Importance of specific rehabilitation methods for patients with intracerebral hemorrage

Intracerebral hemorrhage (ICH) is a severe type of stroke which causes bleeding in the brain parenchyma, accounting for 10-15% of all strokes. Prognosis of patients with ICH remains very poor despite new advances in management strategies, and has not improved in the last decades. Disability remains important in ICH survivors, only a small proportion of patients live an independent life after ICH. Development of new strategies in rehabilitation care is expected to improve survival and outcome after intracerebral hemorrhage. The main neurological sequellae after ICH are similar to those seen after ischemic stroke. Given the clinical and pathological differences between the two types of stroke, clinical recovery is expected to be different. Comparisons between rehabilitation results in hemorrhagic versus ischemic stroke have offered mixed results, but all of them agreed that rehabilitation is highly effective after hemorrhagic strokes. There are no standard recommendations regarding the specific procedures used in the rehabilitation program of ICH patients. In the absence of clinical data to guide specific practice, the rehabilitation of ICH patients is largely based on general principles learned from ischemic stroke recovery. Physical therapy, task-specific training, sensory stimulation, use of assistive devices for upper limb or gait functions, speech and language therapy, physiotherapy and balnear therapy are methods used in rehabilitation of patients with hemorrhagic stroke, with improvement in patients functional outcome. There is a need for further development of specific rehabilitation techniques to enhance recovery in ICH patients

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

Clinical Applications and Biological Effects of Sauna Bathing – a Narrative Review

Background: Regular sauna exposure has been shown to positively influence clinical symptoms in various pathologies. The purpose of this review is to present the evidence accumulated so far in order to evaluate the efficiency, effects, benefits and risks of sauna therapy in the field of various pathologies that require medical rehabilitation. Methods: A literature search was conducted on Publons and PubMed databases from January 2000 onwards. The studies selected for this review included research in humans undergoing repeated sauna sessions with at least one reported health outcome. Results: Constant application of sauna therapy has visible effecta on improving cardiac activity, endothelial function, myocardial perfusion, ventricular arrhythmia. Sauna treatment is a safe proce-dure for patients with cardiovascular, respiratory, musculo-skeletal pathologies, with no notable side-effects. Conclusions: Sauna therapy has proved its effectiveness in medical rehabilitation treatment starting from the musculoskeletal system and skin to the nervous system. In addition, it brings a significant improvement in the quality of life of patients

APPROACHING DEPRESSION IN FAMILY DOCTOR PRACTICE

Depression is a common condition, especially among people suffering from chronic diseases. Some people with depression do not realize that they suffer from this condition and therefore do not seek professional help. The family doctor is the first to come in contact with these patients, and he is the one who monitors their progress. The attitude of the family doctor to depression can influence both the attitude of the patient to depression and his attitude toward treament

ChatGPT Performances in Explanation of Physiopathology by Example

Physiopathology constitutes one of the basic disciplines that helps understand the mechanisms of diseases and, consequently, access effective and personalized therapies. ChatGPT is a working tool that promptly provides detailed answers to targeted questions, revolutionizing the way medical professionals interact with artificial intelligence (AI). The purpose of this study was to compare the answers provided by human intelligence with experience and professional qualification with the answers provided by ChatGPT, regarding the targeted questions addressed to one clinical case, to decipher the key pathophysiological mechanisms. The input was represented by cases published in Bulboacă et al.1 ChatGPT-3.5 (https://chat.openai.com/) free version was used in our study. We provide one case (in Romanian language) and ask ChatGPT to answer five individual questions. We collected the answers on August 7, 2023. The following request was included in the ChatGPT window: We have the following case: “[case description]”. Answer the following questions: [questions]. The evaluation of the responses given by the ChatGPT was done by one researcher and classified as correct, partially correct, or incorrect. The AI generated answers were partially correct in 4 out of 5 questions and incorrect in one question. ChatGPT can be a valuable instrument for medical teaching, but answer analyses must be added to ensure the validity of the responses and explanations

The therapeutic effect of mineral water from spring 3 in Baile Tusnad in experimental alcoholic liver disease in rats – an electron microscopic study

The aim of this study was to investigate by transmission electron microscopy the changes occurring in rat hepatocytes following administration of ethyl alcohol for 70 days, as well as to evaluate the effect of mineral water from spring 3 in Baile Tusnad balneoclimatic resort administered for 30 days after completion of ethyl alcohol administration. After 70 days of ethyl alcohol administration, lipid loading in hepatocytes and a reduction of the rough endoplasmic reticulum were observed. The smooth endoplasmic reticulum was found to be much more abundant and in some hepatocytes that contained high lipid amounts, mitochondria had rarefied matrix and cristae. At 30 days from completion of ethyl alcohol administration, the rats that drank tap water showed progressively decreasing lipid loading. Also, the smooth endoplasmic reticulum was less abundant, while the rough endoplasmic reticulum was more abundant than on day 70 of the experiment. The rats that drank mineral water from spring 3 compared to those that drank tap water over the last 30 days of the experiment had lower hepatocyte lipid loading and the rough endoplasmic reticulum was much more abundant. These ultrastructural differences in the degree of lipid loading and the ratio between the smooth and rough endoplasmic reticulum are due to the beneficial effect of mineral water from spring 3 in Baile Tusnad

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

Pregnancy implanted in the scar of caesarean section and the role of the general practitioner

The increase in the number of cesarean sections led to severe complications, such as the ectopic scar pregnancy and the morbidly adherent placenta. The incidence of scar pregnancy is 1/2000 of pregnancies, the more frequently associated with the higher the number of cesarean sections. These can cause severe bleeding, rupture of the uterus, bladder or digestive injury or maternal mortality. The general practitioner has an important role in the diagnosis and monitoring of these patients. He knows the patient's history, is asked in permanent by it and sometimes is in the situation of being the only one checking pregnancy. This work aims to review the diagnostic and monitoring criteria for ectopic scar pregnancy helpful to family physicians. Addressing all patients with a scarred uterus for early screening ultrasound may increase the rate of diagnosis. The family doctor is an essential partnership in monitoring these high risk cases

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