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Background. Most adult cancer survivors report a significant decrease of their quality of life and limitations in performing activities of daily living. Occupational therapy is a form of rehabilitation treatment that uses certain techniques and tools aimed at improving functional capacity, improve social participation and overall quality of life. Objective. The overall purpose of this narrative review is to provide a better understanding of the role that occupational therapy can play in the rehabilitation of cancer patients with a focus on the most important cancer-related aspects amenable and manageable by occupational therapy interventions and to increase awareness regarding this form of rehabilitation. Discussion. Given the fact that there is constant grow in the number of cancer survivors with complex needs, rehabilitation and occupational therapy strategies can increase functionality and health-related quality of life of patients with cancer at any point of the disease, but it remains underused, due to certain barriers. Conclusions. Occupational therapy, as part of cancer rehabilitation therapy, can lead to improvements in both short and long-term outcomes, while being cost-effective as goals are always set in collaboration with the patients and are aimed to identify and improve the activities most important and relevant for them. Keywords: occupational therapy, cancer, rehabilitation, activities of daily living, quality of life

Introduction: Osteoporosis has a strong genetic contribution, and several genes have been shown to influence bone mineral density. Variants in the human genome are considered important causes of differences in drug responses observed in clinical practice. In terms of bone mineral density, about 26–53% of patients do not respond to amino-bisphosphonate therapies, of which alendronate is the most widely used. Material and method: The current study is prospective, observational, analytical, longitudinal and cohort type. It included 25 postmenopausal women treated with alendronate for 1 year. Bone mineral density at lumbar spine and proximal femur was measured and bone turnover markers (C-terminal telopeptide of type I collagen and procollagen 1N-terminal propeptide) were evaluated at 0 and 12 months of treatment. Six single nucleotide polymorphisms in osteoporosis-candidate genes were genotyped (FDPS rs2297480, LRP5 rs3736228, SOST rs1234612, VKORC1 rs9934438, GGPS1 rs10925503 and RANKL rs2277439). Treatment response was evaluated by percentage changes in bone mineral density and bone turnover markers. Results: The heterozygous CT of FDPS rs2297480 showed lower increases in BMD values in the lumbar spine region and the homozygous CC of the GGPS1 rs10925503 showed lower increases in terms of BMD at the total hip region. No association was found for LRP5 rs3736228, SOST rs1234612, VKORC1 rs9934438 and RANKL rs2277439. Conclusions: Romanian postmenopausal women with osteoporosis carrying the CT genotype of FDPS rs2297480 or the CC genotype of GGPS1 rs10925503 could have an unsatisfactory response to alendronate treatment. Key words: osteoporosis; genetic polymorphism; alendronate; bone mineral density; bone turnover markers

The liver has a central role in the pharmacokinetics (absorption, distribution, elimination, etc.) of drugs. With hepatic insufficiency, the metabolism of drugs decreases, which accumulates metabolically or toxic active products. Some medicines can aggravate a pre-existing liver disease. Medicines used in this group of patients (especially diuretics and centrally acting preparations) can often cause impaired renal function or hepatic encephalopathy. The general principles of assessment, pain management and analgesia should be prescribed taking into account the Word Health Organization (WHO) recommendations for these patients, with careful and frequent monitoring of patient progress during treatment administration. Key words: hepatotoxicity, hepatic dysfunction, cirrhosis, pain medication

Chronic kidney disease (CKD) is one of the most frequently seen comorbidities in patients suffering from musculoskeletal conditions; it is defined by a glomerular filtration rate (GFR) under 60 ml/min/1.73 m2. The following paper focuses on providing a dosage adjustment guideline depending on how advanced renal impairment is. A literature search was carried out using the following items: pharmacokinetics, side effects, drug interactions and dosage, pain medication and antirheumatic drugs in renal failure. The use of non-steroidal anti-inflammatory drugs is inadvisable for a GFR < 30 ml/min as they all pose the risk of inducing acute renal damage, as well as worsening of the underlying chronic renal disease. Non-steroidal antiinflammatory drugs (NSAIDs) should be avoided due to the possibility of kidney disease progression. Paracetamol is an analgesic often chosen in this category of patients. As far as opioid analgesics are concerned, methadone is the only one that can be used without dosage adjustment. Physiotherapy remains a good and safe option for treatment in patients with musculoskeletal complaints. The use of analgesics in patients with CKD continues to be a challenge, as more research is needed.

Alina Deniza Ciubean,1,2 Rodica Ana Ungur,2,3 Laszlo Irsay,2,3 Viorela Mihaela Ciortea,2,3 Ileana Monica Borda,2,3 Ioan Onac,2,3 Stefan Cristian Vesa,1 Anca Dana Buzoianu1 1Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; 2Department of Rehabilitation, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania; 3Department of Rehabilitation Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania Objectives: Osteoporosis is a common skeletal disorder characterized by decreased bone mass and increased susceptibility to fractures, which are associated with pain and decrease in physical function, social function, and well-being, which are all aspects of quality of life (QoL). The purpose of this study was to evaluate the burden of osteoporosis and fragility fractures in Romanian postmenopausal women from Cluj County using the 36-Item Short Form Health Survey (SF-36) and Quality of life questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) questionnaires.Materials and methods: An analytical cross-sectional study on 364 postmenopausal women was carried out between June 2016 and August 2017 in the Clinical Rehabilitation Hospital in Cluj-Napoca, Cluj County, Romania. Data were collected by interview and from the medical documents: clinical and demographic data, personal medical history, risk factors for osteoporosis, and bone mineral density at the lumbar spine and femur. The patients included in the study were asked to complete the Romanian versions of the SF-36 and QUALEFFO-41 questionnaires.Results: Women with osteoporosis had significantly lower scores in the SF-36 domains (P

The intake of minerals are very important in maintaining health, but in returning to health either. Mineral waters represents a source of minerals with high bioavailability. There are evidence based studies for the efficency of mineral waters in a series of disorders for both internal and external cures. The advantage of mineral waters in renal lithiasis are significant and the risks of stone formation are neglectable if medical advise is respected. Amongst the patients- but unfortunately also the medical staff- there is the incorrect oppinion that mineral water is a factor that causes renal stones in all consumers. The purpose of the present paper is to present the factors that favour the renal stones, but also scientific arguments that support the value of mineral water, that has a part not only in ensuring the right mineral balance but also, in certain situations, even in preventing renal stones.

Objectives This study aimed to assess the relationship between bone mineral density and genotypes of four polymorphisms in previously detected osteoporosis-candidate genes (FDPS rs2297480, LRP5 rs3736228, SOST rs1234612, VKORC1 rs9934438) in postmenopausal Romanian women with primary osteoporosis. Methods An analytical, prospective, transversal, observational, case-control study on 364 postmenopausal Romanian women was carried out between June 2016 and August 2017 in Cluj Napoca, Romania. Clinical data and blood samples were collected from all study participants. Four polymorphisms were genotyped using TaqMan SNP Genotyping assays, run on a QuantStudio 3 real-time PCR machine. Results Women with TT genotype in FDPS rs2297480 had significantly lower bone mineral density values in the lumbar spine and total hip, and the presence of the T allele was significantly associated with the osteoporosis. Women carrying the CC genotype in LRP5 rs3736228 tend to have lower bone mineral density values in the femoral neck and total hip. No significant association was found for the genotypes of SOST rs1234612 or VKORC1 rs9934438. Conclusions Our study showed a strong association between bone mineral density and polymorphisms in the FDPS gene, and a borderline association with LRP5 and SOST polymorphisms in postmenopausal Romanian women with osteoporosis. No association was found for VKORC1.