Clinical outcomes of modified direct lateral approach of Hardinge for total hip arthroplasty

The aim of the study was to evaluate a modified direct lateral approach for total hip arthroplasty in terms of clinical and functional outcomes, rate of complications and hospitalization. We retrospectively reviewed the data of 526 patients with THA operated in our department between January 2017 and December 2021. Clinical examination, functional outcome and radiographic evaluation were performed during follow-up. Patients were evaluated at the following time points: preoperatively and postoperatively at 3 days, 6 weeks, 12 weeks and 1 year and we registered surgery related data, complications, Visual Analogue Scale pain score, Harris Hip Score, the Western Ontario McMaster Osteoarthritis Index. Low intraoperative blood loss, short operation time, short hospitalization, early mobilization of the patient and good range of motion imposed the modified direct lateral approach as a valuable procedure for the patients with THA. VAS score evaluated at 3 days and 6 weeks indicated a very good overall postoperative experience. The HHS and Womac scores were evaluated at 6 weeks, 12 weeks and 1 year and showed excellent results. Trendelenburg gait and abductor weakness, traditionally related with direct lateral approach, were not significant statistically and complete reversible. We registered a very low complication rates with good functional outcome. The modified direct lateral approach can lead to superior outcomes, improved quality of life, with reduced intra and postoperative complications rate.

Evaluation of Total Hip Arthroplasty Performed from a Lateral Approach as Optimal Treatment for Femoral Neck Fractures in Elderly, Active Patients

BACKGROUND

The aim of the study was to evaluate total hip arthroplasty in terms of clinical and functional outcomes, rate of complications and hospitalization, as a treatment of choice for displaced femoral neck fractures.

MATERIALS AND METHODS

We retrospectively reviewed the data of 526 patients with THA operated on in our department between January 2017 and December 2021. Clinical examinations, functional outcome assessment and radiographic evaluation were performed during follow-up. Patients were evaluated at the following time points: postoperatively at 3 days, 6 weeks, 12 weeks and 1 year, and we recorded surgery related data, complications, Visual Analogue Scale pain score, Harris Hip Score, the Western Ontario McMaster Osteoarthritis Index, and range of motion.

RESULTS

Low intraoperative blood loss, short surgical time, short hospitalization, early mobilization of the patient and a good range of motion testify that the modified direct lateral approach is a valuable procedure for the patients with THA. A VAS score evaluated at 3 days and 6 weeks indicated a very good overall postoperative experience. The HHS and Womac scores were evaluated at 6 weeks, 12 weeks and 1 year and showed excellent results.

CONCLUSION

THA for active patients with a displaced fracture of the femoral neck is an excellent treatment option which provides lasting pain relief, a high level of function and very low rates of reoperation.

Multiple Bone Metastatic Invasion with Clinical Implications due to Ductal Mammary Carcinoma – Case report and Short Literature Review

Multidisciplinary approach of clinical cases in rehabilitations units can be very complex and divers. Method: We present a case of a woman 30 years old, whose oncological histo-ry begins 9 years ago, when the diagnosis of invasive ductal mammary infiltrating ca-nelular carcinoma grade I was made and treated by tumorectomy (lumpectomy). The pa-tient refused oncological treatment at that time and resorted to alternative medicine dur-ing a period of 7 years: diet without sugar and animal products; regular vitamin B17 treatments; almond kernel cure; high-dose intravenous vitamin C treatment for; intrave-nous ozone therapy; apitherapy with bee venom; oral administration of cannabis oil dur-ing the past four years until now; physical therapy. Results: The evolution is marked by the appearance of multiple bone metastatic lesions. The most worst clinical consequence was a hyperalgesic cervicobrachial neuralgia, due to multiple C6-T3 lytic lesions diag-nosed 2 years ago and C7 compression (close to spinal cord injury), situation which had as medical approach two surgeries interventions, radiotherapy and chemotherapy. Con-clusions: The rehabilitation program was adapted to every stage of clinical evolution and was marked by many complications. All the steps were made for functional improvement and for increase the quality of life.

Evidence of Improvement of Lower Limb Functioning Using Hydrotherapy on Spinal Cord Injury Patients

BACKGROUND

Spinal cord injury (SCI) is a devastating problem for modern society, whether it affects young people in the most productive period of their lives or the elderly. The spinal cord injury is currently without curative treatment and the therapeutic intervention aims to minimize secondary complications and maximize residual function through rehabilitation medicine. The main objective of this scientific paper is to determine whether there is evidence in the literature regarding the importance and/or use of hydrotherapy, as part of the therapeutic management of the SCI patient, in order to decrease the degree of spasticity, of pain symptoms, increase or maintain range of motion, improve respiratory, cardiovascular, and metabolic status, as well as improve function and psychological benefits.

METHODS

Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedures, the following databases were analyzed between 2000 and 2021: Pub Med, Pub Med Central, Science Direct, Scopus, and SpringerLink. Initial keywords: rehabilitation treatment, spinal cord injury. Additional keywords: hydrotherapy, aqua therapy, spasticity, human. For the scientific quality of the included articles, risk of bias was assessed using the Downs and Black Appraisal Modified Scale.

RESULTS

Our research used only four publications as per PRISMA protocol, assessed with Downs and Black Scale. The study models used in the individual studies included in the research are the following: two systematic reviews, one experimental non-randomized control, and one individual semi-structured interview. Due to the low number of studies, despite two of them being reviews, there is the necessity for a more standardized methodology to prove the benefits hydrotherapy for SCI patients for the improvement of lower limb functioning.

CONCLUSION

Hydrotherapy is an important component of the treatment of an SCI patient, despite the limited number of scientific studies that support this aspect. Clinical trials in the future are required.

Successful Management of IT Projects in Healthcare Institutions after COVID-19: Role of Digital Orientation and Innovation Adaption

This research aims to examine specific issues that how healthcare institutions successfully manage IT projects after the deadly disease of COVID-19. The world’s healthcare institute changed its traditional way of treatment to IT-based equipment after COVID-19. Hence, this study investigated the how digital orientation helps healthcare institutes for successful management of IT. Our study identifies the critical role of digital orientation and innovation adaption in the successful management of IT. The mediating role of innovation adaption in the association between digital orientation and successful management of IT was also investigated. In total, 456 questionnaires were used for the collection of data from eight different healthcare centers. We selected participants through random sampling. Findings on the healthcare institution showed that successful management of IT is predicted through digital orientation. This study’s results proved that digital orientation impacts innovation adaption, and similarly, innovation adaption influences the successful management of IT. The outcomes show the mediating role of innovation adaption in the linkage between digital orientation and successful management of IT. Current research contributes to the existing literature through combined impacts of the digital orientation, innovation adaption, and successful management of IT through means of demonstrating how, when, and why digital orientation supports the successful management of IT. Moreover, innovation adaption performs a significant role in the extant digitalize world; thus, we chose innovation adaption as a mediator in this study.

The Influence of Diet and Physical Activity on Oxidative Stress in Romanian Females with Osteoarthritis

Osteoarthritis (OA) is the most prevalent chronic joint disease, increases in prevalence with age, and affects most individuals over 65. The present study aimed to assess the oxidative status in relation to diet and physical activity in patients with OA. We used a cross-sectional study applied to 98 females with OA. Blood samples were collected to determine oxidative stress markers: malonyl dialdehyde (MDA), reduced glutathione (GSH), oxidized glutathione (GSSG), and GSH/GSSG. Diet was estimated with a standardized food frequency questionnaire. We used the International Physical Activity Questionnaire (IPAQ) to assess the females’ physical activity. Multiple regression analyses were executed to determine the association between the oxidative markers and the intake of vegetables and fruit. The study showed that most patients were overweight or obese (88.8%). The level of physical activity was above the recommended level for adults, mainly based on household activities. The intake of vegetables and fruit was low. The MDA marker was inversely, statistically significantly associated with the consumption of vegetables (p < 0.05). Public health policies must address modifiable risk factors to reduce energy intake and obesity and increase the intake of vegetables and fruit. Higher consumption of vegetables and fruit may provide natural antioxidants that can balance oxidative compounds.

Antegrade intramedullary locking nail in the management of proximal and middle thirds of humeral diaphyseal fractures

PURPOSE

The aim of the study was to evaluate the antegrade intramedullary locking nail osteosynthesis for the treatment of the proximal and middle thirds of humeral shaft fractures.

METHODS

A retrospective study was made on 218 patients diagnosed with humeral diaphysis fractures who undergo surgery with antegrade intramedullary locking nail between January 2017 and December 2021. The clinical follow-up started two days after surgery and continued at one month, three months, six months and one year. The functional recovery evaluation was performed using visual analogue scale (VAS) score, Rating Scale of American Shoulder and Elbow Surgeons Form (ASES), Mayo Elbow Performance Score System (MEPS) and rate of complications.

RESULTS

Low intra-operative blood loss, short operation time, short hospitalisation, early mobilisation of the patient and high union rate imposed intramedullary nailing as a standard procedure for the treatment of proximal and middle thirds of humeral diaphyseal fractures in the past years, and the union rate was 99.5%. VAS score evaluated at one month, three months and six months indicated a very good overall post-operative experience. The ASES and MEPS score were evaluated at six months and one year and showed excellent results. All the patients (except 1 case) were able to return to their previous jobs within six months.

CONCLUSION

Humeral nailing is associated with early return to function of the upper limb, with very good clinical and functional outcomes of the shoulder and elbow. This method could be considered the best surgical option for the management of proximal middle humeral fractures.

Complementary Strategies to Promote Hair Regrowth in Post-COVID-19 Telogen Effluvium

Post-COVID-19 telogen effluvium has been largely reported as a sequela in the post-acute phase of COVID-19, causing major emotional distress among the affected patients. The affected individuals are further exposed to a vast amount of misinformation from the internet and social media and it is important for physicians to be familiar with the phenomenon and provide appropriate counselling to their patients regarding this condition. This article aims to review the evidence-based complementary strategies that can help enhance hair regrowth after post-COVID-19 hair loss, from psychological support and patient education to the importance of optimal nutrition and potential indications and benefits of oral nutritional supplementation, as well as the role of both topical and injectable hair growth stimulators.

Benefits of crenotherapy in digestive tract pathology (Review)

Balneotherapy, a branch of physical and rehabilitation medicine using the natural factors of balneal resorts for therapeutical purposes to modulate the symptoms of numerous diseases, represents a non-pharmaceutical therapeutic alternative, easily accepted by patients and used both preventively and curatively. Crenotherapy, a branch of balneotherapy, is the method in which mineral waters are used as a therapeutic internal cure by ingestion. This procedure is performed in spa resorts (where these natural resources exist), and the ingestion of mineral water takes place at the source (spring), in the quantities recommended by the medical rehabilitation physician, according to specific regimens for the condition to be treated. Depending on their physical and chemical composition, the therapeutic mineral waters fall into several categories, having clear indications for certain pathologies. Hypotonic, isotonic, or slightly hypertonic mineral waters are recommended in diseases of the digestive tract and hepatobiliary conditions. Over time, studies have been conducted to determine the effect of these types of treatments, highlighting the complex influence of crenotherapy on the gastrointestinal tract, with favorable results, therefore the use of mineral water intake in various pathologies being recommended. The current review focuses on the existing literature data and refers to the main progress made in understanding the benefit, indications, and crenotherapy procedures in the management of gastrointestinal disorders.

Axial and para-axial loading response evaluation on human cadaver-harvested lumbar vertebral blocks: In vitro experiment with possible clinical implications for clinical practice

The aim of the present study conducted on the lumbar spine was to confirm that the pronounced decrease in resistance in the system is a phenomenon that can be eminently affected by the adaptive changes that occur at the level of the intervertebral disc at axial mechanical stresses. The biomechanical trial was carried out on 11 lumbar segments L1-L5, gathered from adult human cadavers. The dissection considered the complete keeping of all bone, disc, articulated and ligamentous components in their anatomical position. All 11 samples were frozen 24 h prior to the performance of the biomechanical measurement. The specimens were placed in the testing device, their placement being conditioned by the estimated dimensional values. Thus, to calculate the load and axial resistance, the models were placed vertically, central between the test machine ferries. The testing was carried out by applying variable forces and displacement supervision. The displacement interval was represented by a segment of 0-10 mm with surveillance every 2 mm. Mobility in the sagittal plane (flexion earlier in our case) was much higher than that in the frontal plane, obviously limiting mobility via the intervertebral disc and articular complex through the presence of arches. Statistical analysis demonstrated the lack of any correlation values between the two types of movements (R²=0.005507), underlining the absence of any prediction elements. A noteworthy aspect is that the correlations appeared low, statistically insignificant, even within the same movement in the sagittal plane between the two levels, L1-L3 and L3-L5 (R²=0.610427), which may lead to the possibility of the emergence of significant differences in mobility between respective levels. The behavior type of the monitored specimens and the results obtained allowed the mapping of objective parallelism between the values obtained and the behavior in vivo of the lumbar vertebral segment.

Brain - Derived Neurotrophic Factor - a Marker for the Balneal Treatment of Chronic Low Back Pain?

Up till now, to our knowledge, there are no studies evaluating serum Brain - Derived Neurotrophic Factor (BDNF) levels in patients with degenerative chronic low back pain under rehabilitation treatment. BDNF is a neuroprotein associated with neuropathic pain and represents an important mediator of the effects of physical exercise. Complex balneal treatment with hot Techirghiol sapropelic mud reduces pain and increases serum levels of BDNF in these patients.

Correlations between serum cortisol and body mass index at old patients under balnear treatment

Introduction. Glucocorticoids provide a significant resource of scientific progress in medical research, being studied in terms of molecules, genetics, physiopathology at the level of the human body, starting from animal models, with valuable recent discoveries regarding their implications in the human psychic level, stress reaction and the search of new possible therapeutic effects unknown until now. Our work are illustrated the correlations between serum cortisol and body mass index - BMI at old patients under balneal treatment with natural factors from Techirghiol lake. Material and methods. The study monitored 52 patients admitted in Balneal and Recovery Sanatorium of Techirghiol for complex balneal treatment, using mud baths (cold or warm), and physical treatments. The patients were grouped in two batches: batch of cold baths with mud- CMB (15 patients, 28.8%, 6 men and 9 women) and batch of warm baths with mud-WMB (37 patients, 71.2%, 19 man and 18 women). The following issues were statistically analysed: BMI, respectively serum cortisol value variation for each batch studied, both at the time of admission and at the time of discharge; comparative analysis between the two moments for each batch; and the comparative analysis between the two study batches at the time of admission, respectively discharge and the BMI value variation in statistical relation with the serum cortisol values for each batch studies at the time of admission and at the time of discharge. Results. From statistical analysis of the correlation between the body mass index (BMI) of patients included in research in the CMB batch at admission and discharge according to the variations of the serum cortisol level , the two variables (Serum cortisol / BMI) both at admission and discharge are not correlated (r = -0.366; p = 0.180 > α = 0.05; r = -0.035; p = 0.901 > α = 0.05). Also, from statistical analysis of the correlation between the body mass index (BMI) of patients included in research in the WMB batch at admission and discharge according to the variations of the serum cortisol level , the two variables (Serum cortisol / BMI) are correlated at admission (r = -0.406; p = 0.013 > α = 0.05), but are not correlated at discharge (r = 0.200; p = 0.236 > α = 0.05). Conclusions. Previous studies have shown that high levels of adiposity can increase the cortisol stress response. While overweight and obese men showed an increased cortisol response upon each food intake, they can be more susceptible to develop stress associated disorders.

ADIPONECTIN CORRELATION WITH BIOCLINICAL BENEFITS OF USING NATURAL THERAPEUTIC FACTORS IN KNEE OSTEOARTHRITIS

Context and objective

The new insights in the pathogenesis of osteoarthritis (OA) reveal the implications of adipocytokines. This study aims to analyze the correlations between the serum value of adiponectin and the clinical rehabilitation effects in patients diagnosed with knee OA, admitted and treated in the complex balneal resort of Techirghiol lake.

Subjects and methods

The prospective randomized clinical study included 23 patients in the study group, diagnosed with knee OA according to ACR criteria, and a matching control group of 23 subjects. Serum level of adiponectin (using ELISA technique), uric acid, triglycerides, cholesterol, HDL-cholesterol and clinical response using a visual analog scale (VAS) were evaluated in all patients on their admission day and after 10 days of balneal treatment. Control group benefited from the same procedures except for cold mud therapy and mineral water baths.

Results

Plasma adiponectin levels (23.73±6.44 ng/dL) were statistically higher (p<0.05) in the study group compared to the control group (18.15±6.49 ng/dL). The mean VAS in both groups was decreased (p<0.005) compared to the initial moment.

Conclusions

Cold peloidotherapy combined with physical therapy and balneal factors induces serum adiponectin elevation and improves knee pain in OA. Therapeutic properties of Techirghiol mud still need further research.

Considerations Regarding The Quality Of Rehabilitation And Physical Medicine Services From Patients Perspective

The research study aims to assess the quality of physical medicine and rehabilitation (MFR) services offered to the population by specialized sanatoriums and hospitals in Dobrogea, in order to identify some appropriate measures to improve the quality of such services.

The target group (593 respondents) consisted of 6 independent batches, different in number, selected from 6 medical units. The patients responded to a specific questionnaire regarding the quality of MFR services and the collected data were analyzed statistically.

According to the patients′ answers, the medical staff meets their expectations in terms of the information provided at the time of admission, promptitude, kindness, availability, which reflects just one segment of the quality of medical rehabilitation services.

As regards the entity recommending the medical rehabilitation physician, of the total answers, the lowest ratio in the study is held by the answer “family doctor / another doctor”. It thus highlights the poor knowledge of family doctors or other doctors on the therapy benefits specific to medical rehabilitation and therefore the access to such services is not facilitated, a disservice to the patients′ life quality. There is a dependence relation between the level of education and the reason of admission. We see that is not prevention taking the first position, but the pain, which reflects a deficient education for health in all social levels.

Assessing the patient’s satisfaction regarding the mobility facilities in the sanatorium / hospital a percentage of 6.6% patient responded that they are not satisfied. It results that all the 6 partner institutions in the study must evolve to provide decent conditions ensuring the mobility independence to the patients.