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1.
Pharmazie ; 79(3): 49-56, 2024 May 15.
Article in English | MEDLINE | ID: mdl-38872271

ABSTRACT

Multidrug resistance, severe side effects, and high cancer treatment costs are still well-known issues and remain an open challenge. These factors reduce the therapy's efficiency and safety, seriously affecting human health. Developing therapeutic approaches based on plant extracts, especially based on essential oils with cytotoxic and antioxidant properties, could be of efficacious strategies. This work incorporated Thymus capitatus essential oil (TEO) in liposomes. Thymus capitatus is a plant native to the northern region of Albania and found specifically in the Mediterranean region. TEO has several biological activities and cytotoxic properties. Due to its volatility, poor solubility, and chemical instability, however, its applicability is restricted. Incorporation into liposomes enables its effective use because the exposure time to the active compounds can be extended, increasing its efficacy against colorectal cancer cell lines, as highlighted in in vitro studies. TEO demonstrated detectable cytotoxic action against HT-29 colorectal cancer cells, and this action could be enhanced by applying various formulations of TEO-loaded liposomes to this cell line. Among the tested nanosystems, TEO-Phospholipon 90H liposomes showed more significant cytotoxic effects than TEO-Lipoid S100 liposomes and TEO-Phospholipon 85G liposomes. TEO-Phospholipon 90 H liposomes also maintained its physicochemical stability for six months at 25 °C. This research suggests that TEO, particularly when encapsulated in TEO-Phospholipon 90 H liposomes, may offer a promising therapeutic approach. However, these findings are based on in vitro studies and further in vivo research is needed to validate the efficacy and safety of this approach in clinical settings.


Subject(s)
Cell Survival , Liposomes , Oils, Volatile , Thymus Plant , Oils, Volatile/pharmacology , Oils, Volatile/chemistry , Humans , HT29 Cells , Thymus Plant/chemistry , Cell Survival/drug effects , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/pathology , Antineoplastic Agents, Phytogenic/pharmacology , Antineoplastic Agents, Phytogenic/administration & dosage
2.
Pharmazie ; 77(6): 172-178, 2022 06 01.
Article in English | MEDLINE | ID: mdl-35751165

ABSTRACT

Origanum vulgare L. essential oil possesses a wide spectrum of biological activities. Nanoencapsulation of O. vulgare essential oil into liposomes seems to be a promising strategy to maintain and improve these biological properties. This research was carried out to develop a suitable liposomal formulation for the effective encapsulation of O. vulgare essential oil in order to improve the antioxidant and cytotoxic activities. The characterization of liposomal nanocarriers was conducted in terms of size, zeta potential, and encapsulation efficiency. An MTT assay was used to assess the cytotoxic activity of the prepared and characterized O. vulgare essential oil liposomes in MCF-7 cancer cell lines. Antioxidant activity was determined by assessing DPPH scavenging activity. O. vulgare essential oil exerted cytotoxic activity with an IC50 of 50 µg/ml. The essential oil of O. vulgare was effectively encapsulated in liposomes, with no significant change observed among the formulations. The antioxidant activity was significantly enhanced after encapsulating the essential oil in liposomes. Origanum vulgare essential-oil-loaded Phospholipon 90H liposomes demonstrated considerably increased cytotoxic activity against MCF-7 cells, whereas Lipoid S100 liposomes showed no significant differences from the non-encapsulated essential oil. Phospholipon 85G liposomes had the least cytotoxic impact. As a result, liposomes containing O. vulgare essential oil may be promising nanocarriers for the development of anticancer agents.


Subject(s)
Oils, Volatile , Origanum , Antioxidants/chemistry , Antioxidants/pharmacology , Liposomes , Oils, Volatile/chemistry , Oils, Volatile/pharmacology , Origanum/chemistry
3.
Eur Rev Med Pharmacol Sci ; 26(6): 1906-1913, 2022 03.
Article in English | MEDLINE | ID: mdl-35363339

ABSTRACT

OBJECTIVE: The aim of the study was to evaluate retinal and choroidal microvascular morphological changes in non-ocular sarcoidosis (NOS) patients using optical coherence tomography angiography (OCTA) and compare the results to age- and gender-matched healthy individuals. PATIENTS AND METHODS: This study included 37 NOS patients (group 1, 37 right eyes) referred to the Ophthalmology Department between 2019 and 2021, as well as 31 healthy individuals (group 2, 31 right eyes). Non-ocular sarcoidosis was defined as sarcoidosis confirmed by a positive lung X-ray and biopsy without ocular manifestation. All participants underwent a comprehensive ophthalmic examination. The SPECTRALIS® OCT was used for both fundus photography and macular analysis. All OCTA procedures were performed in the Angio Retina mode (6.0x6.0 mm) to assess retinal and choroidal microvascular morphology. RESULTS: Groups 1 and 2 had mean ages of 46.41±12.52 and 47.55±13.81 years, respectively (p=0.482). Group 1 had significantly increased superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel densities (VDs) in whole (p=0.059, 0.016), parafoveal (p=0.051, 0.015), and perifoveal (p=0.060, 0.010) regions relative to group 2. Group 1 was also associated with increased foveal avascular zone (FAZ) area (p=0.196), FAZ circumference (p=0.262), and foveal VD in 300 µm wide regions surrounding FAZ (p=0.003) relative to group 2. The outer retinal (p=0.712) and choriocapillaris (p=0.684) flows did not differ significantly between the two groups. CONCLUSIONS: Quantitative OCTA analysis revealed a higher tendency for retinal and choroidal microvascular morphological changes in NOS patients, demonstrating the potential of this novel, non-invasive imaging technology, which may provide sensitive and reliable results without using contrast materials.


Subject(s)
Retinal Vessels , Sarcoidosis , Adult , Choroid/diagnostic imaging , Choroid/pathology , Fluorescein Angiography/methods , Humans , Middle Aged , Retina , Retinal Vessels/diagnostic imaging , Retinal Vessels/pathology , Sarcoidosis/diagnostic imaging , Sarcoidosis/pathology , Tomography, Optical Coherence/methods
4.
Neurochirurgie ; 68(1): 106-112, 2022 Jan.
Article in English | MEDLINE | ID: mdl-33652067

ABSTRACT

INTRODUCTION: Pituitary carcinomas are rare, with only a few case reports to date. We present a null cell type non-functioning pituitary carcinoma (NFPC) with intracranial metastases and a review of the literature. CASE REPORT: A 56-year-old male with a history of an aggressive pituitary adenoma was admitted. Initial MRI highlighted a large intracranial mass with leptomeningeal involvement, simulating meningioma. Based on his previous pathology report of the sellar mass, a diagnosis of null cell type non-functioning pituitary carcinoma has been made. CONCLUSIONS: An aggressive recurrent pituitary tumor with suprasellar and/or cavernous sinus invasion is the main characteristics of the NFPC. Single or multiple enhancing dural-based mass(es) mimicking meningioma is the most common MRI finding. The proof of malignancy is the same histopathological features of the recurrent aggressive pituitary tumor in the metastases. The histology alone is not distinctive in terms of malignancy. Most patients require a combined surgery, radiotherapy and chemotherapy.


Subject(s)
Adenoma , Meningeal Neoplasms , Meningioma , Pituitary Neoplasms , Adenoma/diagnostic imaging , Adenoma/surgery , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/diagnosis , Pituitary Neoplasms/diagnostic imaging , Pituitary Neoplasms/surgery
5.
Lymphology ; 54(1): 41-51, 2021.
Article in English | MEDLINE | ID: mdl-34506086

ABSTRACT

We designed a study to compare effects of complete decongestive therapy (CDT) and kinesiology taping (KT) (with exercise and skin care) on limb circumference, lymphedema volume, grip strength, functional status, and quality of life in patients with unilateral breast cancer-related lymphedema (BCRL). Forty patients with unilateral stage 2 BCRL were randomized to either the CDT group (n=20) or the KT group (n=20). Patients in the CDT group underwent 30-min manual lymphatic drainage (MLD) and multi-layer, short-stretch bandaging once a week for four weeks. Patients in the KT group underwent taping once a week for four weeks. In addition, all patients were informed about skin care and given an exercise program throughout the treatment. Upper extremity circumference and volume differences as primary outcomes and grip strength, Quick-Disabilities of the Arm, Shoulder and Hand (Q-DASH), and Functional Assessment of Cancer Therapy-Breast (FACT-B) scores as secondary outcomes were assessed initially, after treatment (4 weeks), and at the 1st month follow-up. Limb circumference and volume differences were significantly reduced in the CDT group after the 4-week treatment compared with the KT group (p=0.012 and p=0.015, respectively), but there was no difference between the groups in the 1st month follow-up (p>0.05). There was no difference between the groups in terms of grip strength, Q-DASH, and FACT-B scores after treatment and at the 1st month follow-up (p>0.05). Our results show that both KT and CDT were found to significantly reduce limb volume and circumference individually at 4-weeks and the one-month follow-up in patients with BCRL and that CDT significantly reduced both limb volume and circumference compared to KT at the 4- week time point, but not at the follow-up. Further randomized controlled trials with patients at different stages of BCRL are needed to confirm and expand these results.


Subject(s)
Breast Neoplasms , Lymphedema , Breast Neoplasms/complications , Breast Neoplasms/therapy , Female , Humans , Lymphedema/therapy , Quality of Life , Treatment Outcome , Upper Extremity
6.
Article in English, Spanish | MEDLINE | ID: mdl-33926850

ABSTRACT

PURPOSE: We aim to establish the prognostic value of metabolic parameters of the primary tumor in patients diagnosed with vulvar squamous cell carcinoma (VSCC) who underwent a pretreatment 18F FDG PET/CT scan. MATERIALS AND METHODS: This retrospective study included 47 patients with a histopathologically confirmed diagnosis of VSCC, and who underwent a 18F FDG PET/CT scan prior to treatment. The disease stage and age at diagnosis, the maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) values of the primary tumor, based on a baseline PET scan, were recorded. The relationship between these factors, and progression-free survival (PFS) and overall survival (OS) was evaluated. RESULTS: The mean age of the 47 study patients was 69.6±1.9 years. Among the patients, 18 were in early stage of the disease and 29 were in the advanced stage. The age, and SUVmax, SUVmean, MTV and TLG values were statistically significantly associated with OS and PFS. Furthermore, it was noted that OS and PFS were significantly longer in the early stage patients than in the advanced stage patients, in patients with a tumor size <4cm than those with a tumor size ≥4cm, and in patients with a negative lymph node metastasis than those with a positive lymph node metastasis. CONCLUSION: Our findings suggest that PET parameters are prognostic factors for VSCC. To the best of our knowledge, this study is the first to investigate the prognostic value of the PET parameters of primary tumors in patients with VSCC, and as such, we believe it contributes to literature.

7.
West Indian med. j ; 69(6): 459-460, 2021. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1515684
8.
Andrologia ; 49(6)2017 Aug.
Article in English | MEDLINE | ID: mdl-27681996

ABSTRACT

The purpose of this study was to examine potential long-term post-torsion changes that can occur in the histopathology, biochemistry and spermatogenesis of both torsioned and nontorsioned opposite testes. The study also determines the effect of zinc (Zn) administration on the testicular torsion/detorsion (T/D) damage on both testes. Forty-eight male rats, divided equally into eight groups: (SHAM), (SHAM+,Zn+), (T/D+, Zn- 1 month), (T/D+,Zn- 2 months), (T/D+,Zn- 3 months), (T/D+,Zn+ 1 months), (T/D+,Zn+ 2 months), (T/D+,Zn+ 3 months), have been used. Drug administration was carried out by adding 100 µg (0.016 ml/rat) Zn per rat to drinking water in related groups. Testicular damage decreased superoxide dismutase (SOD) and glutathione (GSH) and increased malondialdehyde (MDA) in the testis tissues of rats, while Zn administration increased SOD and GSH and decreased MDA in the testis tissues in comparison with the SHAM group. The beneficial effect of zinc sulphate was more evident on the nonrotated testis than the rotated testis. In the histopathological study, a significant decrease in torsion and detorsion injuries was observed in the treatment groups compared to the torsion and detorsion groups. We found a protective effect of zinc sulphate on oxidative stress as a result of T/D injuries in rats, especially for the nonrotated testis; results were supported histopathologically.


Subject(s)
Antioxidants/administration & dosage , Oxidative Stress/drug effects , Reperfusion Injury/drug therapy , Spermatic Cord Torsion/drug therapy , Testis/drug effects , Zinc/administration & dosage , Animals , Antioxidants/therapeutic use , Glutathione/metabolism , Male , Malondialdehyde/metabolism , Rats , Rats, Wistar , Reperfusion Injury/metabolism , Reperfusion Injury/pathology , Spermatic Cord Torsion/metabolism , Spermatic Cord Torsion/pathology , Superoxide Dismutase/metabolism , Testis/blood supply , Zinc/therapeutic use
9.
Eur Rev Med Pharmacol Sci ; 20(10): 1947-53, 2016 05.
Article in English | MEDLINE | ID: mdl-27249591

ABSTRACT

OBJECTIVE: We have compared conventional Color Doppler (CD) and Power Doppler (PD) techniques, which are used for evaluating the testicular blood flow in small children, and the Superb Microvascular Imaging (SMI), which is a new technique. We have also investigated their contributions to testicular evaluations. PATIENTS AND METHODS: We evaluated blood flow in testicles using a grading system with CD, PD and SMI techniques. We determined the average duration of the three techniques. RESULTS: There was a statistically significant difference between the SMI and CD techniques for all patients (p < 0.001, p = 0.001). When we compared the PD and SMI, either as much or more vascular information was obtained (p = 0.106). There was a statistically significant difference between the application durations of the tests (p < 0.05). CONCLUSIONS: Superb Microvascular Imaging yields more detailed vascular information in blood flow in testicles in small children, than either CD or PD. Furthermore, this technique decreases the duration of the examination at a significant level. Superb Microvascular Imaging may represent an alternative method that can be used safely for evaluating blood flow in the testicles of small children. Additional studies may increase the reliability of SMI.


Subject(s)
Echocardiography, Doppler , Microvessels/diagnostic imaging , Testis/blood supply , Child , Humans , Male , Reproducibility of Results
10.
Am J Cardiol ; 117(3): 436-42, 2016 Feb 01.
Article in English | MEDLINE | ID: mdl-26705879

ABSTRACT

Degraded by shear stress, loss of high-molecular-weight multimers of von Willebrand factor (VWF) correlates strongly with pressure gradient in aortic stenosis (AS) and obstructive hypertrophic cardiomyopathy (HC). We assessed VWF tests before and after interventions in HC and contrasted the severity of abnormalities in HC to patients with AS, mitral regurgitation, and left ventricular assist devices. Ninety patients with median (interquartile range) age 66 (53 to 72) years, 51% men, with HC had assessments of 3 VWF parameters and B-type natriuretic peptide before and after 26 discreet medical/pacing interventions, 22 alcohol septal ablations, and 28 ventricular septal myectomies. VWF multimers were abnormal in 87% of patients with obstructive HC versus 48% of patients with latent obstruction (p = 0.0001). VWF measurements correlated with peak instantaneous left ventricular outflow tract gradient, Spearman ρ 0.51 to 0.61, p <0.0001. For B-type natriuretic peptide, correlation with left ventricular outflow tract gradient was weaker, ρ = 0.37, p = 0.0005, but stronger with septal thickness or mitral E/e'. In pre-/post-medical treatment of HC, VWF multimers were abnormal in 73%/68% of patients, p = 0.74; pre-/post-septal ablation 74%/26%, p = 0.0035; and pre-/post-septal myectomy 75%/0%, p <0.0001. In obstructive HC, the degree VWF multimer loss was greater than in severe AS or severe mitral regurgitation and overlapped that seen in left ventricular assist devices. In conclusion, VWF activity indexes were predictably abnormal in patients with HC with resting obstruction to a degree where bleeding could be anticipated, accurately reflected gradient changes after intervention, and demonstrated complete normalization after septal myectomy.


Subject(s)
Cardiac Surgical Procedures/methods , Cardiomyopathy, Hypertrophic/surgery , Heart Septum/surgery , Ventricular Function, Left/physiology , von Willebrand Factor/metabolism , Adult , Aged , Cardiomyopathy, Hypertrophic/blood , Cardiomyopathy, Hypertrophic/physiopathology , Echocardiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Retrospective Studies
11.
J Musculoskelet Neuronal Interact ; 15(4): 333-40, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26636279

ABSTRACT

The aim of this study was to investigate the effects of two different frequencies of whole-body vibration (WBV) training on knee extensors muscle strength in healthy young volunteers. Twenty-two eligible healthy untrained young women aged 22-31 years were allocated randomly to the 30-Hz (n=11) and 50-Hz (n=11) groups. They participated in a supervised WBV training program that consisted of 24 sessions on a synchronous vertical vibration platform (peak-to-peak displacement: 2-4 mm; type of exercises: semi-squat, one-legged squat, and lunge positions on right leg; set numbers: 2-24) three times per week for 8 weeks. Isometric and dynamic strength of the knee extensors were measured prior to and at the end of the 8-week training. In the 30-Hz group, there was a significant increase in the maximal voluntary isometric contraction (p=0.039) and the concentric peak torque (p=0.018) of knee extensors and these changes were significant (p<0.05) compared with the 50-Hz group. In addition, the eccentric peak torque of knee extensors was increased significantly in both groups (p<0.05); however, there was no significant difference between the two groups (p=0.873). We concluded that 8 weeks WBV training in 30 Hz was more effective than 50 Hz to increase the isometric contraction and dynamic strength of knee extensors as measured using peak concentric torque and equally effective with 50 Hz in improving eccentric torque of knee extensors in healthy young untrained women.


Subject(s)
Muscle Strength/physiology , Muscle, Skeletal/physiology , Resistance Training/methods , Vibration , Adult , Female , Healthy Volunteers , Humans , Knee , Young Adult
14.
Eur J Phys Rehabil Med ; 49(5): 715-25, 2013 Oct.
Article in English | MEDLINE | ID: mdl-24145230

ABSTRACT

One of the objectives of the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the Union of European Medical Specialists (UEMS) is the development of the field of competence of PRM physicians in Europe. To achieve this objective, UEMS PRM Section PPC has adopted a systematic action plan of preparing a series of papers describing the role of PRM physicians in a number of disabling health conditions, based on the evidence of effectiveness of the PRM interventions. The aim of this paper is to describe the role of PRM physicians in the management of spinal pain focusing particularly on low back pain and neck pain. These disorders are associated with significant disability that results in activity limitations and participation restrictions. A wide variety of PRM interventions including patient education, behavioural therapies, exercise, a number of physical modalities, manual techniques, and multidisciplinary rehabilitation may help patients with low back pain and cervical pain in improving their functioning. PRM physicians may address many of the problems encountered by these patients in many life areas taking the International Classification of Functioning, Disability and Health as a reference guide and may have an important role in improving the quality of their lives.


Subject(s)
Clinical Competence/standards , Low Back Pain/rehabilitation , Neck Pain/rehabilitation , Pain Management/standards , Physical Therapy Modalities/standards , Acute Pain , Analgesics/therapeutic use , Chronic Pain , Disability Evaluation , Europe , European Union , Evidence-Based Practice/methods , Evidence-Based Practice/standards , Humans , Low Back Pain/therapy , Neck Pain/therapy , Pain Management/methods , Physical and Rehabilitation Medicine/methods , Physical and Rehabilitation Medicine/standards , Professional Practice/standards
15.
Eur J Phys Rehabil Med ; 49(5): 727-42, 2013 Oct.
Article in English | MEDLINE | ID: mdl-24145231

ABSTRACT

One of the objectives of the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the Union of European Medical Specialists (UEMS) is the development of the field of competence of PRM physicians in Europe. To achieve this objective, UEMS PRM Section PPC has adopted a systematic action plan of preparing a series of papers describing the role of PRM physicians in a number of disabling health conditions, based on the evidence of effectiveness of PRM interventions. Soft tissue musculoskeletal disorders (MSDs) and injuries are associated with significant pain and loss of function that may lead to significant disability. The aim of this paper is to define the role of PRM physician in the management of local soft tissue MSDs and injuries with their specific focus on assessing and improving function as well as participation in the community. The training of PRM specialists make them well equipped to successfully treat MSDs including soft tissue MSDs and injuries. PRM specialists may well meet the needs of patients with soft tissue MSDs and injuries using PRM approaches including 1) assessment based on the comprehensive model of functioning, the International Classification of Functioning, Disability and Health (ICF), that enable them to identify the areas of impaired functioning in order to apply necessary measures; 2) accurate diagnosis using instrumental diagnostic procedures in addition to clinical examination; 3) outcome measurements available to them; 4) evidence-based pharmacological and nonpharmacological treatments; and finally 5) maintenance of social involvement including "return to work" based on restoration of function, all of which will eventually result in improved quality of life for patients with soft tissue MSDs and injuries.


Subject(s)
Musculoskeletal Diseases/rehabilitation , Physical and Rehabilitation Medicine/trends , Physician's Role , Soft Tissue Injuries/therapy , Therapy, Soft Tissue/standards , Analgesics/therapeutic use , Clinical Competence , Europe , European Union , Evidence-Based Practice/methods , Evidence-Based Practice/standards , Humans , Musculoskeletal Diseases/diagnosis , Musculoskeletal Diseases/therapy , Physical Therapy Modalities , Physical and Rehabilitation Medicine/methods , Professional Practice , Soft Tissue Injuries/diagnosis , Therapy, Soft Tissue/methods
16.
Eur J Phys Rehabil Med ; 49(5): 743-51, 2013 Oct.
Article in English | MEDLINE | ID: mdl-24145232

ABSTRACT

One of the objectives of the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the Union of European Medical Specialists (UEMS) is the development of the field of competence of PRM physicians in Europe. To achieve this objective, UEMS PRM Section PPC has adopted a systematic action plan of preparing a series of papers describing the role of PRM physicians in a number of disabling health conditions, based on the evidence of effectiveness of the physical and rehabilitation medicine interventions. According to the PCC of the UEMS-PRM Section, the role of PRM physician in the management of shoulder pain (SP) has to be situated inside the general pain management field. SP is a common condition that can place limitations on the activity and restriction in social life participation of sufferers. A variety of shoulder problems, commonly including subacromial impingement, calcifying tendinitis, frozen shoulder, acromio-clavicular disturbances, gleno-humeral instability and gleno-humeral arthritis, can cause pain, and patients should be assessed and treated in order to relieve symptoms and reduce disability. This position paper describes the role of the PRM specialist in the management of such patients. Many assessment methods and treatment interventions are usually used in the management of patients with SP. Depending on the process, disability and patient characteristics, some intervention modalities have reported evidence in pain relief, movement and daily life activity (DLA) restoration, thus permiting a patient early recovery and social participation. Oral medications, local injections, physical therapy modalities and exercises are normally used for the management of SP. The PRM specialist should, always use this best medical evidence to decide how to efficiently and effectively reduce SP-related disability. An adequate therapeutic algorithm is also proposed in order to channelize the above mentioned evidence and reach the best results.


Subject(s)
Activities of Daily Living , Physical Therapy Modalities/standards , Physical and Rehabilitation Medicine/standards , Range of Motion, Articular/physiology , Recovery of Function/physiology , Shoulder Pain/therapy , Analgesics/therapeutic use , Clinical Competence/standards , Europe , European Union , Evidence-Based Practice , Humans , Physical and Rehabilitation Medicine/methods , Professional Practice , Range of Motion, Articular/drug effects , Recovery of Function/drug effects , Shoulder Pain/diagnosis , Shoulder Pain/etiology
17.
Eur J Phys Rehabil Med ; 49(5): 753-9, 2013 Oct.
Article in English | MEDLINE | ID: mdl-24145233

ABSTRACT

One of the objectives of the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the Union of European Medical Specialists (UEMS) is the development of the field of competence of PRM physicians in Europe. To achieve this objective, UEMS PRM Section PPC has adopted a systematic action plan of preparing a series of papers describing the role of PRM physicians in a number of disabling health conditions, based on the evidence of effectiveness of the physical and rehabilitation medicine interventions. According to the UEMS-PRM section, the role of PRM physician in musculoskeletal perioperative settings has to be situated inside general pain management. Musculoskeletal surgery (MSS) represents a frequent medical situation among patients suffering from musculoskeletal disorders (MSDs), in which PRM physicians need to be involved. A wide number of MSDs have to be operated in order to diminish disability and relieve symptoms, thus improving the patient´s functioning and social participation: Joint replacements, spine decompressions, vertebroplasties, internal fixation of unstable fractures, arthroscopies for tendon and joint repairs, and others. This paper describes the role of the PRM physician during the perioperative period. A well-coordinated rehabilitation programme followed by a good home rehabilitation programme results in pain reduction, faster recovery with better patient participation and increased cost effectiveness. PRM physicians have to identify patients at risk of continuing activity limitation and participation restriction who will benefit from an early rehabilitation process and formulate a PRM programme of care taking into account each patient's environmental factors.


Subject(s)
Arthroplasty, Replacement/rehabilitation , Clinical Competence/standards , Musculoskeletal Diseases/surgery , Musculoskeletal System/surgery , Perioperative Care/standards , Physical Therapy Modalities/standards , Physical and Rehabilitation Medicine/standards , Arthroplasty, Replacement/methods , Arthroplasty, Replacement/standards , Europe , European Union , Evidence-Based Practice , Humans , Musculoskeletal Diseases/rehabilitation , Musculoskeletal System/injuries , Perioperative Care/methods , Physical Therapy Modalities/organization & administration , Postoperative Complications/prevention & control , Professional Practice
18.
Eur J Phys Rehabil Med ; 49(4): 535-49, 2013 Aug.
Article in English | MEDLINE | ID: mdl-24084413

ABSTRACT

One of the objectives of the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the Union of European Medical Specialists (UEMS) is the development of the field of competence of PRM physicians in Europe. To achieve this objective, UEMS PRM Section PPC has adopted a systematic action plan of preparing a series of papers describing the role of PRM physicians in a number of disabling health conditions, based on the evidence of effectiveness of PRM interventions. Generalised and regional soft tissue pain syndromes constitute a major problem leading to loss of function and disability, resulting in enormous societal burden. The aim of this paper is to describe the unique role of PRM physicians in the management of these disabling conditions that require not only pharmacological interventions but also a holistic approach including the consideration of body functions, activities and participation as well as contextual factors as described in the ICF. Evidence-based effective PRM interventions include exercise and multicomponent treatment including a psychotherapeutic intervention such as cognitive behavioural therapy (CBT) in addition to exercise, the latter based on strong evidence for reducing pain and improving quality of life in fibromyalgia syndrome (FMS). Balneotherapy, meditative movement therapies, and acupuncture have also been shown as efficacious in improving symptoms in FMS. Emerging evidence suggests the use of transcranial magnetic or direct current stimulation (rTMS or tDCS) in FMS patients with intractable pain not alleviated by other interventions. Graded exercise therapy and CBT are evidence-based options for chronic fatigue syndrome. The use of some physical modalities and manipulation for myofascial pain syndrome is also supported by evidence. As for complex regional pain syndrome (CRPS), strong evidence exists for rTMS and graded motor imagery as well as moderate evidence for mirror therapy. Interventional techniques such as blocks and spinal cord stimulation may also be considered for CRPS based on varying levels of evidence. PRM physicians' functioning oriented approaches on the assessment and management, adopting the ICF as a reference, may well meet the needs of patients with soft tissue pain syndromes, the common problems for whom are loss of function and impaired quality of life. Available evidence for the effectiveness of PRM interventions serves as the basis for the explicit role of PRM specialists in the management of these health conditions.


Subject(s)
Complex Regional Pain Syndromes/therapy , Exercise Therapy/methods , Fibromyalgia/therapy , Nociceptive Pain/therapy , Physical and Rehabilitation Medicine/standards , Analgesics/therapeutic use , Chronic Pain/drug therapy , Chronic Pain/therapy , Cognitive Behavioral Therapy/methods , Complementary Therapies , Complex Regional Pain Syndromes/drug therapy , Europe , European Union , Evidence-Based Practice , Fibromyalgia/drug therapy , Humans , Physical and Rehabilitation Medicine/methods , Physician's Role
19.
Eur J Phys Rehabil Med ; 49(4): 551-64, 2013 Aug.
Article in English | MEDLINE | ID: mdl-24084414

ABSTRACT

One of the objectives of the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the Union of European Medical Specialists (UEMS) is the development of the field of competence of PRM physicians in Europe. To achieve this objective, UEMS PRM Section PPC has adopted a systematic action plan of preparing a series of papers describing the role of PRM physicians in a number of disabling health conditions, based on the evidence of effectiveness of the physical and rehabilitation medicine interventions. Inflammatory arthritis is a major cause of disability with an important economic burden in society. The goals in the management of inflammatory arthritis are to control pain and disease activity, prevent joint damage, protect and enhance function and improve quality of life. This paper aims to define the role of PRM physicians in people with inflammatory arthritis. PRM interventions imply non-pharmacological treatments which include patient education for joint protection, energy conservation and self-management techniques, exercise therapy, physical modalities, orthoses/assistive devices and balneotherapy. Therapeutic patient education and exercises are the cornerstones of therapy with strong evidence of their effectiveness to improve function. Physical modalities are primarily used to decrease pain and stiffness whereas orthoses/assistive devices are usually prescribed to enhance activities and participation. PRM physicians have distinct roles in the management of people with inflammatory arthritis such that they effectively organise and supervise the PRM program in the context of interdisciplinary team work. Their role starts with a comprehensive assessment of patient's functioning based on the International Classification of Functioning Disability and Health (ICF) as the framework. In the light of this assessment, appropriate PRM interventions individualised for the patient are administered. Future research and actions regarding the role of PRM in inflammatory arthritis should target access to care, updates on the use and effectiveness of physical modalities, orthoses/assistive devices, and standardization of therapeutic patient education programs.


Subject(s)
Arthritis/rehabilitation , Clinical Competence/standards , Physical and Rehabilitation Medicine/standards , Antirheumatic Agents/therapeutic use , Arthritis/drug therapy , Arthritis/physiopathology , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/physiopathology , Arthritis, Rheumatoid/rehabilitation , Comorbidity , Europe , European Union , Exercise Therapy , Humans , Inflammation/complications , Inflammation/etiology , Pain Management/methods , Patient Education as Topic , Physical Therapy Modalities , Physical and Rehabilitation Medicine/methods , Self-Help Devices , Spondylitis, Ankylosing/drug therapy , Spondylitis, Ankylosing/physiopathology , Spondylitis, Ankylosing/rehabilitation
20.
Eur J Phys Rehabil Med ; 49(4): 565-77, 2013 Aug.
Article in English | MEDLINE | ID: mdl-24084415

ABSTRACT

One of the objectives of the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the Union of European Medical Specialists (UEMS) is the development of the field of competence of PRM physicians in Europe. To achieve this objective, UEMS PRM Section PPC has adopted a systematic action plan of preparing a series of papers describing the role of PRM physicians in a number of disabling health conditions, based on the evidence of effectiveness of PRM interventions. A wide range of health conditions treated by PRM specialists carries the risk of osteoporosis (OP). The consequences of OP may be associated with significant disability. The aim of this paper is: to define the role of PRM physicians in the prevention and management of OP, to describe the needs of people with OP in relation to rehabilitation strategy, and to highlight why and how PRM physicians should be involved in the diagnosis and management of OP. PRM physicians may intervene in the prevention of and risk factor assessment for OP, falls and fractures along with other assessments of functioning and of quality of life. In addition, they are involved in diagnosis and in both pharmacological and nonpharmacological treatment of OP. From a specific PRM perspective based on the International Classification of Functioning, Disability and Health (ICF), there is an important role in optimizing functioning and promoting "activities and participation", including interventions associated with environmental factors for people with OP or osteoporotic fractures. Evidence suggests that a large number of interventions within the scope of PRM that range from preventive strategies (including education and self management and most importantly exercise) to pain management strategies and spinal orthoses or hip protectors may be effective in the prevention and/or management of OP and its sequelae. Competencies and aptitudes of PRM specialists, focusing especially on functioning while providing care over the whole course of a health condition from the hospital to the community, may well place them in the management of OP. Evidence-based effective PRM interventions further warrant the role of PRM physicians in the management of OP.


Subject(s)
Accidental Falls/prevention & control , Clinical Competence/standards , Fractures, Bone/prevention & control , Osteoporosis/rehabilitation , Physical and Rehabilitation Medicine/standards , Primary Prevention/methods , Bone Density Conservation Agents/therapeutic use , Europe , European Union , Evidence-Based Medicine , Exercise , Fractures, Bone/etiology , Humans , Osteoporosis/complications , Osteoporosis/prevention & control , Physical and Rehabilitation Medicine/methods , Risk Assessment , Sleep Wake Disorders/complications , Sleep Wake Disorders/etiology , Sleep Wake Disorders/prevention & control , Urinary Incontinence/etiology , Urinary Incontinence/prevention & control , Urinary Incontinence/therapy , Vibration/therapeutic use , Vitamin D/therapeutic use
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