Vitamin D može smanjiti rizik od virusnih infekcija respiratornog trakta te smanjiti težinu i dužinu trajanja bolesti. Sama činjenica da stanice respiratornog epitela, monociti/makrofazi, dendritične ...stanice, T i B limfociti posjeduju receptore za vitamin D i da mogu autonomno aktivirati vitamin D koji onda djeluje autokrino i parakrino, ukazuje na značajan imunomodulatorni učinak vitamina D u urođenome i stečenome imunom odgovoru. Mehanizmi obrane od respiratornih virusa, uključujući i virus SARS-CoV-2, a koji su pod utjecajem aktivnog oblika vitamina D uključuju: indukciju stvaranja katelicidina antivirusnog proteina respiratornog epitela koji može smanjiti opterećenje virusom, poticanje urođenog imunog odgovora na virusnu infekciju, čuvanje integriteta respiratornog epitela kroz učvršćivanje uskih spojeva između stanica te kroz smanjenje prekomjernog stvaranja proupalnih citokina i pojačanje stvaranja protuupalnih citokina omogućavajući uravnotežen imuni odgovor na infekciju, time smanjujući nepotrebno oštećenje tkiva i takozvanu citokinsku oluju i posljedičnu akutnu ozljedu pluća koja u najtežim slučajevima bolesti COVID-19 rezultira respiratornim distres sindrom. Nadoknada vitamina D je jednostavna, sigurna i jeftina te bi trebala biti neizostavni dio javnozdravstvene politike sprječavanja zaraznih bolesti uključujući i COVID-19, posebice stoga što su za vrijeme pandemije ljudi dodatno izloženi nedostatku vitamina D jer su prisiljeni boraviti u zatvorenom prostoru, čime je onemogućen glavni put sinteze vitamina D u koži djelovanjem UV zraka. Za vrijeme pandemije virusom SARS-CoV-2 racionalno je nadoknadu provesti višim dozama, do 10 000 IJ dnevno, kako bi se u kratkom vremenu postigle koncentracije u krvi potrebne za nekalcemijske učinke vitamina D.
Izvantjelesna terapija udarnim valom ima brojne fiziološke učinke, poput smanjenja bola i poticanja cijeljenja tkiva, zbog čega danas ima široku primjenu u mišićno-koštanoj patologiji. Postoje dva ...osnovna oblika udarnog vala, fokusirani i radijalni, a razlikuju se po tome što fokusirani udarni val najveću energiju postiže u žarištu na željenoj dubini, dok se kod radijalnog udarnog vala najveća energija stvara na mjestu ulaska u tretiranu regiju tijela, te slabi daljnjim prodiranjem u tkivo. Sam mehanizam djelovanja udarnog vala nije do kraja razjašnjen, a pretpostavlja se da mehanička stimulacija dovodi do stanične migracije, proliferacije, diferencijacije ili apoptoze stanica, s tim da visoka razina energije može djelovati i razorno, umjesto da posluži kao mehanički stimulus, zbog čega je nužna prilagodba energije, ovisno o tretiranom području. Modulacija bola objašnjava se „gate control“ teorijom i hiperstimulacijskom analgezijom. Osim ustaljenih indikacija poput epikondilitisa, tendinopatija, plantarnog fascitisa, kalcificirajućeg tendinitisa, udarni val danas nalazi sve širu primjenu, te se upotrebljava i u terapiji spasticiteta, poremećenog cijeljenja kosti, kronične križobolje, smrznutog ramena, osteoartritisa koljena, sindroma trkačke potkoljenice, škljocavog prsta, sindroma bolnoga trohantera, te kod sindroma miofascijalne boli. Međutim, potrebno je provesti dodatna istraživanja kako bi se utvrdila stvarna vrijednost i mjesto udarnog vala u liječenju navedenih bolesti i stanja.
Extracorporeal shockwave therapy has numerous physical effects, such as pain reduction and tissuehealing induction, which gives its way for therapeutic implementation in various musculoskeletalconditions. There are two main forms of shockwaves, focused and radial, the main difference being thatfocused shockwaves achieve the highest energy at certain tissue depth, while radial shockwaves have thehighest energy at the entry point into the tissue. The underlying mechanism is still not fully elucidated, butit is presumed that mechanical stimuli cause cellular migration, proliferation, differentiation and apoptosis.Given in mind that this high energy can be disruptive instead being a mechanical stimulus, which calls forindividual energy adjustment depending on the structure treated. Pain modulation is explained according tothe gate control theory and hyperstimulation analgesia. Besides standard indications such as epicondylitis,tendinopathies, plantar fasciitis and calcific tendinitis, shockwave therapy is nowadays used more broadly,such as for treating spasticity, disrupted bone healing, chronic low back pain, frozen shoulder, kneeosteoarthritis, medial tibial stress syndrome, trigger finger, greater trochanteric pain syndrome andmyofascial pain syndrome. However, further research is needed to determine the exact value and place ofextracorporeal shockwave therapy in treating these conditions.
Calcific shoulder tendinitis (CST) is characterized by hydroxyapatite crystals deposition in the rotator cuff tendons. Therapeutic exercises have been the mainstay of CST treatment, and evidence for ...therapeutic ultrasound (T-US) utilization and efficacy is lacking.
This study aimed to determine whether 4500 J T-US combined with therapeutic exercises is superior to therapeutic exercises alone regarding calcification size reduction and symptom improvement in chronic symptomatic CST.
This is a double-blind, placebo-controlled study.
This study was conducted at a University Department for Rheumatic Diseases and Rehabilitation of a University Hospital.
Patients with chronic CST were analyzed.
After eligibility allocation, 46 patients with sonographically confirmed CST were divided into two groups (56 shoulders, 26 per group). Both groups performed the same therapeutic exercises for half an hour under physiotherapist supervision. In the treatment group T-US (4500 J, 10 minutes per session at a frequency of 1 MHz and an intensity of 1.5 W/cm
), and in the placebo group, sham T-US was applied for 4 weeks. Patients were assessed for: calcification size, shoulder pain, global health (GH), shoulder mobility (ROM), handgrip strength, Health Assessment Questionnaire Disability Index (HAQ-DI), Shoulder Pain and Disability Index (SPADI), and overall rehabilitation satisfaction.
All assessed variables improved in both groups. A significantly greater reduction in calcification size was recorded in the treatment group compared to placebo: -10.92% (IQR 4.61% to 19.38%) versus -5.04% (2.30% to 7.22%), P=0.008. There was a significantly greater decrease in HAQ-DI, reduction of VAS GH, and an increase in hand grip strength in the treatment group, while no significant differences were observed for other parameters between the groups.
Our results showed that adding the 4500 J T-US to therapeutic exercises in chronic symptomatic CST therapy resulted in greater calcification size reduction immediately following the treatment, as well as hand grip strength, HAQ-DI, and VAS GH improvement.
4500 J T-US combined with therapeutic exercises is more effective in reducing calcification size than therapeutic exercises alone in the treatment of chronic symptomatic CST.
Prevencija osteoporoze započinje prije rođenja pravilnom prehranom trudnica i osiguranjem dobrog statusa vitamina D u trudnoći, a nastavlja se tijekom cijelog života. Vršna koštana masa određena je ...prvenstveno genetski, no kako bi se taj genetski potencijal ostvario u dječjoj i adolescentnoj dobi, važne su pravilna prehrana koja uključuje adekvatan unos kalcija i proteina te tjelesna aktivnost uz osiguranje dobrog statusa vitamina D. Isti čimbenici utječu na očuvanje koštane mase u odrasloj dobi i na usporenje gubitka koštane mase u starijoj dobi. Od štetnih navika na koštanu masu utječe tjelesna neaktivnost, neadekvatna prehrana, pušenje i prekomjerno konzumiranje alkohola, stoga javnozdravstvene politike treba usmjeriti na promociju zdravog načina života u svrhu očuvanja koštanog zdravlja.
Rheumatoid arthritis occurs two to three times more often in women than in men and it has been less studied in men. The results of gender influence on clinical course of the disease are ...contradictory. The aim of this study is to determine the difference in handgrip strength between female and male RA patients in comparison to healthy individuals. The study included 100 RA patients and 100 healthy individuals (50% were male in both groups). Handgrip strength was measured in both hands using a dynamometer. A two-way ANCOVA was used to analyse the data and age was included in the study as covariate. The results show that both male and female RA patients have lower handgrip strength compared to healthy individuals. The analysis of gender and disease interaction has shown that male RA patients have lower handgrip strength than female RA patients in comparison with the healthy group, age adjusted. This interaction is evident and statistically significant in both right hand (
F
1, 195) = 14.62;
p
< 0.01) and left hand (
F
1, 195) = 20.54;
p
< 0.01). The common-language effect size has shown that there is 92% (right hand) and 93% (left hand) chance that male individual will have stronger handgrip than his female counterpart. In RA patients, there is 77% chance for both hands that male will have stronger handgrip. Men and women with RA have significantly lower handgrip strength compared to healthy individuals and the difference is more pronounced in men which was not previously observed in the literature.
BACKGROUNDThe main benefits of cryotherapy in rheumatoid arthritis (RA) are in reducing inflammation and swelling and in relieving joint pain. This study aimed to compare the short-term effects of ...cold air therapy vs. ice massage, on pain and handgrip strength (HGS) in patients with RA. SUBJECTS AND METHODSThe study is a non-randomized clinical trial. Patients were recruited if they had disease activity score (DAS28) ≥3.2 with at least 2 swollen joints on the dominant hand and were consecutively divided into two groups of 15 patients. There was no statistically significant difference in DAS28 score between groups. The first group received cold air therapy at -30°C and the second ice massage of the hands. The pain (visual analogue scale, 0-10), and HGS (kg) were measured immediately prior and after cryotherapy, and 30 and 60 minutes after cryotherapy. Descriptive statistics, Independent Samples T-test, and Paired Samples T-test were used for statistical analysis. RESULTSPain intensities for cold air therapy were as follows: 5.33 (±2.44), 3.13 (±2.67), 2.87 (±2.56), 2.80 (±2.73), and for ice massage were: 5.20 (±2.37), 2.87 (±2.42), 2.60 (±2.23), 2.67 (±2.28). In both groups pain was significantly lower immediately after, 30 and 60 minutes after the treatment compared to the baseline (p=0.001). There was no significant difference in pain alleviation between the groups regarding the used method of cryotherapy on all three measured time points. Nonsignificant improvement in HGS occurred after both methods of cryotherapy. There was no significant correlation between pain intensity and HGS. CONCLUSIONSA single application of cold air therapy and ice massage equally provides immediate and significant pain alleviation in patients with active RA, which is maintained for one hour. There is scientific evidence that HGS is influenced greatly by the disease activity. A single application of cryotherapy could not reduce disease activity explaining recorded nonsignificant effect on HGS.
Rheumatoid arthritis (RA) is a chronic, autoimmune and disabling disease that significantly affects the quality of life. Additionally, significant number of patients with RA suffer from depressive ...disorders, which are commonly underrecognised and undertreated. We aimed to estimate the prevalence of depressive symptoms in Croatian RA patients and to assess the relationship between them and clinical correlates.
Fifty-four RA patients treated at the Clinic for Rheumatic Diseases and Rehabilitation at the University Hospital Centre Zagreb were prospectively enrolled in the study and evaluated for functional status using the Disease Activity Score 28 (DAS-28), Health Assessment Questionnaire (HAQ), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and Visual Analogue Scale (VAS) for pain and health related quality of life (HRQL) measurement. The depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II) questionnaire.
Thirty RA patients (55.6%) had some sort of mood disorder, with 10 (18.5%) patients accounting as depressed. Positive correlation was found between depressive symptoms, higher disease activity and disablity during daily activities (τb=0.385, p=0.001 and τb=0.282, p=0.024 respectively). We found no significant association between depression and disease activity in the whole sample of RA patients, but for postmenopausal patients, the disease activity correlated with postmenopausal patients accounting as depressed (BDI-II score moderate or severe; τb=0.363, p=0.021). The use of biologic therapy correlated negatively with the disease acitivity, pain intensity and worse health related quality of life score (τb=-0.360, p=0.06; τb=-0.310, p=0.07; τb=-0.380, p=0.01 respectively).
Considering the high prevalence of depressive sympoms in RA patients and the effect on functional disability and quality of life, we wanted to emphasize the importance of recognizing and optimizing depression treatment through multidisciplinary approach in RA patients.
Rehabilitacija osoba nakon moždanog udara Laktašić Žerjavić, Nadica; Slivar, Luka; Perić, Porin
Medicina fluminensis,
12/2022, Letnik:
58, Številka:
4
Journal Article
Recenzirano
Moždani udar, iako nastupa naglo, u svojoj biti je kronično stanje. Morbiditet i mortalitet od moždanog udara i dalje su vrlo visoki, a onima koji su preživjeli moždani udar, u pravilu, potrebna je ...akutna bolnička skrb koja se zatim nastavlja kroz subakutnu rehabilitaciju i, u konačnici, reintegraciju u zajednicu. Rehabilitacija se provodi timskim interdisciplinarnim pristupom. Usprkos uloženim naporima, još uvijek postoji mnogo nezadovoljenih potreba preživjelih koji su doživjeli moždani udar, počevši od dostupnosti akutne bolničke skrbi, potom dostupnosti i organizacije subakutne rehabilitacije te, u konačnici, od mogućnosti reintegracije u zajednicu. Rehabilitacija bi trebala započeti tijekom akutne bolničke skrbi unutar prvih 24 do 48 sati kroz ranu mobilizaciju bolesnika. U subakutnoj fazi ishod rehabilitacije izravno ovisi o broju sati dnevno provedenih u rehabilitacijskom programu. Za uspješan ishod rehabilitacije važno je individualno procijeniti oštećenje i funkciju pomoću specifičnih mjernih instrumenata, postaviti individualizirane ciljeve i sukladno tome izraditi plan rehabilitacije te pratiti učinkovitost rehabilitacijskog programa. Primarni je cilj rehabilitacije uspostavljanje samostalnosti u obavljanju aktivnosti svakodnevnog života. U članku su pregledno prikazani tijek rehabilitacije nakon moždanog udara, primarna i sekundarna oštećenja tjelesnih funkcija i struktura nakon moždanog udara, kao i ograničenja aktivnosti koja iz njih proizlaze, te osnovni principi njihove rehabilitacije.
A stroke occurs abruptly, but it is in its essence a chronic condition. The stroke morbidity and mortality are still very high, and those surviving the stroke, in general, require acute hospital care, which then continues through subacute rehabilitation and ultimately reintegration into the community. Rehabilitation is carried out through a team interdisciplinary approach. Despite the efforts, there are still a lot of unmet needs of survivors who have suffered a stroke, starting with the availability of acute hospital care and subsequently by the availability and organisation of subacute rehabilitation and ultimately by the possibility of reintegration into the community. Rehabilitation should start during acute hospital care within the first 24 to 48 hours through early patient mobilisation. In the subacute phase, the outcome of rehabilitation directly depends on the number of hours per day spent in the rehabilitation program. For a successful outcome of rehabilitation, it is important to individually assess the damage and function using specific measuring instruments, and set individualised goals, and design a rehabilitation plan accordingly, and monitor the efficiency of rehabilitation program. The primary objective of rehabilitation is to establish independence in carrying out the activities of daily life. In the article the course of stroke rehabilitation, the primary and secondary damage to physical functions and structures after stroke, as well as the resulting limitations of activities, and principles of their rehabilitation are given.
BACKGROUNDEarly diagnosis is the key to successful treatment of inflammatory rheumatic diseases and the use of conventional disease-modifying antirheumatic drugs (csDMARD) and biologic ...disease-modifying antirheumatic drugs (bDMARD) or biologics have substantially contributed to better disease control. Biological drugs have been approved for the treatment of rheumatoid arthritis (RA), juvenile arthritis (JIA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). SUBJECTS AND METHODSThe study involved 79 adult patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS), psoriatic arthritis (PsA) or undifferentiated spondyloarthropathy (USpA) - the last three clinical entities belong to a common group called spondyloarthropathies (SpA); receiving anti-TNF therapy at the department of Rheumatology and Rehabilitation, Clinical Hospital Center Zagreb. The duration of therapy was a minimum of 1 month, with the mean duration of 32.0±24.0 months. The infections recorded were infections that appeared during treatment or soon after the treatment was stopped. RESULTSDuring the course of therapy 17 patients (21.5%) experienced an infection, with the total number of 21 infections. This resulted in an overall incidence rate (IR) of 9.9/100 patient-years. Of the patients with RA 76.5% developed an infection, which was significantly higher than for patients with SpA (p<0.001). The IR/100 patient-years for all infections in RA patients was 23.7 compared to 2.8 in patients with SpA. Female gender was associated with a significantly higher infection rate (70.6%, p=0.005). There were 8 infections that were considered serious, yielding an IR of 3.8/100 patient-years. There was only one malignancy case in our study. CONCLUSIONEvery fifth patient developed an infection during the course of anti-TNF therapy, and more than one third of all infections were serious. RA and female gender was associated with a significantly increased number of infections.
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