Search

Introduction/Objective. Proximal tibial stress fractures associated with bilateral severe knee osteoarthritis are rare and, due to possible consequences, are considered a treatment challenge. This paper aims to present the applied treatment method of these patients and its results. Methods. A prospective study followed 14 patients with an average age of 74.1 years and with unilateral proximal tibial stress fracture associated with bilateral severe knee osteoarthritis. Surgical treatment involved modular total knee arthroplasty (TKA) on the fracture side, in the first act, and contralateral standard TKA, in the second act, based on the severe osteoarthritis. Rehabilitation was performed for 21 days after both operations and included the following: kinesiotherapy, electrotherapy, magnetotherapy, hydrotherapy, and thermotherapy. Monitoring parameters were as follows: X-ray, range of motion, and WOMAC index. Monitoring periods were preoperative and three, six, and nine months after the first TKA surgery. Results. The radiological findings in all patients during these follow-up periods were normal. All tibial stress fractures healed within six months after surgery. Knee function was significantly improved nine months after the first TKA surgery compared to the preoperative finding. A statistically significant improvement in the physical functioning was found in all postoperative periods, especially nine months after the first TKA surgery (p < 0.05). Conclusion. Modular total knee arthroplasty on the tibial stress fracture side and delayed standard total knee arthroplasty of contralateral osteoarthritic knee combined by postoperative inpatient rehabilitation give optimal final functional outcome.

Background/Aim: Optimal intake of magnesium minerals is essential in maintaining the coordinated physiological functions of cells, tissues and organs. The importance of this element is reflected in the fact that it is the fourth most abundant cation in the human body, participating as a cofactor in more than three hundred enzymatic reactions. Its presence is necessary for the proper functioning of a number of vital functions, such as glycaemic control, the work of the heart and the vascular system and it can potentially play a role in the regulation of body weight. Aim of this study was to investigate the effects of subchronic intake of magnesium hydrocarbonate-rich water on changes in body weight, organ weight and cardiovascular variables in rats with streptozotocin-induced diabetes. Methods: Wistar rats (n = 28) were divided into 4 groups: two control groups, on tap water (TW-C, n = 7) and magnesium hydrocarbonate-rich water (MW-C, n = 7); and two experimental groups with streptozotocin-induced diabetes, on tap water (TW-DM, n = 7) and magnesium hydrocarbonate-rich water (MW-DM, n = 7). The values of body weight, organ weight and cardiovascular parameters were compared after 6 weeks between control groups of rats on subchronic treatment with tap water (TW-C) and magnesium hydrocarbonate-rich water (MW-C) and between groups with streptozotocin-induced diabetes on tap water (TW-DM) and with magnesium hydrocarbonate-rich water (MW-DM). Results: By comparing the values of cardiovascular parameters between groups, significant (p < 0.05) positive effects of magnesium hydrocarbonate-rich water were registered on the values of systolic and pulse blood pressure in diabetic rats fed with magnesium hydrocarbonate-rich water (MW-DM) compared to those fed with tap water (TW-DM). In contrast, no significant effect of magnesium hydrocarbonate on changes in body weight and organ weight was observed. Conclusion: Based on the results, the beneficial effects of magnesium hydrocarbonate-rich water in the regulation of blood pressure can be clearly observed. Potential effects on other cardiovascular variables and body weight and organ weight should be further investigated.

Background/Aim: Type 2 diabetes is a common comorbidity in patients with knee osteoarthritis. Bearing in mind that obesity and insulin resistance are risk factors for the development of knee osteoarthritis, physical therapy and balneotherapy containing hydrogen sulphide (H2S) has a positive effect on the functional and metabolic status of these patients. This work was aimed to investigate the effect of sulphate-sulphide-rich mineral baths containing H2S on the level of serum glucose in patients with knee osteoarthritis. Methods: An open prospective randomised clinical trial included patients suffering from stage I and II of the knee osteoarthritis. Patients were divided into two groups of 40 subjects each: control group and experimental group. All subjects underwent inpatient physical treatment consisting of kinesitherapy and transcutaneous electrical nerve stimulation (TENS) 6 days a week. Patients from experimental group, in addition to all the mentioned treatments, also took sulphate-sulphide mineral water baths once a day for 30 minutes for 7 days, unlike the patients from control group who took tap water baths, according to the same schedule. The level of serum glucose was monitored in all patients on admission, after discharge and 6 months after the treatment. The Student t-test was used for statistical data processing and p < 0.05 was considered as statistically significant. Results: Study included 80 patients of both sexes, with an average age of 67.00 ± 5.75 years. All patients had elevated serum glucose values on admission. The initial levels of glycaemia in the control and experimental groups were not significantly different (6.99 ± 1.95 and 7.88 ± 1.90 mmol/L, respectively). At discharge, patients who performed balneotherapy had a statistically significant decrease in serum glucose values compared to patients from the control group (by 1.84 vs 0.26 mmol/L, p < 0.001). This effect did not persist six months after the end of the treatment (p > 0.05). Conclusion: The application of balneotherapy with sulphate-sulphide mineral baths containing H2S as a potent gas transmitter significantly reduces serum glucose levels in patients with knee osteoarthritis.

Background/Aim: Muscle strength and endurance recovery of the quadriceps after anterior cruciate ligament reconstruction is necessary for normal knee function. In addition to the use of the isokinetic dynamometer for diagnostic purposes, its possible therapeutic effect is also important, ie targeted correction of the measured muscle deficit. This work was aimed to examine the level of quadriceps strength and endurance recovery 6 months after the anterior cruciate ligament reconstruction in patients who performed isokinetic training and to determine whether it is a superior therapeutic intervention compared to isodynamic training. Methods: A total of 70 patients of both sexes were monitored in a prospective clinical study. Three months postoperatively, all patients had quadriceps torque measured to body weight on an isokinetic dynamometer at angular speeds of 60 and 180 °/s. Patients were divided into two groups according to the type of applied rehabilitation protocol. Group A patients (n = 35) underwent a rehabilitation program 5 times a week using an individual kinesitherapy program (isometric and isotonic exercises for quadriceps and hamstrings) and neuromuscular electrostimulation of the quadriceps. In addition patients from group B (n = 35) were included in targeted isokinetic exercises for the quadriceps. Control isokinetic testing was performed 6 months after surgery. The comparison of the effect of the applied therapeutic procedures in groups A and B was performed with the Student t-test (p < 0.05). Results: An average age of patients was 27.29 ± 5.94 years. In patients in group B, statistically significantly higher values of the peak torque to body weight were measured at angular velocities of 60 and 180 °/s for the quadriceps of the operated knee 6 months after reconstruction of the anterior cruciate ligament with hamstring tendons (p < 0.05). Conclusion: Isokinetic training achieved significantly better quadriceps strength and endurance in patients 6 months after anterior cruciate ligament reconstruction with hamstring tendons compared to dynamic exercises.

Background/Aim: Hypomagnesaemia is one of the most detected electrolyte abnormalities in diabetics. Modulation of numerous cardiovascular pathophysiological processes is a potential goal for anti-diabetic therapy. Magnesium supplementation prevents subclinical tissue magnesium deficiency, thus delaying the onset of metabolic imbalance in diabetes, but long-term effects of magnesium supplementation in chronic diabetes and numerous pathophysiological processes remain unknown. Aim of this study was to determine the effects of subchronic intake of magnesium hydrocarbonate-rich mineral water on cardiometabolic markers and electrolytes in rats with streptozotocin-induced diabetes. Methods: A total of 28 Wistar, male rats, body weight 160 g at start, were divided into four groups of 7 each: two controls, group that drank tap water and received a single ip injection of saline (0.9 % NaCl) (TW-C), group that drank mineral water rich in magnesium hydrocarbonate and received a single ip injection of saline (0.9 % NaCl) (MW-C); and two experimental groups with streptozotocin-induced diabetes, group that drank tap water and received a single ip injection of streptozotocin (100 mg/kg) in saline (0.9 % NaCl, 1 mL) (TW-DM), group that drank mineral water rich in magnesium hydrocarbonate and received a single ip injection of streptozotocin (100 mg/kg) in saline (0.9 % NaCl, 1 mL) (MW-DM). Results: Regarding the biochemical parameters, a decrease was observed in the MW-C group for vitamin B12 and proteins, while triglycerides were higher compared to the TW-C group. By comparing the haemostatic biomarkers between TW-C and MW-C groups, a statistically significant decrease was found for fibrinogen, while the electrolyte analysis showed an increase in phosphates for the MW-C group. Biochemical value comparison between TW-DM and MWDM groups showed that magnesium hydrocarbonate usage in diabetic rats did not significantly reduce glycaemia although the average glycaemic values were lower in the group treated with magnesium hydrocarbonate. Regarding the electrolyte values, a statistically significant decrease was observed for sodium, potassium and phosphate in the MW-DM group. The MW-DM group also showed a significant increase in iron value compared to TW-DM group. Conclusion: Subchronic intake of magnesium hydrocarbonate-rich mineral water, as a form of magnesium supplementation, did not cause a significant improvement in glycaemia or normalisation of diabetes-induced dyslipidaemia. This study showed the reduction of fibrinogen value, thus indicating the possibility of usage of this form of magnesium supplementation in different pro-thrombogenic conditions.

Introduction: In the overall strategy of developing the optimal treatment of patients after COVID-19 infection, recommended by the World Health Organization, rehabilitation plays one of the key roles in improving the functional capacity of these patients and thus their quality of life. The aim of this study was to investigate the effect of cardiovascular training during post-acute rehabilitation on the functional capacity of patients after moderate COVID-19 pneumonia. Methods: The prospective study included 84 patients of both sexes, mean age 57.92 ± 11.79 years, who were hospitalised at the Institute of Physical Medicine and Rehabilitation ''Dr Miroslav Zotović'' Banja Luka due to moderate pneumonia caused by the COVID-19 virus and after they finished acute rehabilitation. All patients underwent cardiovascular training three times per week and occupational therapy during 28 days of stationary post-acute rehabilitation. The follow-up parameter was a six-minute walk (6-MWT) test at admission and discharge from post-acute rehabilitation. Student t-test for paired samples was used for statistical analysis, and the value of p < 0.05 was taken as statistical significance. Results: The functional capacity of the cardiovascular and respiratory system was statistically significantly improved at discharge compared to admission (p < 0.05). Conclusion: Targeted cardiovascular training during post-acute rehabilitation leads to improvement of functional capacities of patients after moderate COVID-19 pneumonia.

Background/Aim: The positive effect of thermal mineral waters on human health has been known for a long time. Many pathophysiological mechanisms of action of balneotherapy are not specified. Patients with gonarthrosis often have elevated values of serum lipids. This study aimed to examine the effect of drinking sulphate-sulphide thermo mineral water on the lipid status of patients with gonarthrosis. Methods: A prospective clinical study followed 60 patients, both sexes, mean age 65.02 ± 1.03, with gonarthrosis. All inpatient underwent physical treatment with topical application of sulphate-sulphide mineral water. Patients of group A (N = 30) had the use of this mineral water as an additional therapy by drinking, unlike patients of group B (N = 30) who drank plain water. The level of serum lipids of these patients was monitored at admission and 4 weeks after. The variance analysis test (ANOVA) with a level of statistical significance p < 0.001 was used for statistical analysis. Results: A significant reduction in the levels of all lipid fractions in the serum of patients with gonarthrosis was found 4 weeks after the completion of inpatient physical treatment in both study groups. This decrease was statistically significant in patients of group A (p < 0.001). Conclusion: Drinking sulphate-sulphide mineral water in patients with gonarthrosis shows a positive effect on the reduction of serum lipid levels in the short-term follow-up period.

Background/Aim: Proprioception recovery is one of the main postoperative rehabilitation goals after the anterior cruciate ligament (ACL) reconstruction. The aim of this study was to examine the level of proprioception recovery in patients 9 months after the ACL reconstruction using hamstring graft. Methods: A prospective study followed 70 male subjects (mean age 27.36 ± 5.94) divided into two groups depending on the type of proprioceptive exercise applied. Group A patients (n = 35) underwent proprioceptive training on a Biodex 4 Pro System isokinetic dynamometer for 10 minutes 5 times per week. In group B, patients underwent proprioception exercises in the gym for 10 minutes 5 times per week. The degree of recovery of proprioception was measured on an isokinetic dynamometer preoperatively and 9 months after ACL reconstruction. Flexion angles in the operated knee of 15, 30 and 45 degrees were monitored. The Chi-square test was used for statistical analyses. The value of p < 0.05 was considered significant. Results: A significant difference was found in the recovery of proprioception in patients depending on the type of training applied. Statistically significant recovery of proprioception was observed in patients from both groups 9 months after ACL reconstruction, but it was better in patients of group A (p < 0.05). Conclusion: Applying proprioceptive training on an isokinetic dynamometer achieves better proprioceptive recovery in patients 9 months after ACL reconstruction versus dynamic exercises in the gym.

Background/Aim: Total hip replacement is considered as one of the most successful treatment methods in orthopaedic surgery of the 20th century, since it significantly improves the quality of life of the individuals with coxarthrosis. Protocols and the organisation of the postoperative rehabilitation differ significantly around the world. The aim of this study was to investigate the effect of hydrokinesitherapy on the rehabilitation outcome in patients after total hip replacement under in-patient conditions. Methods: This prospective clinical trial included a total of 100 patients of both genders , average age 59.11 ± 8.85 years, which were admitted to the in-patient post-operative rehabilitation after total hip replacement. Patients were randomised in two groups: group A (n = 50) that was subjected to rehabilitation program with hy-drokinesiherapy and group B (n = 50) that was subjected to rehabilitation program only. The parameters registered were: the range of movement in the operated hip, the circumference of the femoral musculature and the Western Ontario and McMas-ter Universities Osteoarthritis Indeks (WOMAC index) at admittance and discharge from in-patient rehabilitation. Results: The average values of hip flexion with extended knee, extension and external hip rotation were significantly better in group A (p < 0.05). The values of the circumference of the femoral musculature and WOMAC index in patients from group A were significantly better on discharge compared to the admission. Also, this group had a statistically significantly better values of the circumference of the femoral musculature and value of WOMAC index at discharge compared to patients from group B (p < 0.05). Conclusion: Hydrokinesitherapy as a part of the protocol for postoperative rehabilitation in patients after total hip replacement leads to a faster improvement of the functional status of the operated hip and patient's quality of life.

Introduction: Quadriceps weakness after knee surgery is the most common consequence that can have different consequences not only for the knee itself but also for the locomotor system in general. This study aimed to compare the results of isokinetic and isotonic exercise on torque restoration quadriceps on knee surgery. Methods: A sample of 180 subjects was analyzed and divided into two subsamples according to the type of rehabilitation protocol that was implemented. The examined group A-isokinetic consisted of 90 male subjects aged 28.54 ± 4.44 years, with a rehabilitation protocol based on the isokinetic exercise of the quadriceps. The examined group B-isotonic also consisted of 90 male subjects aged 27.93 ± 4.27 years, with a rehabilitation protocol for strengthening the quadriceps that applied an exercise program with additional resistance, i.e., isotonic exercise in the gym. Before the start of the rehabilitation treatment, an initial isokinetic test was performed at an angular speed of 60 °/s in all subjects. After 3 and 6 weeks of rehabilitation treatment, the control tests were performed in the same way as in the initial test. Results: Based on the values of MANOVA analysis and discriminative analysis, significantly better results of isokinetic tests were found in the examined group A-isokinetic compared with those in the examined group B-isotonic. At the final measurement of group A, 83 respondents (92.2%) were placed in the "biggest" class out of the 90 respondents. Conclusion: Based on the obtained research results, we conclude that isokinetic exercise is more effective in terms of physiotherapy of quadriceps hypotrophy after knee surgery. [ABSTRACT FROM AUTHOR]

Introduction: Calcific tendinopathy (CT) of the shoulder is frequently a painful condition that is occurring when there are calcium deposits in the tendons of the rotator cuff. There are many options for treatment starting from therapeutic options like medicaments, physical therapy and radial extracorporeal shock wave therapy (rESWT). If conservative treatment fails, surgical treatment is the next option. The purpose of this study was to investigate the outcome effect of rESWT in patients with calcific tendinopathy. Methods: A prospective study from February 2010 to March 2019 monitored 67 patients with CT of the shoulders of the average age of 47.06 ± 15.2 (mean± standard deviation) who were treated with a rESWT. All patients were evaluated clinically with selected radiographic evaluation of the shoulder before therapeutic intervention. The treatment protocol consisted of a sound pressure intensity of 3 bar, a wave frequency of 14/sec, a total of 2,000 waves per session. All patients performed a treatment consisting of three sessions described every seven days. The outcome parameters were VAS scale of pain and shoulder radiography before and after therapy. The Student's t-test was used in the statistical analysis. Results: Clinical and radiographic improvement was recorded in 70% of patients in the treatment of CT of the shoulder 6 weeks after the therapy was performed with a rESWT (p

Background/Aim: Optimal intake of magnesium minerals is essential in maintaining the coordinated physiological functions of cells, tissues and organs. The importance of this element is reflected in the fact that it is the fourth most abundant cation in the human body, participating as a cofactor in more than three hundred enzymatic reactions. Its presence is necessary for the proper functioning of a number of vital functions, such as glycaemic control, the work of the heart and the vascular system and it can potentially play a role in the regulation of body weight. Aim of this study was to investigate the effects of subchronic intake of magnesium hydrocarbonate-rich water on changes in body weight, organ weight and cardiovascular variables in rats with streptozotocin-induced diabetes. Methods: Wistar rats (n = 28) were divided into 4 groups: two control groups, on tap water (TW-C, n = 7) and magnesium hydrocarbonate-rich water (MW-C, n = 7); and two experimental groups with streptozotocin-induced diabetes, on tap water (TW-DM, n = 7) and magnesium hydrocarbonate-rich water (MW-DM, n = 7). The values of body weight, organ weight and cardiovascular parameters were compared after 6 weeks between control groups of rats on subchronic treatment with tap water (TW-C) and magnesium hydrocarbonate-rich water (MW-C) and between groups with streptozotocin-induced diabetes on tap water (TW-DM) and with magnesium hydrocarbonate-rich water (MW-DM). Results: By comparing the values of cardiovascular parameters between groups, significant (p < 0.05) positive effects of magnesium hydrocarbonate-rich water were registered on the values of systolic and pulse blood pressure in diabetic rats fed with magnesium hydrocarbonate-rich water (MW-DM) compared to those fed with tap water (TW-DM). In contrast, no significant effect of magnesium hydrocarbonate on changes in body weight and organ weight was observed. Conclusion: Based on the results, the beneficial effects of magnesium hydrocarbonate-rich water in the regulation of blood pressure can be clearly observed. Potential effects on other cardiovascular variables and body weight and organ weight should be further investigated. [ABSTRACT FROM AUTHOR]

Background/Aim: Hypomagnesaemia is one of the most detected electrolyte abnormalities in diabetics. Modulation of numerous cardiovascular pathophysiological processes is a potential goal for anti-diabetic therapy. Magnesium supplementation prevents subclinical tissue magnesium deficiency, thus delaying the onset of metabolic imbalance in diabetes, but long-term effects of magnesium supplementation in chronic diabetes and numerous pathophysiological processes remain unknown. Aim of this study was to determine the effects of subchronic intake of magnesium hydrocarbonate-rich mineral water on cardiometabolic markers and electrolytes in rats with streptozotocin-induced diabetes. Methods: A total of 28 Wistar, male rats, body weight 160 g at start, were divided into four groups of 7 each: two controls, group that drank tap water and received a single ip injection of saline (0.9 % NaCl) (TW-C), group that drank mineral water rich in magnesium hydrocarbonate and received a single ip injection of saline (0.9 % NaCl) (MW-C); and two experimental groups with streptozotocin-induced diabetes, group that drank tap water and received a single ip injection of streptozotocin (100 mg/kg) in saline (0.9 % NaCl, 1 mL) (TW-DM), group that drank mineral water rich in magnesium hydrocarbonate and received a single ip injection of streptozotocin (100 mg/kg) in saline (0.9 % NaCl, 1 mL) (MW-DM). Results: Regarding the biochemical parameters, a decrease was observed in the MW-C group for vitamin B12 and proteins, while triglycerides were higher compared to the TW-C group. By comparing the haemostatic biomarkers between TW-C and MW-C groups, a statistically significant decrease was found for fibrinogen, while the electrolyte analysis showed an increase in phosphates for the MW-C group. Biochemical value comparison between TW-DM and MWDM groups showed that magnesium hydrocarbonate usage in diabetic rats did not significantly reduce glycaemia although the average glycaemic values were lower in the group treated with magnesium hydrocarbonate. Regarding the electrolyte values, a statistically significant decrease was observed for sodium, potassium and phosphate in the MW-DM group. The MW-DM group also showed a significant increase in iron value compared to TW-DM group. Conclusion: Subchronic intake of magnesium hydrocarbonate-rich mineral water, as a form of magnesium supplementation, did not cause a significant improvement in glycaemia or normalisation of diabetes-induced dyslipidaemia. This study showed the reduction of fibrinogen value, thus indicating the possibility of usage of this form of magnesium supplementation in different pro-thrombogenic conditions. [ABSTRACT FROM AUTHOR]