The profile of patients with atrial fibrillation scheduled for cardioversion or catheter ablation hospitalized in a Romanian rehabilitation hospital

Objectives - Structural cardiac, mainly atrial remodeling in non-valvular atrial fibrillation (NVAF) creates conditions for thromboembolic complications, despite the optimization of oral anticoagulant treatment over the past years. This study aims to provide a comparative analysis of patients with NVAF, with and without atrial thrombotic masses, in an integrated approach using clinical, electrocardiographic, anatomohemodynamic cardiac findings assessed by echocardiography, as well as an evaluation of the inflammatory status based on the usual screening blood markers. Methods – The study was based on the anonymous analysis of the medical records of 50 patients with NVAF monitored in a center of cardiology in Cluj-Napoca between March 2019 – February 2020, who received optimal oral anticoagulant treatment, all undergoing transesophageal ultrasound prior to cardioversion or ablation therapy. The statistical data processing methods were based on the “chi square” test and overall model fit logistic regression. Results – Atrial thrombotic complications were found in 7 (14%) patients with NVAF. These had, compared to patients without thrombotic masses, a mean CHA2DS2-VASc scale of 3 versus 2.76 (p=0.05), more frequently other atrial tachyarrhythmias (p<0.01), a more expressed inflammatory reaction (p=0.02), as well as a reduction of LVEF (p<0.01) and the peak left atrial appendage emptying velocity (p<0.01). Conclusions – In addition to a high CHA2DS2-VASc score, left anatomohemodynamic cardiac alteration, atrial arrhythmic complexity and background inflammatory status create conditions for high thromboembolic risk in patients with NVAF. Keywords: non-valvular atrial fibrillation, cardiac thrombosis, left ventricular ejection fraction, inflammatory status, peak left atrial appendage velocity,

Evaluation of the impact of high-tone therapy on cognitive disorders and quality of life in the complex treatment of patients with comorbid pathology

Introduction. Comorbidity is an independent risk factor for mortality and significantly influences the prognosis and quality of life. Purpose: to evaluate the impact of high-tone HiTOP 4 touch therapy on cognitive disorders and quality of life in the complex treatment of patients with comorbid pathology. Methods: complex treatment of 2 groups of patients with inclusion in the basic treatment regimen of high-tone therapy was carried out - a total of 80 patients (men - 34, women - 46) aged 41 to 79 years old, group I - patients with hypertension and chronic cerebral ischemia (CСI) - 38 patients and group II - patients with hypertension, CСI and concomitant diabetes mellitus (DM) type 2 - 42 patients. The average age in group I was 61.5, in group II - 65.5. Group I received lisinopril and amlodipine in one tablet, group II received metformin in addition to the above therapy. Both groups received a course of 10 sessions of high-tone therapy using the device HiTOP 4 touch (Germany) according to the general method: 2 electrodes on the feet, 2 on the forearms and one on the neck-collar area. All the patients were assessed for their cognitive condition, degree of anxiety and depression, and estimated for quality of life before and after a course of high-tone therapy. In order to do this, we used valid assessment tests, such as the Montreal Cognitive Assessment Scale (MoCA), the Hospital Anxiety and Depression Scale (HADS), and the SF-36 Quality of Life Questionnaire. Results: the course of high-tone therapy for patients with hypertension and CCI led to improved quality of life, on all indicators of the SF-36 scale, except for pain intensity, increased cognitive functions by 3.52 points on the MoCA scale, reduced anxiety by 2.06 points and depression by 1.92 points on the HADS scale. The course of high-tone therapy for patients with CCI, hypertension and type 2 DM resulted in a significant improvement of 5 out of 8 quality of life indicators on the SF-36 scale, cognitive functions by 2.27 points on the MoCA scale and reduced anxiety by 4.3 points, and depression by 0.53 points on the HADS scale. Conclusion: the inclusion of high-tone therapy in the complex treatment of patients with comorbid pathology improves cognitive functions, reduces anxiety and depression, improves quality of life. Keywords: comorbid pathology, high-tone therapy, cognitive functions, anxiety, depression, quality of life,

Assessment of the physical and emotional health concerning the students' physical activity during the COVID-19 pandemic

Introduction. SARS CoV-2 caused the third global pandemic and by applying quarantine / isolation / lockdown, the movement was restricted, the physical contact between people was reduced, the physical activity was low, but the activities using electronic devices at home were frequent. The aim of the study was to assess the physical and emotional health in relation to the physical activities done during quarantine/ isolation during the pandemic. Material and method. The study was cross-sectional and consisted of completing an online questionnaire. It was conducted in a period of 6 months and it included 334 students. In order to point out the symptoms caused by quarantine / isolation/ lockdown, we considered it useful for students to participate by completing an online questionnaire about physical activities, physical health and emotional state, related to the implications of participating in online courses. Results. The questions in this questionnaire were grouped on the following aspects: physical activity, physical health, emotional state, all in the context of the pandemic period, including the period in which the academic activity was online. Thus, in the first year, there is a positive correlation between physical condition, physical activity, emotional signs and cognitive ones. In the second year, the positive correlation is present between the physical and the affective signs, whereas the negative correlation is between the affective signs, the cognitive ones and the physical activity. In the third year, the positive correlation is obvious between the affective signs, the cognitive ones and the physical activity, whereas the negative one between the physical and cognitive signs, as well as between the physical activity and the cognitive and physical signs. Discussions. There is a link between emotional and cognitive symptoms and physical health. Fear, anxiety, behavioral disorders, and limited physical activity among students during this period can be a public health issue. Conclusions. The COVID-19 pandemic affected the physical and mental state, with a greater resonance for youth, especially pupils and students. Many of them had emotional, behavioral, physical and cognitive symptoms. These symptoms are found to a greater extent in students in the final years, due to the social impact, social and professional integration. Keywords: physical health, mental state, students,

The effect of motion games on improving the psychomotor and intellectual performance of children with autism spectrum disorder and intellectual disabilities

Introduction. Depressive states and anxiety are common symptoms of children with autism spectrum disorder (ASD). The persons with intellectual disabilities show problems related to the development of basic motor skills, having learning problems compared to normal ones, imbalances between the processes of arousal and inhibition, limited motor ability, difficult understanding of language and motor tasks, difficult concentration, mechanical assimilation etc. Objectives. The study analyzes the effectiveness of structures and motion games, applied in specific activities for children with intellectual disabilities (ID) and autism spectrum disorders (ASD). Material and Methods. The research involved an experimental group of 5 children with one of these disabilities or their combination (age 10-11 years), included in a training process at the Ion Teodorescu Special Vocational School in Slobozia / Ialomița / Romania and comparing their results with a control group (6 normal children, with an average age of 10 years), between 20.09.2020-10.03.2021. The assessment of the level of psychomotor and intellectual development was made by the Cutout Test, the Cohs Cube Test (light task configurations) and an Attention Flexibility Test (movement to the corners of the room/field depending on the assigned color, counting successful attempts and mistakes). Results and discussion. The obtained results confirm the working hypothesis, so the use of the structures and games proposed in the program contributes to a significant improvement of the psychomotor and intellectual performances of students with intellectual disabilities and autism spectrum. Conclusion. espite all these improvements, they cannot approach or equal the reference values of children without problems, falling into the same age category. Keywords: psychomotor skills, adapted physical activities, recovery, children, learning disabilities,

The influence of low back pain on health – related quality of life and the impact of balneal treatment

Introduction. Low back pain has a direct and proportional impact on function and a general one on the quality of life. The present study aims to evaluate the functional impact of low back pain using specific self-assessment tools as indexes of appreciation and epidemiological correlations of potential risk factors involved. The conceptual model of our research is based on the importance of correlating symptoms with clinical assessment, using scales of pain, disability, quality of life, and determination of epidemiological correlations of these areas and the determined factors of the pathology. Material and method. The study group is made up of 106 cases with clinical diagnostic of low back pain, admitted from 28 September 2020 to 28 March 2021, at Balneal and Rehabilitation Sanatorium of Techirghiol. After performing anamnesis, general clinical examination, specific neuro-musculo-skeletal examination, the patients filled the surveys highlighting the impact of their low back pain on functionality and disability deriving from it. The survey included the Oswestry Disability Index, the Functional Independence Measure (FIM) instrument and the Visual analog scale (VAS) score evaluated at the moment of hospitalization and at discharge. Statistical analysis of data was carried out and correlations between variables resulting from study were highlighted. The study was conducted according to the norms of deontology and medical ethics. The authors declare no conflict of interest. Results and discussions. Lumbar pathology is common in patients who are hospitalized for a complex balneary-physical-kinetic treatment at Balneal and Rehabilitation Sanatorium of Techirghiol. About 80% of patients who have addressed to our unit in which the study was conducted, have presented low back pain. The majority of patients were females, representing 57,55% of the total number. Regarding the patients’ age, 58,5% of them were in the 50-70 years interval. The study reveals a major positive impact of our treatment on spinal symptomatology, an effect pointed out by the relevant statistical differences between the admittance and discharge VAS scores(p<0.001). Reporting the investigated disability with the Oswestry questionnaire of painful lumbar syndrome, and functional evaluation scale (FIM) demonstrates the impact of this pathology on the patient's social life, once again emphasizing the special attention to be paid to axial pathology, both as curative treatment and the importance of prophylactic treatment. Statistical analysis of identified risk factors, reveals the importance of prophylaxis and patient’s education in this area. A strong and important statistical correlation was found between the Oswestry total score and the walking and standing items, and a moderate, but strong correlation with the other items. Regarding the sex life item, the correlation is existent, but at a modest level. Conclusions. The study reveals the importance of correlation of the data obtained from anamnesis, the general clinical examination and the specific examination neuromioarthrokinetic with assessment tools that determine the level of functional independence, the functional impact on social life in high-frequency pathologies treated in medical facilities that provide healthcare in the field of medical recovery. It is necessary to quantify the therapeutic results obtained, in order to assess the level of improvement in quality of life. Keywords: low back pain, balneal, functional indicators, quality of life,

The oral and gut microbiota: beyond a short communication

Introduction. The current treatment and prevention of oral disorders, dental caries, periodontal and gum diseases, follow a very non-specific control of plaque as the main causative factor. The main therapeutically approach is carried out on the sole perspective to keep the levels of oral bacteria in an acceptable range compatible with one-way vision of oral-mouth health, as something completely separated from a systemic microbial homeostasis (dysbiosis) concomitant present in the gut. A sealed compartmental view which sees separate and incommunicable responses to a specific condition without considering the presence of interacting confounding factors can negatively influence the diagnosis a diseases and of course its progression. A general non-specific antimicrobial with more general antiplaque therapy based mainly on oral care products together with surgery interventions represent at the moment the only mechanical responses in treating oral diseases. Material and method. The present paper is a narrative review concening interractions between oral and gut microbiota, with a focus on the interdisciplinary approach in antimicrobial treatment. Pubmed, Cochrane Library database were used for searching engines. Key words used were as follows: “inflammatory bowel syndrome (IBS)”, “ulcerative colitis”, “oral dysbiosis”, “gut dysbiosis”, “probiotics”, “periodontitis”. Results and discussions. Literature research showed that there are few issues to be discussed the ever increasing resistance to antibiotics, the high consumption of industrial food and sugars and their negatively effect on gut and oral microbiota. There is a need to highlight and develop a novel philosophical approach in the treatments for oral diseases that will necessarily involve non-conventional antimicrobial solutions. Such approaches should preferably reduce the consumption of both intestinal and oral microbiota, that are intimately connected and host approximately well over 1000 different species of bacteria at 108–109 bacteria per mL of mucous and saliva. Preventive approaches based upon the restoration of the microbial ecological balance, rather than elimination of the disease associated species, have been proposed. Conclusions. Having both oral-gut microbiota screened is an essential moment that influence the healthy immune modulatory and regenerative capacity of the body and, the new proposed formula integrates a wider screen on the patients where oral condition is strictly evaluated together with gut screen; therefore any proposed treatment will be inevitably sustained by the use of prebiotics and probiotics to promote health-associated bacterial growth. Keywords: inflammatory bowel syndrome (IBS), ulcerative colitis, oral dysbiosis, gut dysbiosis, probiotics, periodontitis,

Improving functional and motor capacity through means/resources and methods specific to acvatic activities

Introduction. Exercise programs in the aquatic environment have as their main objective the improvement and maintenance of physical capacity/ capability, these being in continuous development and diversification. Water exercise amplifies the effects of general physical exercise, by allowing a more precise control over the movement of each body segment and of the body as a whole. The aquatic environment offers a number of beneficial effects compared to ones offered by the terrestrial environment. The benefits obtained through the aquatic activities are fundamental and are reflected throughout the entire body including both motor, functional and aesthetic level. Material and method. The objective of this study is represented by the identification of new forms of physical exercise that will increase the motor’s capacity. In order to achieve this goal, several methodological requirements were met, such as: successive engagement of the joints and muscle groups in effort (starting with the neck’s muscles, shoulders, arms, torso and legs, simultaneously with scapular-humeral joints, spine and coxo-femoral joints and legs), the gradually usage of exercises, starting with the most basic and then increasing the complexity of the exercises, the usage of the accessible exercises in the beginning of the training, executed with high amplitude and reduced speed, focusing on the correctness of the execution, the selection and the adequate/ appropriately usage of the initial positions according to the subject’s particularities and the shape/form of the exercise, the optimal control of the effort, achieved through a number of iterations, optimal execution time and breaks, the sets of general physical exercises will consist of sets of 8-12 exercises/reps, the principle of symmetry in the execution of the exercises has to be respected, the continuity of practicing a set of exercises for 6 to 8 consecutive lessons, the recommended work method is fragmented-imitative, efficiently combining the explication with the demonstration, the number of repetitions and the movement’s correction. Results and discussions. Analyzing results obtained after the evaluation, we have noticed significant growth in the functional and motor capacities. Conclusions. The systematization of water activities on objective criteria effectively contributes to their knowledge, while allowing them to be included in the spectrum of recreational, sporting, relaxing or therapeutic activities. Keywords: acvatic activities, physical exercise, evaluations,

Anti-inflammatory effects of exercise training. A systematic review

Introduction: The diseases number with a known inflammatory etiology is constantly increasing. Cardiovascular and neurodegenerative diseases, osteoporosis, cancer, asthma, atherosclerosis, type 2 diabetes and obesity are associated with chronic low-grade inflammation. There is evidence that individuals who engage in intense physical activity or who exercise regularly, shows changes in biomarkers associated with chronic inflammation. Physical exercise is useful in preventing many diseases, due to improved cardiorespiratory, metabolic, musculoskeletal function. All these improve the immunity and antioxidant capacity, thus reducing the incidence of acute and chronic inflammatory diseases. Materials and Methods: In this study were included 90 bibliographic sources, of which the title contains the following keywords: exercise - 23, inflammation - 27, anti-inflammatory - 6, IL-6 - 13, IL-10 - 4, myokine - 3, IL-15 - 3, irisin - 6, obesity - 11, chronic inflammation - 7. This study discussed aspects of exercise, pro- and anti-inflammatory cytokines, immunological mechanisms, the dual role of IL-6 cytokine, and the anti-inflammatory effects of physical exercise. Results: Physical exercise is an efficient clinical tool, that limits chronic inflammation activating the immune system that will increase the level of anti-inflammatory IL-6 myokine. There is a direct relationship between the volume and intensity of exercise and the amount of IL-6 myokine in the blood stream. Conclusions: These studies contribute significantly to the understanding of the mechanisms of the anti-inflammatory effect of exercise. More studies on chronic low-grade inflammatory diseases are needed to understand their pathophysiology, and that will inspire the specialists improve long-term treatment strategies. Keywords: physical exercise, chronic low-grade inflammation, anti-inflammatory, IL-6, myokine,

Aphasia after acute ischemic stroke: epidemiology and impact on tertiary care resources

Introduction. This study aimed to reveal the disease burden of aphasia after acute ischemic stroke (AIS) at the national level and investigate the impact of aphasia on tertiary care resources and patient outcomes. We aimed to investigate the length of stay (LOS) and discharge modified Rankin Scale (mRS) score in aphasic, acute ischemic stroke (AIS) patients in order to estimate aphasia-related disease burden at a national level. Material and method. The local database from the Cluj-Napoca Emergency County Hospital (CNECH), the second largest stroke center in Romania was used to export demographics, baseline clinical and laboratory data, inpatient length of stay (LOS), NIH Stroke Scale (NIHSS), and discharge modified Rankin Scale (mRS) score data for all AIS patients admitted during March 2019. Results and discussions. Of 92 patients included in the study, 30 (32.6 %) had aphasia on admission. In a marginally significant unadjusted hierarchical multiple regression model, individuals with aphasia had a LOS of 1.86 days longer than stroke survivors without aphasia. In an adjusted version of the model, the NIHSS score at baseline was a significant predictor for LOS. In addition, the presence of aphasia was associated with a 1.49 increase in the mean mRS score. Aphasia was a marginally significant predictor for increased LOS. Presence of aphasia was more likely to produce a poor functional outcome. Conclusions. Considering an estimated impact of approximately EUR 3 million on direct medical expenditure annually, future policymaking efforts should improve prevention of stroke and improved access to post-stroke aphasia care in Romania. Keywords: aphasia; acute ischemic stroke; length of stay; disability, outcome,

Effects of low laser level therapy in rehabilitation of patients with COVID19 pneumonia

Introduction. An unprecedented public health crisis has been triggered worldwide by SARS-CoV-2’s high contagiosity and it’s mortality rates of 1-5%. Although the majority of COVID-19 cases have a good outcome, there is a small percentage that develop severe pneumonia and citokine storm and may be in the need of mechanical ventilation. Methods. Identifying the exact drivers of the excessive inflammation and the biomarkers that can predict a hyperinflammatory response to SARS-CoV-2 would be extremly helpful in finding efficient anti-inflammatory interventions that may stop the progression to acute respiratory distress syndrome (ARDS). Results. In the search for such interventions we have identified the promising effect of low level LASER therapy (LLLT) on lung inflammation from COVID-19 pneumonia. Due to its well known anti-inflammatory effect and modulatory activity on immune cells, laser therapy may be able to decrease lung and systemic inflammation without affecting lung function in acute lung lesions, relieve respiratory symptoms, normalize respiratory function and stimulate the healing process of lung tissue. The recovery time may also be significantly shortened and all blood, immunological and radiological parameters may improve. Conclusions. This findings need further confirmation from clinical trials but we are hopeful for their contribution on the global battle against COVID-19 pandemic. Keywords: SARS-CoV-2, pneumonia, low LASER level therapy, anti-inflammatory effect, citokine storm,