Rehabilitation therapy versus drug-only therapy in patients with multiple sclerosis.

Background/aim: The treatment for multiple sclerosis (MS) does not cure the disease, but it is intended to reduce the intensity, duration, and frequency of symptoms. Rehabilitation therapy (RT), including an individualized physical therapy program (PTP) and adapted occupational therapy (OT), has benefits in terms of aerobic capacity, muscle strength, coordination, and ability to perform activities of daily living (ADL). The primary objective of this study was to examine the efficacy of RT comprising PTP, OT, and drug treatment (DT) versus DT alone in patients with MS. Another objective was to highlight the importance of continuing the PT and OT at home, in the long term, practically for their entire life. Materials and methods: Between 2020 and 2022, a follow-up observational study was conducted that included 77 patients diagnosed with MS, independent in terms of ability to perform ADL, divided into two groups: group A (39 patients who complied with the RT) and group B (38 patients who did not comply). At the beginning and end of the study, the following parameters were assessed: timed walk for 25 feet [Timed 25-Foot Walk test (T25FW test)], dexterity of the upper limbs [9-Hole Peg Test (9HPT)], and cognitive function [Paced Auditory Serial Addition Test (PASAT)]. Results: Significant improvement in the experimental group was observed regarding the mobility and the performance of leg function (T25FW, p < 0.05) and finger dexterity (9HPT, p < 0.05) for the dominant hand. Conclusion: The current study proves the importance of combining DT with RT in MS therapy with clear benefits in regaining muscle strength in the lower limbs, thus improving coordination and balance while walking and improving dexterity in the dominant hand.

Analyzing Sustainable 3D Printing Processes: Mechanical, Thermal, and Crystallographic Insights.

In this study, the objective was to optimize energy consumption in the fused deposition modeling (FDM) 3D printing process via a detailed analysis of printing parameters. By utilizing thermal analysis techniques, this research aimed to identify lower printing temperatures that could lead to reduced energy usage. Experimental analysis was conducted using a three-level L9 Taguchi orthogonal array, which involved a systematic combination of different extruder temperatures and cooling fan capacities. Furthermore, the research incorporated differential scanning calorimetry (DSC) and X-ray diffraction (XRD) methods to analyze the thermal properties and crystallinity of the 3D-printed specimens. The results indicated that temperature was a key factor affecting crystallinity, with samples printed at 190 °C and 60% fan capacity showing the highest mean values. By conducting a multi-objective desirability analysis, the optimal conditions for maximizing ultimate tensile strength (UTS), tensile modulus, and elongation at break while minimizing energy consumption for PLA 3D-printed samples were determined to be a temperature of 180 °C and a fan speed of 80%.

Predictors of disability in patients with chronic low back pain.

Introduction: Chronic low back pain (CLBP) is a common and disabling health problem. In this study, we aimed to assess the relationship between pain intensity, the components of catastrophizing, depression and disability in patients with chronic low back pain. Material and methods: Seventy-six patients diagnosed with CLBP (age range 25-77 years; 73.7% female) participated in the study. Participants' socio-demographic data were collected: age, gender, height, weight, and work status (employed or retired). All participants were asked to complete the Pain Catastrophizing Scale (PCS), the visual analogue scale (VAS), the Oswestry Disability Questionnaire (ODQ), and the Beck Depression Inventory (BDI). Results: The mean group scores revealed moderate CLBP complaints (VAS - 4 [3-6]), mild depression (BDI - 10 [5-16]), a moderate level of catastrophizing (PCS total score 20.5 [10-34]) and moderate disability (Oswestry Disability Index [ODI] - 31 [14-38]). Positive significant correlations were found between ODI and age, residence, work status, VAS, PCS-rumination, PCS-magnification, PCS-helplessness and BDI, and also between PCS subscales and VAS. Our multivariate linear regression analysis showed that age, pain intensity, PCS-helplessness and depression can predict disability in patients with CLBP, explaining 84% of the variance of disability (R2 = 0.851, adjusted R2 = 0.843). Conclusions: A multidisciplinary approach is needed for patients with CLBP and should include physical, mental and social evaluation in order to offer an optimal treatment.

Effects of Complex Rehabilitation Program on Reducing Pain and Disability in Patients with Lumbar Disc Protrusion-Is Early Intervention the Best Recommendation?

(1) Background: Due to its frequency and possible complications, low back pain (LBP) has a high social impact, it is a common problem of the active population and the second reason for visiting a physician. In patients with lumbar disc protrusion (LDP), one of the most common causes of LBP, the nucleus pulposus bulges against the disc and then protrudes into the spinal cord, but the annulus fibrosus remains intact; (2) Objectives: The primary objective of this study was to determine the efficacy of a rehabilitation treatment (RT) comprising electrotherapy (ET), hydrotherapy (HT) and individualized physical therapy (PT) versus ET alone in patients with LDP. The second objective was to investigate whether there is a correlation between early RT and the symptomatology of patients with LDP; (3) Methods: The research was conducted between July 2021 and January 2022 at the Ceres Hotel Treatment Centre from Baile 1 Mai, Romania, and all the study subjects signed an informed consent form. For this study, the block randomization method was used to randomize subjects into groups that resulted in equal sample size, in order to maintain a reasonably good balance among groups. Therefore, the two groups had the same number of subjects (30 subjects) and the randomization was made taking into account the patient's motivation or the subject's willingness to receive not only electrotherapy treatment, but also the physical exercises and hydrotherapy. The eligibility criteria were: low back pain for more than three months, an MRI confirmed diagnosis of LDP (without dural compression), and ability to perform a PT program. The control group received only a classical ET program. In addition, the patients in the experimental group received a complex individualized PT program associated with HT and ET. To achieve these objectives, the study subjects were monitored for spinal mobility (lateral lumbar flexion-LLF, index fingers-ground-IFG, lumbar Schober tests for flexion-LS, Inverted Schober test for extension-ILS), trunk flexor and extensor muscle strength (LF strength, LE strength), level of pain (Short Form McGill Pain Questionnaire-SF-MPQ, Visual Analogue Scale-VAS), and the degree of limitation in activities of daily living (Oswestry Disability Index-ODI); (4) Results: Comparing the evolution of the subjects, using the One-Way ANOVA between groups, we observed a significant improvement in all variables [SF-MPQ (95% CI, 7.996/11.671), VAS (95% CI, 1.965/3.169), mobility FTF (95% CI, -7.687/-3.940), LS (95% CI, 2.272/2.963), LE strength (95% CI, -5.676/-3.324), LF strength (95% CI, -5.970/-3.630), disability (95% CI, 8.026/10.441) after six months of treatment for the experimental group subjects. A clear correlation was found, using the Bravis-Pearson test, between the earliest possible initiation of RT and improvement of patients' symptoms; (5) Conclusion: The current study proves the importance of combining ET with HT and PT. The earlier the RT is implemented, the lower the pain perception and level of disability associated with the lumbar disease.

Work-related musculoskeletal complaints in massage practitioners.

BACKGROUND: Work-related musculoskeletal complaints (WMSCs) are induced or aggravated by work activities and/or work conditions. OBJECTIVE: The aim was to evaluate the impact of work as a massage practitioner, with a special emphasis on WMSCs. METHODS: Massage practitioners were invited to participate in the study through an advert in the rehabilitation medical clinics. The participants completed a self-administered questionnaire, collecting general data and questions about WMSCs. RESULTS: Thirty-seven subjects (88.09%) reported pain in at least one body part in the last 4 weeks. The most common WMSCs was pain in the neck region (69.04%), followed by pain in the shoulder region (54.76%), upper back (52.38%), lower back (40.48%), wrist-hand (33.33%) and elbow (21.43%). The massage practitioners aged between 21 and 30 years old reported significantly more frequently WMSCs localized in neck, shoulders, wrist-hand, upper back and lower back. CONCLUSIONS: This study shows that WMSCs are widely reported among massage practitioners. The most common complaints were reported in the neck and shoulder regions, especially in younger massage practitioners.

Vitamin D and disease activity in rheumatoid arthritis patients: a retrospective study in a Romanian cohort.

BACKGROUND: The relationship between the serum levels of Vitamin D and the severity of RA is a subject of great interest for the future therapeutic strategies. Although the evidence on the relationship between hypovitaminosis D and early RA is contradictory, preliminary data suggest that the serum levels of vitamin D are inversely associated with the disease activity. AIM: the main objectives of this study include: (1) to analyze the serum levels of vitamin D in patients with RA in comparison to healthy controls; (2) to investigatea possible correlation with disease activity. MATERIALS AND METHODS: This was a retrospective, comparative study conducted on 37 subjects suffering from RA and a group of 21 healthy matched controls. The following were determined in all studied subjects: erythrocyte sedimentation rate (ESR), white blood cells (WBC), hemoglobin (Hb), platelets (PLT), serum calcium (Ca), serum phosphorus (Phos), and serum 25 hydroxy-vitamin D. Moreover, in the RA group the IgM-Rhematoid Factor (RF) and anti-citrullinated protein antibodies (ACPA) (immune-enzymatic method) were assessed. The Disease Activity Score of 28 joints (DAS28) was calculated for the RA patients. RESULTS: We observed that vitamin D deficiency is more common in RA patients than in healthy controls. No significant correlation between 25OHvitD and DAS28-ESR was found in our study cohort. CONCLUSIONS: There is no significant association of serum 25(OH)D with disease severity in a Western Romanian cohort with RA. However, this result could have implications for the disease management, as patients with RA could be supplemented with vitamin D even in the absence of disease activity.

Linking myeloperoxidase with subclinical atherosclerosis in adults with metabolic syndrome.

BACKROUND: Myeloperoxidase (MPO) is a leukocyte-derived enzyme that has been associated with cardiovascular diseases in many studies. Together with hydrogen peroxide and a halogen, MPO forms a very strong antimicrobial system and there is evidence of links between MPO and inflammation in cardiovascular diseases. Brachial flow-mediated dilation (FMD) refers to a physiologic measure, and carotid intima-media thickness (IMT) is an anatomic structural measure of subclinical atherosclerosis. This research aimed to assess the correlation of MPO serum levels with subclinical atherosclerosis in patients with metabolic syndrome (MS) using the parameters FMD and IMT. METHODS: A total of 88 patients with metabolic syndrome defined according to the International Diabetes Criteria (IDF) criteria were recruited in the study. Doppler ultrasound was used to determine the left and right common carotid artery thickness (left and right CCA IMT) and FMD of brachial artery. The MPO concentrations were measured using the Immundiagnostik MPO ELISA kit. RESULTS: A significant inverse correlation between MPO and brachial FMD (r = -0.354, p < 0.001), a significant positive correlation between MPO and right CCA IMT (r = 0.327, p < 0.001), and a significant positive correlation between MPO and left CCA IMT (r = 0.301, p < 0.001) in patients with MS were obtained in this research study. CONCLUSION: Serum MPO concentration is correlated with subclinical atherosclerosis in patients with MS. The MPO may be a potential therapeutic goal in patients with MS. This finding suggests that new biological markers for MS and subclinical atherosclerosis are helpful for understanding the mechanisms of the risk factors and their role as a considerable burden on the population.

Heart Involvement in Inflammatory Rheumatic Diseases: A Systematic Literature Review.

Introduction: Patients with inflammatory rheumatic diseases have an increased risk of developing cardiovascular manifestations. The high risk of cardiovascular pathology in these patients is not only due to traditional cardiovascular risk factors (age, gender, family history, smoking, sedentary lifestyle, cholesterol), but also to chronic inflammation and autoimmunity. Aim: In this review, we present the mechanisms of cardiovascular comorbidities associated with inflammatory rheumatic diseases, as they have recently been reported by different authors, grouped in electrical abnormalities, valvular, myocardial and pericardial modifications and vascular involvement. Methods: We conducted a systematic search of published literature on the following online databases: EBSCO, ScienceDirect, Scopus and PubMed. Searches were limited to full-text English-language journal articles published between 2010 and 2017 using the following key words: heart, systemic inflammation, autoimmunity, rheumatic diseases and disease activity. After the primary analysis we included 50 scientific articles in this review. Results: The results showed that cardiac manifestations of systemic inflammation can occur frequently with different prevalence in rheumatoid arthritis (RA), systemic lupus erythematosus(SLE), systemic sclerosis(SSc) and ankylosing spondylitis(AS). Rheumatologic diseases can affect the myocardium, cardiac valves, pericardium, conduction system and arterial vasculature. Conclusions: Early detection, adequate management and therapy of specific cardiac involvement are essential in rheumatic disease. Electrocardiographic and echocardiographic evaluation should be performed as routine investigations in patients with inflammatory rheumatic diseases.

Unusual occurrence of avascular necrosis with bilateral involvement and ankylosing spondylitis, meningioma and Hodgkin lymphoma.

This case report aimed to reveal the multidisciplinary aspect and discuss an association of disorders in a complex case with Hodgkin disease, meningioma, avascular necrosis with bilateral involvement and ankylosing spondylitis. We report the case of a 47-year-old patient, diagnosed with Hodgkin lymphoma at the age of 14. Two decades later, she was diagnosed with frontal chordoid meningioma, which was surgically removed, without radiotherapy. She was re-operated 10 years later for recurrence of meningioma. At the age of 39, she was diagnosed with bilateral avascular necrosis of the humeral head, femoral head and scaphoid bones. In the same year, she was also diagnosed with ankylosing spondylitis. We considered that the occurrence of rare chordoid meningioma, avascular necrosis with multiple locations and bilateral involvement in a patient with a malignancy during childhood and an autoimmune disease was unusual and there may be some common pathways.

A comparative study of rehabilitation therapy in traumatic upper limb peripheral nerve injuries.

INTRODUCTION: Lower motor neurons are the only neurons of the central nervous system (CNS) with the ability to regenerate without any intervention after an axotomy. AIM: This present study was conducted to analyze clinical and electrophysiological parameters in four groups of upper limb peripheral neuropathies, before and after treatment, comparing the results obtained after three cures of complex rehabilitation therapy. MATERIALS AND METHODS: We selected a number of 107 patients (66 women and 41 men) aged between 29 and 77 years (mean age = 49.6). Clinical (muscular strength, sensitivity) and electrophysiological parameters (accommodation coefficient α, nerve conduction velocity) were analyzed. All patients received 3 comprehensive treatment cures, each cure of 14 days and a rest period of 3 months between the cures. RESULTS: From the total of 107 patients included in the study, 52 were diagnosed with brachial plexus palsy, 27 with radial nerve palsy, 18 with median nerve palsy and 10 with ulnar nerve palsy. We did not observe a statistically significant difference between the mean age of males (47.2) and females (51.2) (p = 0.07), but peripheral neuropathies were more common in young males. At the end of the rehabilitation treatment all patients achieved better outcomes in muscle strength, sensitivity, adjustment coefficient α and nerve conduction velocity (p < 0.001).CONCLUSIONThe intervention of a physical therapy program in patients with peripheral neuropathies provided significantly better outcomes in clinical and electrophysiological parameters. Our rehabilitation protocol can be considered an alternative in order to stimulate and accelerate the nerve regeneration process.

Influence of exercise training and eating behavior on arterial stiffness in young healthy students.

AIM: Increased arterial stiffness is an important risk factor for the development of cardiovascular disease. The aim of the present study was to compare arterial function and other anthropometric parameters in trained vs sedentary, healthy young students. Furthermore, the study explores the relationship between arterial stiffness and eating behavior in these students. METHODS: Two groups of healthy university students were recruited for this study. The first group consisted of 10 men and 8 women (mean age: 23.27 ± 3.2 years) with an athletic predisposition. Furthermore, over the course of 6 months this group participated in 60-min training sessions designed as interval training circuits with a frequency of three to five times a week. For comparison, a group of age-matched sedentary students (5 men and 13 women; 24.27 ± 2.6 years) were recruited from the same institution. Weight, height, body mass index (BMI), as well as neck and abdominal circumferences (ABs) were recorded. Arterial tension, heart rate, arterial stiffness measurements were simultaneously determined. Lastly, all students completed a 51-item "Eating Behavior Patterns Questionnaire". RESULTS: Age, weight, BMI, AB, and blood pressure were not significantly different between the two groups (p > 0.05). The moderately aerobic trained students showed a significantly lower heart rate, neck circumference, and arterial stiffness as compared with their untrained, sedentary counterparts. Additionally, pulse wave velocity (PWV) measurements were correlated to a lower weight, heart rate, blood pressure, AB, and neck circumference (p < 0.05) found in trained subjects at the end of the 6-month training period. Furthermore, the nutritional habit analysis showed that in the sedentary group, snacking, emotional eating, and cultural/lifestyle behaviors are positively correlated with PWV (p < 0.05). CONCLUSION: Healthy subjects with higher PWV may benefit from consistent aerobic exercise training to improve arterial stiffness. Our eating behavior study shows that healthy eating may improve vascular function and therefore can reduce the risk of cardiovascular diseases.