Importance of Rehabilitation in Primary Knee Osteoarthritis.

In our observational study, we aim to highlight the role of rehabilitation program in the control and maintaining of the clinical and functional status of people with primary knee osteoarthritis and co-morbidities. We established that the complete rehabilitation program (diet, symptomatic medication and herbal products, electrotherapy measures and kinetic exercises) will give the optimal healthcare for this type of patients.

Posttraumatic Complex Regional Pain Syndrome and Related Comorbidities.

The complex regional pain syndrome (CRPS) is a neuropathic disorder, often precipitated by a fracture, injury of the soft tissue or a surgical procedure followed by extended immobilization. Clinical signs and symptoms of this syndrome include abnormalities of pain processing (mechanical and thermal allodynia, hyperalgesia and hyperpathia), skin changes regarding local temperature and the presence of erythema, cyanosis or mottled appearance, neurogenic edema, motor and trophic disorders. The CRPS has three evolutionary stages-acute, dystrophic and atrophic, and it is divided into two types, reflecting the absence or presence of nerve damage. The patient presented in this study was a female with a history of metabolic syndrome, diagnosed with polyarticular chronic gout, which despite the specific drug treatment administered, had multiple predisposing factors for the development of CRPS consecutive to the fracture of both bones of the right forearm. It is evident that the recovery period after injury is slightly different in each individual and depends on the severity of the injury and patient factors such as age, general condition and the presence of other comorbidities. The delay between the onset of symptoms and her presentation to the physician, conferred a poor prognosis for the developing pathology, with important functional and motor impairment.

In Vitro Cytotoxicity of Zinc Fructoborate, a Novel Zinc-Boron Active Natural Complex.

In recent years, the role of zinc in biological systems has been a subject of intense research. Zinc is required for multiple metabolic processes as a structural, regulatory, or catalytic ion. The objective of this study, was to assess the toxicity profile of a newly synthesized zinc-boron molecule on cultured cells. Zinc fructoborate, at different levels of concentration, was tested for its impact on the Vero kidney cell line (ATCC® CCL-81™) using the MTT assay. The compound exhibited a low cytotoxic effect on the cell line. Thus, our study demonstrates that the zinc fructoborate could become a promising dietary supplement molecule.

The Effectiveness of Shockwave Therapy in Patients with Lateral Epicondylitis.

Shockwave therapy is based on generating a very intense energy in a very short period of time. It creates a mechanical pressure over the affected tissues that leads to an increased cellular permeability, thus increasing the microcirculation and the cellular metabolism. Therefore, the healing process is accelerated. Lateral epicondylitis represents a common arm injure, which usually affects early to late middle-aged patients, more common and with a longer evolution period in women, characterized by inflammation of the arm muscles' tendon insertion and manifests with pain on elbow extension and forearm rotation. Our study aims to investigate the efficacity of the shockwave therapy in comparison with a classical treatment of local and systemic drugs. The 50 patients were evenly split into two groups. The diagnosis of lateral epicondylitis was based on exhaustive physical examination. Enthesis evaluation was performed through power Doppler ultrasound. The pain was quantified using the visual analogue scale for pain intensity. All parameters were evaluated at diagnosis and after 30 days, following treatment. One group received shockwave therapy, while the other group received nonsteroidal anti-inflammatory drugs and local topics associated with laser and ultrasound application. The results of our study report that both groups experienced significant improvement after treatment. The shockwave therapy recorded a higher improvement rate in all the parameters. Consequently, this new non-invasive, effective and safe technique can be successfully used in the treatment of abarticular pathology of the elbow.

The benefits of a comprehensive rehabilitation program in patients diagnosed with spastic quadriplegia.

Spastic quadriplegia has as an etiopathogenic substrate, a non-progressive brain lesion; however, the clinical manifestations of the disease evolve over time. Children diagnosed with spastic quadriplegia show a variety of symptoms in different areas: sensorimotor, emotional, cognitive, and social. The purpose of this study was to assess the functional status in patients diagnosed with spastic quadriplegia, who followed a complex medical rehabilitation program, during a year, and highlight the importance of using physical and kinetic techniques in improving their status. A total of 10 children diagnosed with spastic quadriplegia were included in the study and the Gross Motor Function Classification System (GMFCS) and manual ability classification system (MACS) were used to evaluate the functionality status of each patient. Every patient was evaluated initially (T1), after six months of program (T2), and after they completed the study. All the children were originally monitored daily, for 5 days per week for a period of one month, then two times a week for a year. A statistically significant difference regarding the modification of the GMFCS and MACS stage was found, which occurred between the first and the third evaluation. The inverse correlation of the statistical significance between the ages of patients and the decrease in GMFCS or MACS stage was highlighted; the younger the patient, the more the scale decreased. A direct link between the gross motor function and the manual ability was noticed. Applying a complex rehabilitation program has proven efficient by improving both the gross motor functionality and the manual ability.

Correlations between risk factors and functional evolution in patients with spastic quadriplegia.

Cerebral palsy is the most common cause of developing neuro-motor disability in children, in many cases, the triggering cause remaining unknown. Quadriplegia is the most severe spastic cerebral palsy, characterized by severe mental retardation and bi-pyramidal syndrome. The purpose of this paper was to demonstrate the importance of knowing the risk factors and the psychosomatic ones, determining to what extent they influence the functional evolution in patients diagnosed with spastic quadriplegia. 23 children diagnosed with spastic quadriplegia were included in the study, being aged between 1 year and half and 12 years. Patients were assessed at baseline (T1), at one year (T2) and after two years at the end of the study (T3). Patients received a comprehensive rehabilitation program for the motor and sensory deficits throughout the study. Initially, a comprehensive evaluation (etiopathogenic, clinical and functional) that started from a thorough medical history of children (the older ones), was conducted but chose parents to identify the risk factors, and a complete physical exam. At each assessment, joint and muscle balance was conducted. To assess functionality, the gross motor function classification systems (GMFCS) and manual ability (MACS) were used. Many risk factors that were classified according to the timeline in prenatal factors, perinatal and postnatal, were identified from a thorough history. A direct correlation was noticed between the decrease of coarse functionality and manual ability, both initially and in dynamic and low APGAR scores, low gestational age, low birth weight and a higher body mass index of the mother. A direct link was observed between the gross motor function and the manual ability. A significant improvement in the MACS score was noticed in patients with a better GMFCS score.

High Frequency Ultrasonography of the Hand in Rheumatoid Arthritis, Psoriatic Arthritis, Gout and Osteoarthritis Patients.

Over the past decades, management of rheumatic diseases improved both due to development of new drugs and to new imaging techniques. OBJECTIVE: The aim of this study was to evaluate the type and frequency of different structures involvement in the hand of patients with rheumatoid arthritis, psoriatic arthritis and gout compared to patients with osteoarthritis of the hand Methods: We designed an observational, transverse study, which included 110 consecutive patients evaluated in the Rheumatology Department, Emergency County Hospital Craiova, during one year 2014-2015, from which 50 were diagnosed with rheumatoid arthritis, 20 with psoriatic arthritis, 20 with gout and 20 with osteoarthritis. All patients uderwent clinical, biological and US examination. RESULTS: The global prevalence showed any US abnormalities at the hand level in 47 (94%) RA patients with respect to 17 (85%) patients in PsA group, 15 (75%) patients with gout and 12 (60%) patients in OA group (p=0.01) (Table 1). In all groups, except PsA patients, the tendon involvement (Figure 3a,b) was present in less than 30% of the patients, the high global prevalence being explained by the joint involvement (Figure 3c,d). In most of the patients with tendon involvement, we found joint involvement too. CONCLUSIONS: In conclusion, although further studies are needed, with more patients and more homogenous population, the study reveals some US involvement pattern depending on the patient's disease.

Kinetic Program and Functional Status in Patients with Parkinson's Disease.

The main purpose of kinetic program integrated in complex medical assistance of PD patients is the improvement of life quality, through amelioration of self-care activities, and possibility of making various activities in stability, balance and coordination conditions. We choose the kinetics techniques according to the clinical form and the gravity of the functional deficit. Taking into consideration the locomotors dysfunctional status, almost patients were included in the second and third evolutional stages. For quantize the results and monitories the patients with assessment of the kinetic program benefits we have use different scales and questionnaires. The age of the patients was over 45 years and more patients were male then women; this aspect confirm the increase frequency of disease in the male subjects. The individual and global clinical motor aspects were been influenced by the kinetic program. The global functional impact upon the individual general state was appreciated with scale FIM scale (Functional Independence Measure). Each patient and the entire studied group had presented an increase of the final motor score; this evolution mode proved the important of the kinetic program in the management of the Parkinsonism patient global state. "The PD patients have not be help" in the quotidian activities performance - is one of the kinetic rules that has be respected by all the family patient members.

Cognitive - Emotional Coping Strategies in First Year Romanian Medical Students.

We have studied the cognitive-emotional coping strategies to a number of 333 students in the first year of the Medicine and Pharmacy University of Craiova, from the Medicine, Pharmacy and Medical Nursing specializations, by using the CERQ (Cognitive Emotion Regulation Questionnaire). The result revealed that the medical students employ these strategies relatively different from the general population, while differences were recorded between this study and the previous research. It has been ascertained that, generally, the students from the different medical specializations use strategies belonging more to the dysfunctional range, such as: rumination, self-blame, catastrophizing.

Superior digestive tract side effects after prolonged treatment with NSAIDs in patients with osteoarthritis.

INTRODUCTION: Anti-inflammatory drugs (NSAIDs) represent one of the classes of drugs commonly recommended for patients with osteoarthritis. These drugs have side effects that sometimes affect the digestive tract. PATIENTS AND METHODS: 30 patients with either axial or peripheral osteoarthritis, hospitalized between January 2013 and January 2015 in the Rehabilitation Clinic of the Clinical Emergency County Hospital of Craiova, were followed. All the patients included had upper gastrointestinal endoscopy performed, excluding patients who had a history of gastritis, endoscopically demonstrated ulcer or those with a history of gastrointestinal dyspeptic phenomena. RESULTS: The endoscopic examination found acute erosive gastritis in eight cases, gastric ulcer (four cases) and duodenal ulcer (six cases). No serious complications were encountered. Four patients had no clinical manifestations with endoscopic expression. Lesions were mainly mild esophagitis (Grade I) and only in three cases, esophagitis grade II or III was found. Twelve patients (40%) had Helicobacter pylori infection and had endoscopic changes (gastric ulcer, duodenal ulcer, or gastric lesions). CONCLUSIONS: The adverse effects of NSAIDs in patients with osteoarthritis vary in severity. Patient age significantly influences the severity of injuries. We have not found significant differences in the incidence of COX2 selective and non-selective NSAID-induced lesions. Pathogenic interaction between the NSAID and Helicobacter Pylori infection is most often a synergistic effect in the development of gastritis or gastroduodenal ulcer.

The Recovery Physical Therapy Effects upon the Ventilation Dysfunction in Patients with Ankylosing Spondylitis.

Purpose - The evaluation of the ventilation function improval in patients with ankylosing spondylitis following the medical recovery procedures. Methods - The study included 24 patients that were diagnosed with AS stages I and IV that were monitored for 24 months. We recorded ventilation functional tests, respiratory gas levels, thorax involvement in inspiration and expiration, the medical, physical and balneotherapy that they had followed. The activity of the disease was evaluated using the BASDAI score. The evaluation of the functional disability was based on the BASFI score and the life quality needed the QLQ questionnaire. The age of the disease has started was also considered. Results - The study included 24 patients, 22 men and two women (11/1 men/female ratio), ages between 35 and 55 years. The disease has begun 18 plus or minus 2 years before. After 24 months a significant improval was noticed concerning the restrictive ventilation dysfunction specific parameters and also an increase of oxygen pressure by 7 plus or minus 2 mmHg. Conclusions - The constant and correct application of respiration recovery and the spine mobility procedures lead to better life quality regarding the patients with AS and the main parameters that evaluate ventilation dysfunction.

Clinical, evolution and therapeutical considerations upon a case of fibrodysplasia ossificans progressiva (FOP).

Fibrodysplasia ossificans progressiva (FOP) is an autosomal dominant genetic transmitted disease, with a rare incidence (1-2 cases/million persons) and it usually affects female patients. Its manifestations include acute pain episodes that tend to repeat, involving the soft tissue and the axial muscles with later appearance of ectopic bone tissue in ligaments, joints and tendons. In the great majority of times, the skeletal modifications are observed at birth but the first clinical symptoms occur at 2-4 years old. The clinical symptoms include pain and inflammation of the soft tissue, sometimes associated with fever and cutaneous erythema, joint symptoms--pain, stiffness most frequently concerning the scapular and pelvic girdle, bone malformations--short hallux, microdactilia, kyphoscoliosis, thorax malformations. The diagnosis is established based on the clinical symptoms and the imagistic investigations: CT, MRI - which indicate the joint modification and the ectopic bone tissue. Muscular biopsy is not indicated as it leads to new lesions in the already traumatized areas.