The evolution of disability after ischemic stroke depending on the circadian variation of stroke onset

Introduction. The circadian variation of ischemic stroke onset is known, but its impact on recovery prognosis has been less studied. Materials and method. The study included 32 patients with ischemic stroke, admitted to Neurology Departments I and II of the Rehabilitation Hospital in Cluj-Napoca between 1 June 2008 and 31 December 2009 and followed up for 2 years, during 5 successive admissions. The diagnosis of ischemic stroke was defined according to updated World Health Organization criteria. The onset time of ischemic stroke was assigned to one of the following six-hour intervals: 00.01-06.00 (night), 06.01-12.00 (morning), 12.01-18.00 (afternoon) and 18.01-24.00 (evening). For each patient we recorded demographic data and the values of ADL and IADL scales on the occasion of each assessment. Statistical analysis was performed using Excel Microsoft, descriptive and one-way ANOVA test. Results and conclusions. Our study confirms the incidence pattern of ischemic stroke, with a morning peak, which is more obvious in the case of the male sex and patients aged less than 65 years. Patients with nocturnal stroke onset have a less favorable functional evolution during the second year after ischemic stroke

The influence of circadian variation in ischemic stroke onset on the evolution of the severity of the clinical picture and disability

Introduction. The chronobiology of ischemic stroke describes an occurrence pattern with the highest incidence in the morning according to most literature reports, but its influence on the evolution of the severity of the neurological picture and functional status is little studied. Materials and method. This cohort study included 63 patients with ischemic stroke admitted to the Neurology Departments I and II of the Rehabilitation Hospital in Cluj-Napoca between 1 June 2008 and 1 June 2009, who were followed up for 2 years by 5 successive evaluations. The onset time of ischemic stroke was assigned to one of the six hours intervals: 00.01- 06.00 (night), 06.01-12.00 (morning), 12.01-18.00 (afternoon) and 18.01-24.00 (evening). For each patient, the National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) scores were recorded on the occasion of each evaluation. Statistical analysis was performed using Excel Microsoft, descriptive and ANOVA test. Results and conclusions. Our study confirms the incidence pattern of ischemic stroke with a morning peak, which is more obvious in the case of patients aged less than 65 years. Patients with stroke onset in the nocturnal interval have a less favorable neurological and functional evolution during the second year after ischemic stroke

CONDYLOMATA ACUMINATA AND CANDIDA VULVOVAGINITIS DURING PREGNANCY – CURRENT FACTS AND THERAPEUTIC POSSIBILITIES

Condylomata acuminata during pregnancy represents genital, perineal and perianal hyperplasia as a result of infection with human papillomavirus during pregnancy. Candida vulvovaginitis is a symptomatic vaginitis (inflammation of the vagina and / or vulva) caused by Candida infection, with 10% of women being asymptomatic. These diseases present some particularities and therapeutical problems during pregnancy

Translation of the Fugl-Meyer assessment into Romanian: Transcultural and semantic-linguistic adaptations and clinical validation

PurposeThe Fugl-Meyer Assessment (FMA) scale, which is widely used and highly recommended, is an appropriate tool for evaluating poststroke sensorimotor and other possible somatic deficits. It is also well-suited for capturing a dynamic rehabilitation process. The aim of this study was to first translate the entire sensorimotor FMA scale into Romanian using the transcultural and semantic-linguistic adaptations of its official afferent protocols and to then validate it using the preliminary clinical evaluation of inter- and intra-rater reliability and relevant concurrent validity.MethodsThrough three main steps, we completed a standardized procedure for translating FMA's official afferent evaluation protocols into Romanian and their transcultural and semantic-linguistic adaptation for both the upper and lower extremities. For relevant clinical validation, we evaluated 10 patients after a stroke two times: on days 1 and 2. All patients were evaluated simultaneously by two kinesi-physiotherapists (generically referred to as KFT1 and KFT2) over the course of 2 consecutive days, taking turns in the roles of an examiner and observer, and vice versa (inter-rater). Two scores were therefore obtained and compared for the same patient, i.e., being afferent to an inter-rater assay by comparing the assessment outcomes obtained by the two kinesi-physiotherapists, in between, and respectively, to the intra-rater assay: based on the evaluations of the same kinesi-physiotherapist, in two consecutive days, using a rank-based method (Svensson) for statistical analysis. We also compared our final Romanian version of FMA's official protocols for concurrent validity (Spearman's rank correlation statistical method) to both of the widely available assessment instruments: the Barthel Index (BI) and the modified Rankin scale (mRS).ResultsSvensson's method confirmed overall good inter- and intra-rater results for the main parts of the final Romanian version of FMA's evaluation protocols, regarding the percentage of agreement (≥80% on average) and for disagreement: relative position [RP; values outside the interval of (−0.1, 0.1) in only two measurements out of the 56 comparisons we did], relative concentration [RC; values outside the interval of (−0.1, 0.1) in only nine measurements out of the same 56 comparisons done], and relative rank variation [RV; all values within an interval of (0, 0.1) in only five measurements out of the 56 comparisons done]. High correlation values were obtained between the final Romanian version of FMA's evaluation protocols and the BI (ρ = 0.9167; p = 0.0002) for FMA–upper extremity (FMA-UE) total A-D (motor function) with ρ = 0.6319 and for FMA-lower extremity (FMA-LE) total E-F (motor function) with p = 0.0499, and close to the limit, with the mRS (ρ = −0.5937; p = 0.0704) for FMA-UE total A-D (motor function) and (ρ = −0.6615; p = 0.0372) for FMA-LE total E-F (motor function).ConclusionsThe final Romanian version of FMA's official evaluation protocols showed good preliminary reliability and validity, which could be thus recommended for use and expected to help improve the standardization of this assessment scale for patients after a stroke in Romania. Furthermore, this endeavor could be added to similar international translation and cross-cultural adaptations, thereby facilitating a more appropriate comparison of the evaluation and outcomes in the management of stroke worldwide

PROBLEMS OF DOCTOR-PATIENT COMMUNICATION IN MEDICAL PRACTICE. WAYS TO APPROACH THE PATIENT IN COMPLICATED CASES

Currently, the physician-patient relationship is a bidirectional one, the center of which is communication. Communication is no longer regarded as an option but as a necessity in the day-to-day practice of physicians. The way we use communication can make a big difference on the physician-patient relationship, on the understanding of the disease, the treatment, and on the subsequent conduct of the patient. The approach to this subject comes in the absence of formal courses for doctors in communication, a necessary and beneficial thing both for the doctor and for the patient

EFFECTIVENESS AND SIDE EFFECTS OF COMPLEMENTARY AND ALTERNATIVE THERAPIES IN ACNE

Acne is a condition that occurs in both sexes, affects several age groups (especially adolescents) and can have a high degree of impairment of the quality of life of patients. Therapies prescribed by the physician are generally long-lasting and may have significant side effects. Patients tend to try other therapies, either concomitantly with those prescribed by the physician or by replacing them. This analysis seekstohighlightthemechanisms of action, efficacyandthe adverse effects of alternative and / or complementarytherapiesused in acne

A META-ANALYSIS OF OBSERVATIVE STUDIES REGARDING METABOLIC SYNDROME AS A COMORBIDITY OF PSORIASIS

Psoriasis is a chronic multisystemic disease associated with multiple comorbidities such as obesity, obesity being a relevant risk factor for the occurrence of metabolic syndrome. Metabolic syndrome is known as a complex disorder that combines abdominal obesity, glucose intolerance/insulin resistance (diabetes mellitus), dyslipidemia and arterial hypertension. Existing literature shows that psoriasis is associated with an increased prevalence of metabolic syndrome. The purpose of this meta-analysis was to clarify the possible association, in terms of comorbidity, between psoriasis and metabolic syndrome

IMPACT ON MOTHER, FETUS AND NEWBORN IN CASE OF VARICELLA IN PREGNANCY

A wide range of infectious diseases can occur during pregnancy, clinical presentation and course during pregnancy may be altered due to a maternal cell immune disorder. Some infectious diseases can lead to serious consequences for the mother or the fetus, including congenital malformations. It is very important to know in detail the clinical presentation, the course of the disease, the management but also the maternal and fetal risks especially in the case of congenital varicella syndrome, the mother's varicella-zosterian pneumonia and neonatal varicella infection

THE IMPORTANCE OF OVERDIAGNOSIS IN FAMILY MEDICINE. HOW DO WE MINIMIZE THE RISKS?

Because the family doctor is the main medical contact for patients, it can play a crucial role in overdiagnosis. Although it is not a very common topic, overdiagnosis can have important negative consequences both on the health system, from an economic point of view and most importantly on the patient (unnecessary therapies, expensive therapies, impairment of quality of life etc.). Certain diseases have a higher percentage of overdiagnosis and need to be addressed

PREDICTION OF HIV PREVALENCE UNTIL 2022 IN ROMANIA AND THE EUROPEAN UNION

In the last decade, AIDS diagnosis has decreased, most likely through easier access to treatment and faster management of HIV infections. Due to the decrease in the number of AIDS patients, the reduction of deaths and the idea of eradication of AIDS can be considered. For all of this, we need to look at the HIV infection that causes AIDS. HIV infection at European level has been declining in recent years, yet there are still countries that continue to grow. Late diagnosis, pre-exposure prophylaxis and the lack of proper education in prevention are still a problem in some European Union countries