The aim of this study is to compare four forms of axial spondyloarthritis (axSpA): non-radiographic axial spondyloarthritis (nr-axSpA), ankylosing spondylitis (AS), non-radiographic axial psoriatic ...arthritis (nr-axPsA) and radiographic axial psoriatic arthritis (r-axPsA). In a cross-sectional retrospective study, gender difference, human leukocyte antigen (HLA) typing, laboratory C-reactive protein (CRP) and erythrocyte sedimentation (SE) values, and radiographic and magnetic resonance scans were analyzed. One hundred and thirty-seven patients were included in the study: 45 AS, 51 nr-axSpA, 32 r-axPsA and 9 nr-axPsA; 74 women and 63 men. Most of the gender, laboratory and radiological findings confirmed the results of previously conducted studies about each group of the investigated axSpA. The key findings of our study are the newly detected findings of HLA typing beyond HLA-27 positivity: HLA-DR16 in AS, HLA-DR11 in nr-axSpA, HLA-B13, HLA-B57, HLA-Cw12 and HLA-DR7 in r-axPsA, and HLA-B18 in nr-axPsA. Our study also confirmed some of the results of previously conducted studies on predominant genes of HLA typing in axSpA: HLA-B27 in AS, HLA-B39 and HLA-Cw6 in r-axPsA, and HLA-Cw7 in nr-axPsA. Important conclusions about the nr-axPsA group cannot be drawn because of the very small number of subjects included in this group of axSpA. Our results suggest that the newly detected HLA typing findings beyond HLA-B27 positivity could be possible biomarkers of early detection of axSpA, but further studies on larger samples are needed.
We aimed to verify by Rasch analysis whether the Mini-BESTest, a balance measure, confirms its main psychometric properties in patients with subacute stroke undergoing rehabilitation in three ...different countries (Slovenia, Croatia, and Italy), and to examine the stability of item hierarchy and difficulty across the three national versions through a differential item functioning analysis. We investigated 159 patients with subacute stroke consecutively admitted to three rehabilitation facilities after screening for an intensive, tailored rehabilitation program. Balance function was tested within 36 h from admission and after ∼25 days. As no differential item functioning was found between admission and discharge data or among countries, all data were pooled. Rasch criteria for the functioning of rating scale categories were fulfilled. In terms of internal construct validity, all items except item #14 (Cognitive Get Up & Go; infit value=1.42) showed an acceptable fit to the Rasch model. The patient ability-item difficulty matching was very good. Reliability indices were high. The Principal Component Analysis of standardized residuals confirmed the unidimensionality of the test. On the basis of the item calibration, raw scores of the Mini-BESTest were transformed into linear estimates of dynamic balance and six statistically detectable levels of balance ability were defined. Good psychometric features of the Mini-BESTest were confirmed. The three different national versions showed stability in item hierarchy, indicating equivalence of their cross-cultural adaptations. Problems with item #14 in these patients warrant further study.
•Quality assurance of ultrasound transducers in the hospital environment.•Method can be used to distinguish highly non-uniform beams with high value of BNR.•Influence of exposure duration on obtained ...ERA and BNR values was analysed.
The evaluation of the performance of nine physiotherapy ultrasound transducers used clinically was performed in the hospital environment using an acoustically absorbing thermocromic tile developed at the National Physical Laboratory (UK). The method consists of exposing an acoustic absorber tile, part of which contains a thermochromic pigment, to the ultrasonic beam, thereby forming an image of the intensity profile of the transducer. Images acquired using thermochromic materials were postprocessed in order to estimate effective radiating area (ERA) and beam nonuniformity ratio (BNR) for ultrasound transducers operating within the frequency range from 1.0 to 3.3 MHz, and nominal applied intensities in the range of 1–2W/cm2. Results of our measurements have shown that thermocromic tile can be used for quality control of ultrasound transducers in the hospital environment. Experimental results show that proposed method can be used to distinguish highly non - uniform ultrasound beams with high value of BNR.
Influence of exposure duration on obtained ERA and BNR values was also analysed. Our results show that values for ERA increase with insonation time, while BNR values decrease. In order to compare our results with theory we have estimated temperature rise in thermochromic material experimentally and compare it with theoretical prediction.
Cerebralna paraliza je klinički entitet kojeg karakterizira poremećaj pokreta i položaja uzrokovan neprogresivnim oštećenjem nezrelog mozga. Mnogo je etioloških faktora zbog kojih dolazi do oštećenja ...mozga koja može uzrokovati cerebralnu paralizu. Posljedice oštećenja utječu na motoričku funkciju te mišićno-koštani i kognitivni razvoj, a javlja se i niz drugih pridruženih zdravstvenih poteškoća. Također, kada se govori o cerebralnoj paralizi, uvijek treba naglasiti da cerebralna paraliza predstavlja, ne samo medicinski problem, nego i psihološki i socijalni problem. Dijagnoza se postavlja kod djece kod koje je uočen usporeni razvoj motorike, a koji se potvrđuje nalazima magnetske rezonancije. Terapija djeteta s cerebralnom paralizom je usmjerena na ostvarivanje zadanog cilja. Dva glavna cilja su smanjiti komplikacije uzrokovane cerebralnom paralizom i poboljšati sposobnost usvajanja novih vještina. Dodatni ciljevi su edukacija roditelja, smanjenje tjelesnih deformacija i poboljšanje pokretljivosti. Cerebralna paraliza zahtjeva interdisciplinarni pristup te ima veliki utjecaj i na dijete i na čitavu obitelj i njihov život. Svaki terapijski pristup se bazira na individualnom pristupu. Vrlo je bitno terapiju započeti što ranije jer ranija terapija olakšava razvoj djeteta i pridonosi boljem ishodu terapije i kvaliteti života. Terapija cerebralne paralize ne treba biti usmjerena samo na motoričke tretmane, već i na tretmane i drugih poremećaja od kojih dijete pati. Postoji niz terapijskih sistema koji se primjenjuju u radu s djecom s cerebralnom paralizom. Rijetko se kad terapija oslanja na samo jedan sistem, najčešće se primjenjuje kombinacija terapijskih postupaka. Takav pristup omogućava fleksibilnost i individualizaciju kako bi se ostvarili ciljevi postavljeni za dijete i obitelj.
Malnutrition is usually related to some diseases such as inflammatory bowel disease, chronic pancreatitis, chronic liver disease and malignant tumors. It is characterized by weight loss, protein ...deficiency, and deficit of specific nutrients. The aim was to estimate the prevalence of nutritional risk among 160 gastrointestinal patients by use of the Nutritional Risk Screening (NRS-2002) score at hospital admission and discharge. The patients stayed in the hospital between 5 and 15 days or longer. Results showed that 40% of patients at admission and 36.2% at discharge were malnourished. There were 53.1% of patients with recognized malnutrition at admission that received nutritional support, whereas at discharge 34.4% of patients at risk were not dietary supported. Malnourished patients were significantly older, had lower body mass index, longer hospital stay and higher rate of malignant diseases than properly nourished patients. Regular screening for malnutrition should be conveyed in hospitals as to provide appropriate dietary support for all patients at risk.
Križobolja je jedan od najčešćih uzroka fizičke nesposobnosti, čije je najčešće izvorište degeneracija intervertebralnog diska. Nemogućnost točnog utvrđivanja potjecišta boli jest ograničavajući ...čimbenik u učinkovitijoj prevenciji i liječenju. Nova saznanja, napose u područjima genetike i analize proteina primjenom spektrometrije masa, bacaju novo svjetlo u razumijevanju etiopatogeneze degenerativne bolesti diska. Novim slikovnim metodama kao što je CEST magnetska rezonancija ili ADC magnetska rezonancija mogu se detektirati rane degenerativne promjene. Napredak je ostvaren glede razjašnjenja uloge fizičkog opterećenja, kao i tipa vježbi koje mogu imati utjecaj kako na razvoj tako i na liječenje bolesnika s degenerativnim promjenama diska. Na kraju, značajan napredak je ostvaren u kirurškom liječenju tih bolesnika, s naglaskom na minimalno invazivne tehnike. Ostali kirurški modaliteti liječenja su pokazali napredak koji ohrabruje, kao što su totalna zamjena diska i liječenje mezenhimalnim matičnim stanicama. Uz navedeno, i ostale novosti u dijagnostici i liječenju degenerativne bolesti vertebralnog diska raspravljene su u ovom članku.
Knee osteoarthritis (KOA), the most common type of osteoarthritis (OA), is associated with pain and inflammation of the joint capsule, impaired muscular stabilization, reduced range of motion and ...functional disability. High-intensity laser therapy (HILT) involves higher-intensity laser radiation and causes minor and slow light absorption by chromophores. Light stimulation of the deep structures, due to high intensity laser therapy, activates cell metabolism through photochemical effect. The transmissions of pain stimulus are slowed down and result in a quick achievement of pain relief. The aim of our research was to investigate the prompt analgesic effect of HILT on patients with KOA. Knee radiographs were performed on all patients and consequently graded using the Kellgren-Lawrence grading scale (K/L). A group of 96 patients (75 female, 21 male, mean age 59.2) with K/L 2 and 3 were submitted to HILT therapy. Pain intensity was evaluated with visual analogue scale (VAS) before and after the treatment. HILT consisted in one daily application, over a period of ten days, using protocol wavelength, frequency and duration. The results showed statistically significant decrease in VAS after the treatment (p < 0.001). Considering these results, HILT enables prompt analgesic effects in KOA treatment. Therefore HILT is a reliable option in KOA physical therapy.
COVID-19 multisistemska je bolest koja, iako dominantno utječe na dišni sustav, može zahvatiti gotovo svaki organski sustav te zahtijeva strukturiranu rehabilitaciju koju provodi multidiciplinarni ...tim. Akutna, rana, rehabilitacija tijekom prvih 30 dana od infekcije čini tek prvu fazu rehabilitacije osoba oboljelih od bolesti COVID-19. Simptomi i znakovi fizičkih, neurokognitivnih i psihičkih posljedica nakon infekcije virusom SARS-CoV2 mogu trajati tjednima ili mjesecima nakon kraja akutne faze bolesti, a mogu se razviti i u osoba koje su imale blagu kliničku sliku i nisu bile hospitalizirane. Najčešći simptomi i znakovi koji se javljaju nakon akutne faze bolesti COVID-19 jesu umor, zaduha, kašalj, bol u zglobovima i mišićima te nesanica i pojačani efluvij kose. Bolesnici čije je kliničko stanje u akutnoj fazi bolesti zahtijevalo liječenje mehaničkom ventilacijom, mogu imati dugotrajne posljedice uključujući fizičku slabost i neurokognitivnu disfunkciju (brain fog) obilježenu gubitkom intelektualnih funkcija poput koncentracije i kratkoročnog pamćenja. Bolesnici s kognitivnom disfunkcijom imaju problema s prisjećanjem riječi, diskalkulijom i koncentracijom. Rehabilitacijski program Post-COVID dnevne bolnice za fizikalnu medicinu i rehabilitaciju provodi multidisciplinarni tim koji je fokusiran na cjelokupno funkcioniranje bolesnika, a ne samo na ledirani organ ili organski sustav, uključujući posljedice bolesti COVID-19 te moguće komplikacije liječenja i komorbiditete. Cilj rehabilitacije bolesnika u razdoblju poslije COVID-a jest postizanje potpunog funkcionalnog oporavka i adekvatne kvalitete života.
COVID-19 is a multisystem disease that, although predominantly affecting the respiratory system, can affect almost any organ system and requires structured rehabilitation of a multidisciplinary team. Acute, early, rehabilitation during the first 30 days of infection constitutes only the first phase of rehabilitation of persons with COVID-19. Symptoms and signs of physical, neurocognitive, and psychological consequences after SARS-CoV2 infection may persist for weeks or months after the end of the acute phase of the disease, and may develop in individuals who have a mild clinical picture and have not been hospitalized. The most common symptoms and signs that occur after the acute phase of COVID-19 are fatigue, shortness of breath, cough, joint and muscle pain, and insomnia and increased hair effluvium. Patients whose clinical condition in the acute phase of the disease required treatment with mechanical ventilation may have long-term consequences, including physical weakness and neurocognitive dysfunction (brain fog) characterized by loss of intellectual functions such as concentration and short-term memory. Patients with cognitive dysfunction have problems with word recollection, dyscalculia, and concentration. The PostCOVID Day Hospital for Physical Medicine and Rehabilitation rehabilitation program is implemented by a multidisciplinary team focused on the overall functioning of patients, not just the treated organ or organ system, including the consequences of COVID-19 disease, possible treatment complications and comorbidities. The goal of rehabilitation of patients in the post-acute COVID-19 period is to achieve complete functional recovery and adequate quality of life.
Cilj: Istražiti jesu li nakon ozljede prednjeg križnog ligamenta koljena aktivni mehanizmi stabilizacije zgloba, potaknuti vježbama propriocepcije i ravnoteže tijekom programa rehabilitacije, ...dovoljni za uspostavljanje normalne funkcije zgloba, praćenjem živčano-mišićne kontrole na nestabilnoj podlozi u ranim razdobljima od ozljede, odnosno operacije rekonstrukcije prednjeg križnog ligamenta (od 1 mjesec do 1 godine). Ispitanici i metode: U kliničko istraživanje bilo je uključeno 53 ispitanika s ozljedom prednjeg križnog ligamenta (PKL) koljena, liječenih konzervativno/operacijski. Svi su nakon ozljede/operacije proveli rehabilitacijski program s naglaskom na vježbama na nestabilnoj podlozi za poticanje živčano-mišićne koordinacije i ravnoteže. Statičku i dinamičku stabilnost pratili smo i mjerili aparatom SportKAT 2000. Usporedbu rezultata vršili smo prema usporedbenoj skupini zdravih ispitanika i/ili prema zdravom ekstremitetu istog ispitanika. Rezultati: Koristeći se Sport KAT metodom, pronašli smo disfunkciju neuromišićne kontrole u održavanju statičke i dinamičke stabilnosti zgloba i ravnoteže u promatranim skupinama pacijenata određivanjem statičkih i dinamičkih ravnotežnih indeksa. Vježbe živčano-mišićne koordinacije, kao dio rehabilitacijskog protokola nakon ozljede PKL-a koljena, vrlo brzo dovode do poboljšanja obaju ravnotežnih indeksa (p < 0,001), u obje skupine pacijenata. No, ako se navedene vježbe svakodnevno ne izvode, dinamički ravnotežni indeks pogoršava se u neoperiranoj skupini, dok se nakon operacijske stabilizacije zgloba uspostavlja „normalizacija” ravnoteže (p < 0,001). Zaključak: S ciljem rehabilitacije neurosenzoričkih i propriocepcijskih oštećenja nastalih nakon ozljede PKL-a koljena liječenih konzervativno/operacijski, potrebno je koristiti vježbe koje stimuliraju dinamičke stabilizatore zgloba, preko mehanizama neuromišićne ko-kontrakcije tijekom održavanja ravnoteže. Spomenuto predstavlja znanstveni doprinos ovog rada s naglašavanjem važnosti živčano-mišićne koordinacije u rehabilitaciji donjeg ekstremiteta pri održavanju stabilnosti zglobova.
Aim: To evaluate if the restoration of neuromuscular coordination in knee ACL-injured patients could be estimated by the stimulation of neuromuscular control during the rehabilitation or if operative stabilisation should be performed previously. The study had to examine a short-term and long-term efficiency by monitoring the indicators of joint functionality in the early stages, from one month to one year after the injury/operation. Patients and methods: We analysed 53 ACL-injured patients treated operatively and non-operatively. All the patients underwent a functional rehabilitation programme with balance exercises. The measuring of static and dynamic balance on SportKAT 2000 device was performed, and the results were compared with the healthy subjects and the healthy limb of the same subject. Results: Measuring the static and dynamic balance indexes, a dysfunction of neuromuscular control was found in the maintenance of balance in the patient groups. Exercises that included stimulation of the neuromuscular coordination, as a part of the rehabilitation procedure following ACL injuries, soon lead to an improvement of both balance indexes (p<0,001) in both groups, however, no long term impact was noted in non-operatively treated group. Namely, if the above exercises are not conducted on a regular daily basis, the balance indexes will deteriorate. Contrary, after the operative joint stabilization the balance indexes tend to improve to the ‘normal’ balance (p<0,001). Conclusion: In order to restore dynamic stabilization of the joint in ACL injured patients, exercises stimulating the neuromuscular mechanisms are necessary. This suggests the importance of neuromuscular coordination in the rehabilitation of the lower extremity while maintaining joint stability, which represents the scientific contribution of this paper.
Female athletes participating in high-risk sports suffer anterior cruciate ligament (ACL) knee injury at a 4- to 6-fold greater rate than do male athletes. ACL injuries result either from contact ...mechanisms or from certain unexplained non-contact mechanisms occurring during daily professional sports activities. The occurrence of non-contact injuries points to the existence of certain factors intrinsic to the knee that can lead to ACL rupture. When knee joint movement overcomes the static and the dynamic constraint systems, non-contact ACL injury may occur. Certain recent results suggest that balance and neuromuscular control play a central role in knee joint stability, protection and prevention of ACL injuries. The purpose of this study is to evaluate balance neuromuscular skills in healthy Croatian female athletes by measuring their balance index score, as well as to estimate a possible correlation between their balance index score and balance effectiveness. This study is conducted in an effort to reduce the risk of future injuries and thus prevent female athletes from withdrawing from sports prematurely. We analysed fifty-two female athletes in the high-risk sports of handball and volleyball, measuring for their static and dynamic balance index scores, using the Sport KAT 2000 testing system. This method may be used to monitor balance and coordination systems and may help to develop simpler measurements of neuromuscular control, which can be used to estimate risk predictors in athletes who withdraw from sports due to lower sports results or ruptured anterior cruciate ligament and to direct female athletes to more effective, targeted preventive interventions. The tested Croatian female athletes with lower sports results and ACL knee injury incurred after the testing were found to have a higher balance index score compared to healthy athletes. We therefore suggest that a higher balance index score can be used as an effective risk predictor for lower sports results and lesser sports motivation, anterior cruciate ligament injury and the ultimate decision to withdraw from active participation in sports. If the balance testing results prove to be effective in predicting the occurrence of ligament injuries during future sports activities, we suggest that prophylactic training programs be introduced during athlete training, since the prevention of an initial injury will be more effective than prevention of injury recurrence.
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