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(1) Background: Low Back Pain is a major health concern. Pregnancy-related lower back pain is a common complaint among women. The aim of this study was to determine the influence of pregnancy history on the occurrence and profile of pain in the lower spine. (2) Methods: The diagnosis of Lower Back Pain during pregnancy was based on the authors’ questionnaire, Visual Analogue Scale (VAS), Oswestry Disability Index and Roland Morris Disability Questionnaire. The research group consisted of 1112 women who were students or came for various reasons to the Gynecology and Obstetrics Clinical Hospital of Poznan University of Medical Sciences and completed the questionnaires. Patients were divided into two groups. The first group consisted of women who had never been pregnant (never-pregnant, n = 872 (78.4%), and the second group consisted of women who had been pregnant at least once in their lives (ever-pregnant, n = 240 (21.6%)). (3) Results: In the never-pregnant and the ever-pregnant women, respectively, the intensity of pain was 4.6 ± 1.6 and 5.0 ± 2.0 on the VAS scale, the degree of disability on the Oswestry Disability Index Questionnaire was 5.0 ± 3.9 and 5.5 ± 4.4, while the impact of pain on functioning on the Roland Morris Disability Questionnaire was 3.9 ± 3.1 and 3.9 ± 3.3. There were no significant differences (Mann-Whitney U test) between the studied groups in the parameters tested. (4) Conclusions: Pregnancy is a risk factor for back pain during pregnancy, but one year or more after pregnancy the occurrence of back pain is similar to that in women who have never been pregnant.

Background: Low Back Pain (LBP) is a frequent, very common, and costly health problem. LBP, which occurs during pregnancy, may become a lifelong problem. The aim of this study was to determine the risk factors associated with LBP in pregnant women. Methods: The study included 1510 pregnant women. A questionnaire assessing demography, lifestyle, prevalence, and characteristics was designed and used in the study. Pain intensity was assessed with the VAS (Visual Analogue Scale). The RMDQ (Roland Morris Disability Questionnaire) was used to assess the effect that low back pain had on the functional capacity of a pregnant woman. Middle (thoracic) and low back pain disability was measured with the help of the ODI (Oswestry Disability Index) questionnaire. Results: The study confirmed that lying/sleeping (49.6%) and sitting positions (38.7%) as well as walking (37.2%) are the most significant factors causing LBP. It was also found that women who had not engaged in physical activity were more likely to experience LBP. Conclusions: Predisposing factors for LBP in pregnancy are LBP in previous pregnancies, back pain during menstruation, a younger age and a lack of physical activity. Most women in pregnancy with LBP experienced minimal and mild disability.

Background The aim of the present paper is to assess the gait pattern of patients with Peripheral Artery Disease (PAD). A more specific aim is to compare the gait pattern of PAD patients before and after the appearance of intermittent claudication symptoms. Methods The study involved 34 PAD patients with a claudication distance ≥200 m and 20 participants without PAD, who formed the control group. The gait pattern of PAD patients was assessed twice: before the appearance of intermittent claudication symptoms (pain-free conditions) and after the appearance of intermittent claudication symptoms (pain conditions). Results Compared to the control group, PAD patients presented a statistically significant decrease in step length both during pain-free conditions (52.6 ± 12.5 vs. 72.8 ± 18.5 cm, p = 0.008) and in pain conditions (53.3 ± 13.3 vs. 72.8 ± 18.5 cm, p = 0.006). As for the remaining spatiotemporal parameters, there were no differences observed between the patient group and the controls. Intermittent claudication symptom induced by the walking test on the treadmill did not bring about any new abnormalities in the gait pattern or intensify the existing abnormalities of the gait. Conclusions PAD patients have a tendency to shorten their step length regardless of the presence of intermittent claudication.

Objectives: Collagen type I plays an important role in the bone matrix and is encoded by COL1A2 (collagen type I alpha 2) gene that may be a potential candidate for osteoporotic fracture. The aim of this study is to determine whether EcoR I, Del 38 and Pvu II polymorphisms of COL1A2 are associated with the development of osteoporosis and osteopenia in post­menopausal Polish women. Moreover, analysis of relationship between frequency of COL1A2 gene polymorphic variants and clinical parameters of bone turnover and degree of osteoporosis was performed. Material and methods: The study group comprised of women with osteoporosis (n = 90), osteopenia (n = 56) and healthy individuals (n = 56). The EcoR I, Del 38 and Pvu II polymorphisms in COL1A2 gene were detected by PCR-RFLP method. Results: In women with osteoporosis the TT genotype of EcoR I polymorphism had the lowest Z-score value compared to other genotypes (p = 0.034). In case of Del 28 polymorphism, there was a statistically significant correlation between lower BMI values and the DD genotype in women with osteopenia (p = 0.041). There was no statistically significant correlation between polymorphic variants of Del 28 polymorphism and clinical parameters of women with osteoporosis. The analysis of Pvu II polymorphism showed that in women with osteopenia the CC genotype had the lowest body weight compared to other genotypes (p = 0.039). Pvu II polymorphism and clinical parameters in the group of women with osteoporosis had no statistically significant correlations. Conclusions: The analyzed COL1A2 polymorphisms seem to be related to osteoporosis development and their particular clinical parameters. Hence, the COL1A2 polymorphism may be a genetic risk factor related to the development of osteoporosis.

Objectives: Choline and folate metabolism disturbances may be involved in the occurrence of intrauterine fetal death (IUFD). The proper activity of this metabolism could be determined by genetic variants involved in choline pathway e.g. CHKA (gene encoding choline kinase α), PCYT1A (gene encoding CCTα) and CHDH (gene encoding choline dehydrogenase). Our study aimed at determining the genotype and allele frequencies of CHKA rs7928739, PCYT1A rs712012, PCYT1A rs7639752, CHDH rs893363 and CHDH rs2289205 polymorphisms in mothers with IUFD occurrence. Material and methods: The study involved 76 mothers with IUFD occurrence and 215 mothers of healthy children. Genetic analysis was performed with the use of PCR/RFLP method. Results: The frequency of genotypes and alleles of studied polymorphisms was similar in both groups. The study revealed no association of PCYT1A, CHKA and CHDH polymorphisms in analysed groups of women. While evaluating the co-existence of analysed polymorphisms statistically significant correlation was revealed. Co-existence of CHKA rs7928739 AC/CHDH rs2289205 AA genotypes was observed statistically more frequently in the study group than in the control group (p = 0,031). Conclusions: There is no correlation between single CHKA rs7928739, PCYT1A rs712012, PCYT1A rs7639752, CHDH rs893363 and CHDH rs2289205 polymorphisms and the incidence of intrauterine fetal death. However, revealed statistically significant difference between co-existence of CHKA rs7928739 AC/CHDH rs2289205 AA genotypes between study groups suggest the need of further analysis.

Objective. Pre- and postoperative comparative evaluation of neurophysiological tests and clinical trials. Analysis of the diagnostic value of motor evoked potentials (MEP) induced by a magnetic field after supraspinal stimulation. Evaluation of the sensitivity and specificity of electromyography (EMG) and MEP is achieved. Methods. EMG, ENG, M-wave, F-wave, and MEP tests were performed on 35 patients with confirmed cervical radiculopathy in pre- and postoperative evaluations. The clinical trial consisted of evaluation of muscle strength, a sensory perception test and evaluation of tendon reflexes and pain severity. Results. The sensitivity of the resting EMG and MEP tests is 24%-67% and 6%-27%, while their specificity is 43%-80% and 86%-100%, respectively. The postoperative evaluation revealed a statistically significant reduction in pain severity (p=0001), an increase in muscle strength in DP (p=0.0431), BB (p=0,0431), and TB (p=0.0272), and improvement of touch sensation in terms of dermatomal innervation in C5 (p=0.0001) and C6 (p=0.0044). Conclusions. Tests comparing MRI sensitivity to neurophysiological tests show that neuroimaging is more sensitive in diagnostics of patients with cervical radiculopathy; however, clinical neurophysiology tests are more specific in reference to clinical trials.

There are different sorts of stereotype, prejudice or discrimination against the handicapped individuals, which obviously influences the social attitude towards such people. This article contains an assessment of students’ attitudes toward people with different disabilities. The assessment was done on the basis of literature review. The authors of this paper have briefly described some of the research tools used to assess these attitudes: the scale ATDP – Attitudes Towards Disabled People; scale SADP – scale of Attitudes Toward Disabled Persons; scale DSATHS – Dental Students’ Attitudes Toward the Handicapped Scale; scale CDP – Contact with Disabled Persons Scale and questionnaire IDP – Interaction with Disabled Persons; instrument ATPDSC – Attitudes Toward Physically Disabled College Students. Based on a literature analysis, it might be noticed that medical students or healthcare professionals, like individuals from outside the healthcare sector, do not necessarily have positive attitudes toward disabled people.

Low back pain is a massive problem in modern population, both in social and economic terms. It affects large numbers of women, especially those aged 45-60. Going through a perimenopausal period is associated with many symptoms, including low back pain. This paper is a review of published research on the association between the perimenopausal age and low back pain. PubMed databases were investigated. After the search was narrowed to “menopausal status, back pain”, 35 studies were found. Seven studies, which suited our area of research best, were thoroughly analyzed. All studies show increased pain when women enter this period of their life. There is no agreement among researchers regarding which stage of menopause is the most burdensome. Examples of possible treatments and physiotherapeutic methods targeting low back pain are also presented. Physiotherapeutic procedures used to treat low back pain include exercises in safe positions, balance exercises, manual therapy, massage and physical measures.

Changes in body posture, musculoskeletal disorders and somatic dysfunctions are frequently observed during pregnancy especially ligament, joint and myofascial impairment. The aim of the paper is to present the use of osteopathic manipulative treatment (OMT) for back and pelvic pain in pregnancy on the basis of a review of the available literature. MEDLINE and Cochrane Library were searched in January 2014 for relevant reports, randomized controlled trials, clinical and case studies of OMT use in pregnant women. Each eligible source was verified and analyzed by two independent reviewers. OMT procedures appear to be effective and safe for pelvic and spinal pain management in the lumbosacral area in pregnant women.

Urinary incontinence is a serious medical, social, economic and therapeutic issue. This paper is a review of current ideas on the influence of menopause and age on the risk of incontinence. The paper presents selected physiotherapeutic methods used in the treatment of urinary incontinence. The most commonly used methods include: urogenital diaphragm exercises (Kegel exercise), behavior therapy (biofeedback, bladder training), electrostimulation, magnetic therapy and mechanical tools (e.g. vaginal cones). The importance of patient and health professional prophylaxis is also discussed.

Objective. The objective of this paper is to compare the impact of supervised walking and resistance training upon the walking distance in PAD patients. Materials and Methods. The examination involved 50 PAD patients at the 2nd stage of the disease according to Fontaine’s scale. The participants were randomly allocated to two groups: one exercising on the treadmill (n=24) and one performing resistance exercises of lower limbs (n=26). Results. The 12-week program of supervised rehabilitation led to a significant increase in the intermittent claudication distance measured both on the treadmill and during the 6-minute walking test. The group training on the treadmill showed a statistically significant increase of the initial claudication distance (ICD) and the absolute claudication distance (ACD) measured on the treadmill, as well as of ICD and the total walking distance (TWD) measured during the 6-minute walking test. Within the group performing resistance exercises, a statistically significant improvement was observed in the case of parameters measured on the treadmill: ICD and ACD. Conclusions. The supervised rehabilitation program, in the form of both walking and resistance exercises, contributes to the increase in the intermittent claudication distance. The results obtained in both groups were similar.

Pacjenci po zabiegach chirurgicznych w obrebie jamy brzusznej wymagają kompleksowej opieki medycznej, na ktorą sklada sie m.in. usprawnianie narządu ruchu. Dotyczy to rowniez kobiet po zabiegach ginekologicznych. Waznym aspektem jest odpowiednio ukierunkowana fizjoterapia dopasowana do rodzaju zabiegu. Celem pracy bylo przedstawienie kompleksowej fizjoterapii pacjentek po operacjach ginekologicznych. Zabiegi fizjoterapeutyczne przywracają sprawnośc ruchową i prawidlową ruchomośc stawow oraz zwiekszają sile mieśniową, przez co wplywają na zmniejszenie stanow zapalnych oraz szybsze gojenie ran. Operacje w obrebie jamy brzusznej niosą ze sobą szereg powiklan: ze strony ukladu oddechowego, moczowego – wysilkowe nietrzymanie moczu, mieśniowo-szkieletowego – zaburzenia postawy ciala, zaburzenia mieśniowo-powieziowe spowodowane zbliznowaceniem tkanek. W pracy omowiono usprawnianie pacjentek w okresie przedoperacyjnym, wczesnym pooperacyjnym i poszpitalnym oraz masaz blizny. Slowa kluczowe: operacje ginekologiczne, kinezyterapia.

Objective Preeclampsia (PE) is a major cause of mortality of mothers, fetuses and newborns around the world. The etiology of preeclampsia has not yet been clarified, but many studies indicate a multifactorial basis of PE. Aldosterone synthase (CYP11B2) is responsible for synthesis of aldosterone responsible for regulating blood pressure. Similarly, natriuretic peptide (ANP) regulates blood pressure through a variety of mechanisms affecting the sodium concentration and the amount of extracellular fluid. Currently, attention is paid to the role of the polymorphisms in the expression level of these genes. The aim of the study was to determine the frequencies of genotypes and alleles for polymorphisms of −344C > T CYP11B2 gene and 2238T > C ANP gene in women with preeclampsia and healthy pregnant women from the Caucasian population. Study design The study included a group of 165 pregnant women (59 women with preeclampsia and 109 healthy pregnant women). DNA was extracted from peripheral blood. Determination of the polymorphism of −344C > T CYP11B2 gene and 2238T > C ANP gene was performed by PCR-RFLP method. Results The results showed that the frequencies of the TC and CC genotypes of 2238T > C polymorphism in ANP gene were significantly higher in patients with PE compared to control group. For −344C > T polymorphism of CYP11B2 gene, the frequency of TT genotype was significantly higher in patients with hypertension than in controls (32.2% vs. 23.58%). Conclusions Our findings showed that gene polymorphism of CYP11B2 (−344C > T) and ANP (2238T > C) may be associated with developing PE during pregnancy.

Women have three very important physiological functions that are not observed in men--menstruation, pregnancy and lactation. Each of these mechanisms influences pharmacokinetics and pharmacodynamics of many drugs. Individualization of pharmacotherapy is a major challenge of modern medicine. The differences in response to drug are responsible for the effectiveness of pharmacological treatment and the occurrence and severity of toxic effects and side effects. Therapeutic decision should be based not only on account of the dose-effect, but the consideration of gender, genetic and environmental differences affecting the final therapeutic effect. Many important differences between men and women like sex-based differences in normal physiology, or in the predisposition to a specific disease, can be due to genetic differences, the actions of the sex steroid hormones or an interaction between these factors. Women generally have a lower body mass, a reduced hepatic clearance, differences in activity of cytochrome P450 (CYP) enzymes (increase in CYP3A4, decrease in CYP2D6, CYP2C19 and CYP1A2) and different from men's rate of drug metabolism. Other important factors contributing to gender differences in the pharmacokinetics of drugs are conjugation, absorption, protein binding and urinary excretion. It still remains unexplained how gender differences affect the increased risk of side effects. This review is an attempt to assess the biological, physiological and hormonal basis of women differences in the pharmacokinetics and pharmacodynamics of many drugs.

Osteoporosis is a disease with low bone mass and disorganization of the internal microarchitecture of bone tissue. Determination of biochemical markers allows for early diagnosis of changes in bone tissue metabolism. The search for a marker whose biological function could be directly connected with bone metabolism, clearly indicating a connection between its concentration and risk fracture as well as response to treatment, continues. Currently measurement of collagen-derived markers of bone resorption is used in the majority of cases. They are, first of all, telopeptides of collagen type 1 localized on the amino end-N-terminal telopeptide of type 1 collagen (NTX), as well as on the carboxy end-C-telopeptide of type 1 collagen (CTX) of collagen molecule. Among markers of bone synthesis, special attention is paid to the procollagen type 1 carboxy-terminal propeptide (POCP) and procollagen type 1 amino-terminal propeptide (P1NP). Simultaneous application of bone synthesis and resorption markers allows for a full imaging of the bone remodeling process and application of biochemical markers in the diagnosis and therapy of osteoporosis.

OBJECTIVES The goal of this study was to evaluate the frequency of Sp1 +1245G>T (rs 1800012) and -199 7G>T (rs 1107946) COL1A1 gene polymorphisms in postmenopausal women with osteoporosis and osteopenia as well as assessing their relations with the clinical parameters and parameters of bone turnover. STUDY DESIGN The study included 538 (236 postmenopausal and 302 healthy reproductive) Polish women. The postmenopausal group included women with osteoporosis (n = 90), osteopenia (n = 90), as well as healthy individuals (n = 56). All women of reproductive age were healthy BMD was marked in the L2-L4 lumbar region of the spine using dual energy X-ray absorptiometry (DXA). Genomic DNA was isolated from peripheral blood, the genotype frequency of investigated polymorphisms was determined by PCR-RFLP technique. RESULTS The frequency of Sp1 +1245G>T and -1997G>T polymorphisms of COL1A1 gene showed no statistically significant differences between group with osteoporosis, osteopenia and correct T-score and women of reproductive age. In postmenopausal women it was found that osteopenia and osteoporosis were correlated with age, birth weight, age of last menses occurrence, height, body weight and BMI value. Clinical parameters in all groups of women did not show any statistically significant correlation with frequency of Sp1 +1245G>T and -1997G>T COL1A1 polymorphisms. CONCLUSIONS An evaluation of Sp1 +1245G>T (rs1800012) and -1997G>T(rs 1107946) COL1A1 polymorphisms showed any influence of these genetic variants on osteoporosis development in Polish postmenopausal women. The presented correlation between osteoporosis and age, birth weight, age of last menses occurrence, height, body weight and BMI value confirms the important role of environmental factors in disease etiology.

Neuropathic pain is a type of chronic pain caused by a lesion or disease of the somatosensory nervous system. Current therapy for this pain includes the use of pharmacological and nonpharmacological methods but due to the fact that a lot of therapy does not produce the analgesic results, it is necessary to search for new and more effective pharmacological strategy in relief of this type of pain. One of the interesting natural sources of compounds against this type of pain is extract of Cannabis sativa without psychotropic cannabinoids. Medicinal properties of C. sativa have been explored for centuries. It is well established that active compounds of this herb act through two cannabinoid receptors (CB1, CB2) as endocannabinoid system in the central nervous system. The present review addresses the recent advances in the study of pharmacological mechanisms on cellular and receptor level underlying non-hallucinogenic cannabinoid analgesic effect. In recent years, results of studies allow to state that special plant extract of C. sativa (without psychotropic cannabinoids) may be a promising source of drug used to relieve neuropathic pain.

Hip joint dysplasia is a deformation of the articular elements (pelvic acetabulum, head of the femur, and/or ligament of the head of the femur) leading to laxity of the hip components and dislocation of the femoral head from the pelvic acetabulum. Diagnosis is based on symptoms observed during clinical and radiological examinations. There are two treatment options: conservative and surgical. The classic surgical procedures are juvenile pubic symphysiodesis (JPS), triple pelvic osteotomy (TPO), total hip replacement (THR), and femoral head and neck resection (FHNE). The aim of this experiment was to present an original technique of filling the acetabulum with a polypropylene implant, resting the femoral neck directly on the mesh. The experiment was performed on eight sheep. The clinical value of the new surgical technique was evaluated using clinical, radiological, and histological methods. This technique helps decrease the loss of limb length by supporting the femoral neck on the mesh equivalent to the femoral head. It also reduces joint pain and leads to the formation of stable and mobile pseudarthrosis. The mesh manifested osteoprotective properties and enabled the formation of a stiff-elastic connection within the hip joint. The method is very cost-effective and the technique itself is simple to perform.

Valeriana officinalisis one of the most popular medicinal plants commonly used as a sedative and sleep aid. It is suggested that its pharmacologically active compounds derived from the root may modulate the CYP3A4 gene expression by activation of pregnane X receptor (PXR) or constitutive androstane receptor (CAR) and lead to pharmacokinetic herb-drug interactions. The aim of the study was to determine the influence of valerian on the expression level of CYP3A1 (homologue to human CYP3A4) as well as nuclear receptors PXR, CAR, RXR, GR, and HNF-4α. Male Wistar rats were given standardized valerian extract (300 mg/kg/day, p.o.) for 3 and 10 days. The expression in liver tissue was analyzed by using real-time PCR. Our result showed a decrease of CYP3A1 expression level by 35% (P=0.248) and 37% (P<0.001), respectively. Moreover,Valerianaexhibited statistically significant reduction in RXR (approximately 28%) only after 3-day treatment. We also demonstrated a decrease in the amount HNF-4αby 22% (P=0.005) and 32% (P=0.012), respectively. In case of CAR, the increase of expression level by 46% (P=0.023) was noted. These findings suggest thatValeriana officinalisextract can decrease the CYP3A4 expression and therefore may lead to interactions with synthetic drugs metabolized by this enzyme.

Pain of lumbosacral segment of the vertebral column and the pelvis concerns about 45% of all pregnant women. The change of the body posture during pregnancy is the result of gravity centre relocation, which affects the musculosceletal system. Development of the joint, ligament and myofascial dysfunctions, as well as the pain in the lumbosacral segment and the pelvis, are the most common reasons of spine pain. The aim of this review is to present the current state of knowledge about lumbar spine pain in pregnant women with special focus on the pain connected with muscular, joint and ligament disorders. Pregnancy is a serious burden for the female osteo-skeletal system. Lumbar pain with different location and intensification is the negative consequence of the position changes during pregnancy. Pharmacotherapy could be useful only in cases of intensive low back pain, with possible application of small spectrum of drugs that are safe during pregnancy. Physical therapy including manual therapy exercises, massage and techniques of local anesthesia are alternative methods in case of low back pain in pregnant women.