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Multiple sclerosis (MS) is an immune-mediated disease characterized by inflammation, demyelination, and neurodegeneration within the central nervous system. Brain plasticity, the brain's ability to adapt its structure and function, plays a crucial role in mitigating MS's impact. This paper explores the potential benefits of lifestyle changes and nutraceuticals on brain plasticity in the MS population. Lifestyle modifications, including physical activity and dietary adjustments, can enhance brain plasticity by upregulating neurotrophic factors, promoting synaptogenesis, and reducing oxidative stress. Nutraceuticals, such as vitamin D, omega-3 fatty acids, and antioxidants like alpha lipoic acid, have shown promise in supporting brain health through anti-inflammatory and neuroprotective mechanisms. Regular physical activity has been linked to increased levels of brain-derived neurotrophic factor and improved cognitive function. Dietary interventions, including caloric restriction and the intake of polyphenols, can also positively influence brain plasticity. Integrating these lifestyle changes and nutraceuticals into the management of MS can provide a complementary approach to traditional therapies, potentially improving neurological outcomes and enhancing the quality of life for the MS population. [ABSTRACT FROM AUTHOR]

Multiple Myeloma is a malignancy characterized by multisystem involvement, including multiple osteolytic lesions, anemia, and renal insufficiency. The debilitating course of this disease highlights the importance of exploring the therapeutic potential of physical rehabilitation in improving patients' quality of life and providing meaningful clinical outcomes. The aim of this study is to investigate the benefits and challenges associated with the implementation of physical rehabilitation programs for patients with multiple myeloma, analyzing the evolution and characteristics of multiple myeloma cases in a medical clinic in Romania. Through this, we seek to contribute to the development of new approaches and protocols in physical rehabilitation, which may improve the therapeutic management and quality of life for patients with this complex condition. A retrospective analysis was conducted on newly diagnosed multiple myeloma patients over a 7-year period (2017-2023) at a clinic in Romania. The collected data included the time of initial diagnosis, patient age, residence (rural or urban), multiple myeloma subtype,treatments initiated, hematological parameters, presence of bone lesions, and comorbidities. We reviewed the existing literature on physical rehabilitation in multiple myeloma and assessed the associated advantages and challenges. Statistical analysis was performed to identify trends and correlations within our cohort. Out of a total of 255 patients diagnosed with multiple myeloma at a medical center in Romania, the majority were men from urban areas. It was observed that the average age at diagnosis was lower among patients from urban areas. Additionally, 69.8% of patients presented with bone lesions, while pancytopenias were rarely encountered at the time of diagnosis. Personalization of physical exercises is essential to maximize rehabilitation benefits for patients with multiple myeloma. Complications such as pancytopenias and frequently encountered bone lesions should not discourage the recommendation of rehabilitation. Decisions must be individually tailored and coordinated by a multidisciplinary team to ensure the rehabilitation program's safety and efficacy. [ABSTRACT FROM AUTHOR]

The study aimed to identify predictors of 6 -month outcomes in acute ischemic stroke (AIS) patients using the modified Rankin Scale (mRS). A prospective observational cohort study was conducted on 277 AIS patients admitted to the Neurology Departments of Cluj-Napoca Emergency County Clinical Hospital between December 2020 and July 2021. After excluding those lost to follow-up or who withdrew due to COVID-19 concerns, 121 patients were followed for six months. Data collected included demographic details, clinical assessments (including NIHSS and mRS scores), laboratory tests, and imaging results. The study found significant differences between patients with mild/moderate disability (mRS 0-3) and those with severe disability (mRS 4-5) at six months. Age, heart failure, NIHSS score, resistin levels, C-reactive protein, and lesion volume were significantly associated with worse outcomes. Multivariate logistic regression revealed that heart failure was an independent predictor of severe disability, increasing the risk by over seven times. Specific clinical and biochemical markers at admission may be able to predict long-term functional outcomes in AIS patients, which may inform individualized patient management and rehabilitation strategies. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency and type 2 diabetes mellitus are risk factors for colorectal cancer, suggesting a role for vitamin D receptor (VDR) and insulin receptor (INSR) gene polymorphisms. We investigated the prevalence of the VDR-BsmI (rs1544410) and NsiI A/G-INSR (rs2059806) polymorphisms and their associations with colorectal adenoma (CRA) in a Romanian population. A case–control study was conducted with 110 participants (67 with CRA and 43 controls) who underwent colonoscopy. Polymerase chain reaction–restriction fragment length polymorphism analysis was used to determine the genotype and allele frequencies of the two polymorphisms. Regarding rs1544410 and CRA patients, genotype distribution was 35% B/B, 47% B/b, and 19% b/b. In the controls, the distribution was 21% B/B, 45% B/b, and 34% b/b. For rs2059806, 12% of CRA patients had A/A, 30% A/G, and 58% G/G, while 8% of the controls had A/A, 40% A/G, and 52% G/G. The recessive model showed an odds ratio of 2.84 (95% CI: 1.04–7.72, p = 0.033) for the b/b genotype. CRA patients with b/b or G/G genotypes were diagnosed at a younger age. The b allele of the rs1544410 was a risk factor for CRA. Patients with the b/b and G/G genotypes were diagnosed earlier. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is one of the most common neoplasms in developed countries, with increasing incidence and mortality, even in young people. A variety of serum markers have been associated with CRC (CEA, CA 19-9), but neither should be used as a screening tool for the diagnosis or evolution staging of CRC. The sensitivity and specificity of these markers are not as good as is required, so new ones need to be found. Matrix Gla protein and PIVKA II are involved in carcinogenesis, but few studies have evaluated their usefulness in predicting the presence and severity of CRC. Two hundred patients were divided into three groups: 80 patients were included in the control group; 80 with CRC and without hepatic metastasis were included in Group 1; 40 patients with CRC and hepatic metastasis were included in Group 2. Vitamin K-dependent proteins (VKDPs) levels in plasma were determined. Patients with CRC without methastasis (Group 1) and CRC patients with methastasis (Group 2) presented significantly higher values of CEA, CA 19-9, PIVKA II (310.05 ± 38.22 vs. 430.13 ± 122.13 vs. 20.23 ± 10.90), and ucMGP (14,300.00 ± 2387.02 vs. 13,410.52 ± 2243.16 vs. 1780.31 ± 864.70) compared to control group (Group 0). Interestingly, Group 1 presented the greatest PIVKA II values. Out of all the markers, significant differences between the histological subgroups were found only for ucMGP, but only in non-metastatic CRC. Studying the discrimination capacity between the patients with CRC vs. those without, no significant differences were found between the classical tumor markers and the VKDP AUROC curves (PIVKA II and ucMGP AUROCs = 1). For the metastatic stage, the sensitivity and specificity of the VKDPs were lower in comparison with those of CA 19-9 and CEA, respectively (PIVKA II AUROC = 0.789, ucMGP AUROC = 0.608). The serum levels of these VKDPs are significantly altered in patients with colorectal carcinoma; it is possible to find additional value of these in the early stages of the disease. [ABSTRACT FROM AUTHOR]

Introduction: Reduced serum levels of paraoxonase 1 (PON1) activities are associated with diseases involving increased oxidative stress, such as acute coronary syndrome. We aimed to determine whether serum PON1 activities are a prognostic factor for one-year survival following ST-elevation myocardial infarction (STEMI).

The increase in the prevalence of both colon and rectal cancer in recent years poses challenges for the medical system in terms of patient management and indirectly incurs significant financial burdens. Purpose: The aim of this paper is to track the changes in the prevalance of the colon and rectal cancer at a tertiary clinic in Romania over time and to identify complementary methods to improve the prognosis and quality of life of cancer patients. Material and methods: We conducted an observational, longitudinal, population-based study, including all patients newly diagnosed with colon or rectal neoplasia within the time frame from 1 January 2013 to 1 January 2024 in a tertiary medical clinic in Romania. For each case included in the study, we gathered demographic data (age at the time of cancer diagnosis, gender, place of origin), location of the tumor, duration until surgical intervention, alternative treatment methods employed (such as radiation or chemotherapy, and immunotherapy), and the length of survival. We also assess the feasiblity of physical prehabilitation and rehabilitation programs for inpatients diagnosed with malignant neoplasms of the colon or rectum. Results: The study found significant differences in patient ages and the execution of prehabilitation and rehabilitation practices between those admitted for colon and rectal cancer during the periods 2013-2018 and 2019-2023, with a notable shift in the prevalence of colon versus rectal cancer over these periods. Conclusions: Prehabilitation and rehabilitation practices for colorectal cancer patients are underdocumented or suboptimal, with recent improvements in documentation, especially for rectal cancer due to colostomy needs, and an observed increase in patient age due to COVID-19 pandemic protocols. Additional research and the development of standardized protocols are needed. [ABSTRACT FROM AUTHOR]

(1) Background: The aim of the study was to investigate the effecs of mofettes and carbonated mineral water baths on bone healing using a rat femoral defect model; (2) Methods: A 2mm diameter unicortical defect in the left femoral diaphysis in 40 Wistar Rats was surgically created. Furthermore, the subjects were divided into 4 treatment-groups: control, mofette therapy, mofette therapy and carbonated mineral water bath, and carbonated mineral water bath. At the end of the 2-week treatment and at 4 and 6 weeks, the animals were evaluated through Micro-CT analysis of the bone defect and histological analysis of bone tissue and skin; (3) Results: The processes of bone consolidation and repair are not completed at 6 weeks in all groups. However, comparing the proliferated bone tissue in the created orifice and the degree of thickening of the femoral wall, it can be affirmed that at 6 weeks, the best results are present in Group 4, treated with carbonated mineral water baths, followed by the combination of mofettes and carbonated water. (4) The use of these treatments could open a new possibility for shortening the healing time in patients with bone defects, as it is non-invasive and accessible. [ABSTRACT FROM AUTHOR]

Obiectivul studiului a fost de investigarea fenotipului şi genotipului PON1 la pacienţii români cu obezitate abdominală. Material şi metodă. Loturile din studiu au constat din 88 de pacienţi cu obezitate abdominală şi 46 subiecţi cu circumferinţă abdominală normală. Pentru fiecare pacient am determinat parametri clinici care ar putea influenţa activităţile PON1. Polimorfismele Q192R şi L55M ale genei PON1 au fost identificate prin PCR-RFLP (polimorfismul lungimii fragmentelor de restricţie) prin utilizarea unor primeri şi enzime de restricţie specifice. Activităţile PON1 lactonază, paraoxonază şi arilesteraza au fost măsurate prin metode spectofotometrice. Analiza statistică a genotipurilor PON1 şi activităţilor ei la pacienţii obezi şi nonobezi a fost realizată cu programul MedCalc (versiunea 12.5.0.0). Rezultate: Nu am găsit o diferenţă semnificativă între pacienţii obezi şi nonobezi în ceea ce priveşte vârsta şi sexul. Studiul a revelat faptul că activităţile PON1 nu sunt influenţate de sexul pacienţilor. Dintre activităţile PON1, doar activitatea paraoxonazei a fost invers corelată cu vârsta (p=0,05). Circumferinţa abdominală a influenţat independent doar variaţia activităţii arilesterazei (R2=6,5%); p=0,003). Distribuţia genotipurilor PON1 între loturi a fost semnificativ diferită doar pentru Q192R (p=0,007), dar nu şi pentru genotipurile L55M. Genotipul QR a avut cea mai mare influenţă asupra activităţii paraoxonazei (R2=40,6; p

Non-steroidal anti-inflammatory drugs (NSAIDs) are extensively used worldwide due to their analgesic, antipyretic and antiinflammatory effects. NSAIDs (both non-selective NSAIDs and selective cyclooxygenase-2 inhibitors) have nephrotoxic potential, particularly when used chronically.The principal mechanism of action of NSAIDs is cyclooxygenase inhibition, which prevents the conversion of arachidonic acid to prostaglandins, prostacyclins and thromboxanes. In the kidney, prostaglandins induce vasodilation and counter the action of the renin-angiotensin-aldosterone system and the sympathetic nervous system, ensuring optimal renal perfusion. Inhibition of this mechanism by NSAIDs can result in renal damage: acute kidney injury through hemodynamic mechanism, acute interstitial nephritis, glomerular disease, papillary necrosis, water and electrolyte imbalances, HTN. Chronic NSAID use may lead to chronic kidney disease.The nephrotoxic effect is reduced in young patients without renal disease or other comorbidities, but increases significantly in elderly patients with pre-existing kidney disease, nephrotic syndrome, diabetes mellitus, severe congestive heart failure, volume depletion, cirrhosis with ascites, HTN, atherosclerosis, or in patients under treatment with diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor inhibitors. [ABSTRACT FROM AUTHOR]

Introduction. Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease. The pulmonary rehabilitation (PR) is a mutidisciplinary and comprehensive intervention in symptomatic patients with COPD. Objective. This review aims to synthesize evidence from available studies on the relative efficacies of different methods of rehabilitation therapies in patients with stable COPD. Material and Methods. A search was performed on the databases Pubmed, Embase, ResearchGate. Of the 410 articles retrieved from databases, only 20 met the inclusion criteria. Two reviewers independently reviewed selected eligible studies. Results. Rehabilitation is a multidisciplinary intervention in symptomatic patients with COPD, including speleotherapy, halotherapy, muscular training, soft tissue manual therapy and neuromuscular electrostimulation. All of the case-control studies using speleotherapy reported improved respiratory function to varying degrees and there were improvements in lung functional tests including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1), oxygen saturation, partial pressure of oxygen in arterial blood, and partial pressure of carbon dioxide in arterial blood. In addition, halotherapy has been associated with relief of respiratory conditions such as COPD, asthma and cystic fibrosis by its bactericidal effect, improvement of immunity and rheological properties of secretions. Respiratory muscle training is a part of rehabilitation for COPD subjects. In patients who can not perform physical activity, neuromuscular electrostimulation (NMES) increased 6 minute walking distance and time to symptom limitation exercising at a submaximal intensity and reduced the severity of leg fatigue on completion of exercise testing. Conclusion. The management of COPD should include a multidisciplinary therapy, including rehabilitation therapies as an adjuvant to the medical treatment, especially because due to the high prevalence, mortality, and morbidity, COPD will be one of the biggest public health challenges in the next century. [ABSTRACT FROM AUTHOR]

Introduction. Mineral waters are administered in medical hydrology as prophylaxis or treatment, both internal and external. The mineral water from spring 3 in Baile Tusnad, with a total mineralization of 3351.0 mg/l, is recommended in chronic liver diseases. From the point of view of its chemical composition, it contains sodium chloride, iron, carbon dioxide, traces of iodine, boron. Some studies have evaluated the therapeutic properties of mineral water as a whole, but it is considered that the different components of the waters may also act in an antagonistic manner. Material and method. For the experimental study, 25 white rats were used. The animals were assigned to 3 groups: group I - negative control, 5 animals; group II - positive control, 6 animals; group III - experimental group, 14 animals. Group I animals received tap water (50-75 ml/animal/day) throughout the experiment; group II and III animals received 12% ethyl alcohol (12-15 ml/animal/day) during the first 70 days. Over the last 30 days, group II animals received tap water (50-75 ml/animal/day), while group III animals were administered mineral water from spring 3 in Baile Tusnad (50-75 ml/animal/day). Before starting alcohol administration, at 70 days, after alcohol administration, and at 100 days, after administration of tap water and mineral water for 30 days, 0.1 ml serum/blood sample from each animal was collected in order to determine the values of some biochemical components: transaminases, glycemia, total protein, urea, creatinine, sodium, calcium, iron, potassium. Results and discussions. Transaminases, particularly aspartate aminotransferase (ASAT), increased after alcohol consumption, but after mineral water consumption for 30 days, they decreased more compared to the group that drank only tap water. Renal function was not affected. There were slight increases in glycemia and total protein values after alcohol administration, which decreased after water administration. During the study, the blood iron value statistically significantly increased at 100 days compared to day 70, p<0.005. Sodium (Na) and potassium (K) values increased on day 70 after alcohol consumption, but on day 100 they decreased to normal in both groups. A slight increase in calcium ion (Ca) levels was observed in the group that consumed mineral water compared to the group that drank tap water, but without statistical significance. Conclusions. Both the indications and the methods of treatment are based on pharmacodynamic effects in the pre-absorption phase and after absorption of the water in the digestive tract. However, administration of mineral water requires careful monitoring of some biochemical components after its consumption. [ABSTRACT FROM AUTHOR]

Ethical aspects related to the approach of persons addicted to tobacco use are a particular concern of pneumologists. Considered for a long time ”an expression of the modern way of life”, smoking is viewed today as a pandemic disease, being at the same time an epidemic that can be completely prevented. We present the ethical aspects of the approach of persons addicted to tobacco use, the peculiarities of the medical approach in smoking cessation and implicitly, of the doctor-patient relationship and how to make patients responsible for their own health within this relationship. The final aim of the medical intervention was to restore patient’s autonomy in making decisions regarding smoking cessation, along with a change in lifestyle. In changing the patients’ attitude, the principles of autonomy and non-maleficence represented a strong motivation, the patients benefiting from the presence and implementation of a National Smoking Cessation Program. [ABSTRACT FROM AUTHOR]

Non-alcoholic fatty liver disease (NAFLD) comprises a spectrum of disorders which affect the liver, but were proven to have implications in many other organs and systems. It is now widely accepted that NAFLD has many comorbidities, mainly metabolic and cardio-vascular. Even if much comorbidity are well-explained, there are many other diseases associated with NAFLD in which the pathophysiological pathways are not completely understood. Research is conducted nowadays with the goal of completely elucidate the pathogenesis of NAFLD and its comorbidities, in order to eventually find a targeted cure for this "epidemic" liver disease. The purpose of this review is to present the non-cardiometabolic comorbidities of NAFLD, by using epidemiological and , physiopathological data, and to bring updated information on their treatment. [ABSTRACT FROM AUTHOR]

Carbon dioxide baths might represent an effective therapeutic method in the rehabilitation of coronary heart disease, myocardial infarction and stroke, as well as in the treatment of chronic venous insufficiency, inflammatory diseases and functional disorders. According to the World Health Organization, 5.5 million deaths from stroke were recorded in 2001, and about 15 million people survive stroke every year. Mortality from stroke is 11% for women and 8.4% for men. According to the European Association for Cardiovascular Prevention Rehabilitation, phase II and III cardiovascular rehabilitation is performed in Romania only in a proportion of 10%. The therapeutic effects of carbonated mineral waters are due to the action of carbon dioxide. This induces cutaneous vasodilation, with a decrease in blood pressure values. It also causes an increase of cardiac output, while reducing blood pressure and heart rate. Mofettes are natural emanations along the Harghita volcanic massif, which contain CO2 in concentrations of 90-98% with cutaneous vasodilator effects, increasing cerebral and muscle blood flow. The natural therapeutic factors in Baile Tusnad, consisting of carbonated mineral water baths, mofettes, climate therapy, along with medical physical culture, indicated in the rehabilitation treatment of post-stroke patients had a beneficial effect on clinical and functional symptomatology, improving the quality of gait and balance, functionality and exercise capacity in a patient who suffered stroke five years before and was followed up for three years, while she attended an annual medical rehabilitation program in Baile Tusnad. Continuing medical rehabilitation programs, in the absence of contraindications, in Romanian spa resorts for cardiovascular treatment, as well as conducting randomized clinical studies on the efficiency of these treatments is important. [ABSTRACT FROM AUTHOR]

Introduction. Renal impairment and neurological symptoms are common manifestations of Fabry disease. Although rare, Fabry disease should be taken into consideration when consulting a patient who presents with neurological and renal impairment, acroparesthesia and fatigue. The aim of this paper is to discuss the case of a female patient presenting with mild systemic symptoms and consequent renal impairment. Case report. The female patient, aged 64, presented for a painful ankle swelling, acroparesthesias, nycturia and fatigue. We diagnosed a gout attack, but found that she had biological signs of renal impairment, aggravated by the use of non-steroidian anti-inflammatory drugs. The search for an etiology of her renal failure proved difficult because she refused the kidney biopsy. The positivity of pANCA antibodies added another potential cause of kidney disease. The mild deficiency of alphagalactosidase could not fully support the diagnosis of Fabry disease. Discussions and conclusions. In women, Fabry disease should be suspected even if the symptomatology is not typical and as severe as in men. It is difficult to diagnose the Fabry disease in a female patient with chronic kidney disease, because of its polymorphic manifestations and association with other comorbidities, in our case, pANCA vasculitis. [ABSTRACT FROM AUTHOR]

Introduction. Osteoporosis is a frequently ignored disease, that has the potential to develop an adverse outcome, leading to complications that lower patients' quality of life. Postmenopausal osteoporosis is a well-studied subject, being a disease with an increasing prevalence. However, there is a large number of drugs to choose from for the treatment of postmenopausal osteoporosis. Bisphosphonates are the most used therapeutic choice but, with an almost 10-year clinical experience, RANKL inhibitor Denosumab is becoming more frequently used in practice, with great results. The main purpose of this review is to evaluate the efficacy of bisphosphonates compared with that of Denosumab by analyzing different parameters. Matherials and methods. We included randomized studies that directly compared bisphosphonates to Denosumab after 1 year of treatment, which included data regarding the bone mineral density (BMD) and bone turnover markers (BTM) measured at baseline and after 12 months. Results. Seven randomized studies were included in this review, combining a total of 4535 patients. In all 7 studies the changes in lumbar spine bone mineral density were statistically significant in favor of Denosumab. Denosumab also produced a decrease in bone turnover markers as early as 1 month from the beginning of the treatment. After 12 months of treatment the reduction percentage of BTM were similar between the two groups. The rate of adverse effects' occurrence is similar between the two groups. Conclusion. Denosumab treated patients present an increase in bone mineral density after 12 months of treatment when compared to bisphosphonates. Both therapies have a similar reduction of bone turnover markers. The rate of adverse effects' occurrence during the 12 months of monitoring were also similar between the two drugs. [ABSTRACT FROM AUTHOR]

Surgical pathology in athletes is an important chapter of modern surgery, and in many cases it also has a high degree of difficulty in terms of a positive diagnosis. Whether chronic or acute, the diagnosis for inguinal pain should be made as early as possible to reduce as much as possible the period during which the athlete is absent from training and competitions, thus speeding up the athlete's comeback. Moreover, the treatment algorithm in these cases must be chosen correctly, the differential diagnosis thus gaining special importance. One should keep in mind that if wrongly diagnosed and treated, this pathology can lead to a premature termination of the athlete's career. On the other hand, the late return of the athlete to the characteristic activity of the chosen sport can have an important economic impact on the club or organization where the athlete is active. [ABSTRACT FROM AUTHOR]

Pannus-related prosthetic valve dysfunction, a complication of mechanical prosthetic valve replacement, is rare, with a slowly progressive evolution, but it can be acute, severe, requiring surgical reintervention. We present the case of a patient with a mechanical single disc aortic prosthesis, with moderate prosthesis-patient mismatch, minor pannus found on previous ultrasound examinations, who presented to our service with angina pain with a duration of 1 hour, subsequently interpreted as non- ST segment elevation myocardial infarction (NSTEMI) syndrome. Coronarography showed normal epicardial coronary arteries, an ample movement of the prosthetic disc, without evidence of coronary thromboembolism, and Gated Single-Photon Emission Computerized Tomography (SPECT) with Technetium (Tc)-99m detected no perfusion defects. Transthoracic echocardiography (TTE) evidenced a dysfunctional prosthesis due to a subvalvular mass; transesophageal echocardiography (TOE) showed the interference of this mass, with a pannus appearance, with the closure of the prosthetic disc. Under conditions of repeated angina episodes, under anticoagulant treatment, surgery was performed, with the intraoperative confirmation of pannus and its removal. Postoperative evolution was favorable. This case reflects the diagnostic and therapeutic management problems of pannus-related prosthetic valve dysfunction. [ABSTRACT FROM AUTHOR]