid accidentally discovered during routine anteroposterior (AP) and lateral x-ray, within the nuchal ligament (NL) at the C3-C6 spinous processes level. A cervical MRI scan was performed and the result showed 'fabella nuchae'. This type of sesamoids are rarely symptomatic, but it should be differentially diagnosed anyway. We review its morphology, the mechanical factors of the region acting throughout life and last, but not least, the differential diagnosis.

Cauda Equina Syndrome Due to Lumbar Disc Herniation: a Review of Literature.

Cauda equina syndrome (CES) is a rare neurologic condition that is caused by compression of the cauda equina. Cauda equina consists of spinal nerves L2-L5, S1-S5 and the coccygeal nerve. The compression of these nerve roots can be caused mainly by lumbar disc herniation (45% of all causes). The diagnosis consists of two critical points: a) detailed history and physical examination and b) MRI or CT. The gold standard of the treatment of this syndrome is the surgical approach in combination with the timing of onset of symptoms. The surgery as an emergency situation is recommended in the fi rst 48 hours of onset of symptoms. Any delay in diagnosis and treatment leads to a poor prognosis of CES.

Physical Improvement and Biological Maturity of Young Athletes (11-12 Years) with Systematic Training.

AIM: The aim of this study was to investigate the influence of systematic training in physical growth and biological maturity in prepubertal males and estimate how this affects the physical growth and skeletal maturity. MATERIALS AND METHODS: 177 primary school students of the fifth and sixth grade, from schools in Alexandroupolis, participated voluntarily in our study. Questionnaires were used in order to measure physical activity levels. The subjects were subdivided into two groups; control group (prepubertal, whose physical activity was the physical education of their school and which had never participated in systematic training, n = 95) and experimental group (prepubertal, whose weekly physical activity included physical education in their schools and additionally 3-4 training units organized training in various sports clubs in the city, n = 82). The following parameters were recorded: biological age measured by determination of skeletal age; bone density measured by ultrasound methods; anthropometric and morphological features such as height, body composition, selected diameters, circumferences and skinfolds; motor ability features. RESULTS: The experimental group exhibited older biological age (p = 0.033), higher bone density (p < 0.001), lower BMI and body fat (p < 0.001), better anthropometric features and higher performance throughout all motor ability tests (p < 0.05), compared to the control group. CONCLUSION: The present study demonstrates that systematic physical activity has a positive effect on both the physical and biological maturity of pre-pubertal children. This effect is mainly expressed in bone strengthening as a result of the increased bone density and in improvement of the kinetic skills of pupils who participated in organized extracurricular sport-activities.

The structure of trauma patients, its management and health care in the University Hospital of Alexandroupolis.

OBJECTIVE: The present study was designed to describe the patterns of trauma patients using a newly-introduced trauma registry, as well as retrospectively assess the management and outcome facts of these patients. MATERIALS AND METHODS: The study included 2346 patients (62.15% male) with a mean age of 34.06 +/- 23.77 years. Of these patients, 355 were multiple trauma patients. Privately owned vehicles were used as a mode of transportation for most of the trauma patients (96.65%). Data regarding patient demographics, arrival at the Emergency Department, mechanism of injury, injury severity, anatomical location and type of injury were collected and analyzed. RESULTS: Falls were the most prevalent mechanism of injury, accounting for 62.19% of the total admitted cases, with other causes (that also included occupational accidents and machinery trauma) being the second most prevalent, and MVAs--the third with a rate of 11.46%. The most commonly injured body regions were the extremities (50.26%), the head (42.50%), and the torso (19.39%). Fractures represented 11.46% of the injuries, while open wounds were much more frequent (29.41%). The mean abbreviated injury severity (AIS) score was 1.78 +/- 1.48 for all admitted patients and 3.56 +/- 1.02 for multiple trauma patients. A multi-disciplinary approach was required for 23% of the multiple trauma patients. The clinic admission rate for the whole patient sample was 13.55% and 48.96% for multiple trauma patients. The mean duration of stay for all clinic admissions was 2.7 days and 2.9 days for multiple trauma patients. CONCLUSIONS: With the epidemiology of trauma in Greece being rather poorly investigated, the present study manages to identify the major epidemiological patterns of trauma cases presenting to a tertiary regional hospital and addresses the need for development and implementation of injury prevention activities and policies.

Exercise training modes in rehabilitation of patients with chronic heart failure.

Modern cardiac rehabilitation (CR) in chronic heart failure (CHF) is a multidisciplinary process with the patient being the centre of the focus. Various CR models (inpatient, outpatient and home based) have been used the last two decades in the pursuit of higher effectiveness and better results. The aim of this review is to present different exercise training modes applied in rehabilitating patients with CHF and to highlight their clinical value, advantages and disadvantages and practical implication.

Fractures of the femoral neck treated with hemiarthroplasty. A comparative study.

INTRODUCTION: Hemiarthroplasty is the treatment of choice in the management of displaced intracapsular fractures of the proximal femur in old patients with low functional demands. AIM: To assess the effectiveness of cementless Austin-Moore and the cemented Thompson prostheses used in the treatment of displaced intracapsular fractures of the proximal femur. PATIENTS AND METHODS: We studied retrospectively 376 patients with fresh, displaced, nonpathological femur neck fractures. They were treated with either a cementless Austin-Moore prosthesis or a cemented Thompson prosthesis. Criteria for the choice of the prosthesis were the fracture site on the neck of the femur and the bone quality. The follow-up period was 3 to 8 years and the number of reviewed patients was 122. RESULTS: The Thompson prosthesis group showed slightly better results. Acetabular erosion rate was significantly lower in the uncemented group while loosening rate here was significantly higher. CONCLUSION: Advantages and disadvantages were identified in both groups although we believe that none of the approaches proved definitively superior to the other.

Quality of life in patients with Parkinson's disease.

BACKGROUND: Health-related quality of life has been increasingly recognized as an important outcome measure for patients with Parkinson's disease because both motor and non-motor symptoms affect patients' functioning and well being. OBJECTIVE: To assess the quality of life (QoL) of patients with Parkinson's disease (PD) and to determine the extent of negative impact of disease on various aspects of their lifestyles. PATIENTS AND METHODS: A sample of 866 patients with PD, at the mean age of 73.76 +/- 0.25 years (range 46 to 88 years) was studied. We used the specific tool PDQ-39 Bb (a validated Bulgarian version of PDQ-39 Eng). The QoL was assessed in all patients and analyzed by gender and residence (urban-rural). SPSS v11.5 software was used for the statistical analyses. We used descriptive statistics and the Mann-Whitney U test for the comparisons between groups. RESULTS: Highest average scores in relative points (corresponding to poor QoL) were obtained for the dimensions "mobility" (57.08), "bodily discomfort" (55.68), "activities of daily living" (54.25) and "emotional well-being" (53.70). Women gave significantly more negative assessment of their QoL than men in the aspects "mobility", "emotional well-being", "social support" and "bodily discomfort", and rural residents gave more negative assessment of "mobility", "activities of daily living" and "stigma". CONCLUSIONS: The study demonstrated that PD had a significantly negative impact on patients' QoL. In some aspects the impact was significantly more aggravating in women and rural residents.