Physiotherapeutic behavioral pattern of carpal tunnel syndrome induced by occupational activities

Introduction: Carpal tunnel syndrome (CTS) is the most common compression neuropathy that can lead to functional disability at working age. Since 2003, it has been registered in the list of occupational diseases of the European Union. In 2001, the disease was the sixth most frequent among all occupational diseases recognized in the European Union. Often underestimated, CTS can cause serious changes in the quality of life of the patients—their professional and usual daily activities, social and household contacts are violated.Aim: The aim of this article is to analyze the results of physiotherapy treatment in patients with mild and moderate form of CTS induced by excessive upper limb load in terms of their working ability, daily activities and their social activity based on anamnestic data, a survey and a Boston questionnaire for carpal tunnel syndrome.Material and Methods: A total of 57 patients with mild to moderate degree of manifestation of the syndrome were investigated—22 (38.60%)—with right hand affected, 9 patients (15.80%) with affected left hand, and 26 patients (45.60%) with bilateral involvement. In the last group, both hands were examined, i.e. 57 patients and 82 hands were examined.Conclusion: The combination of kinesitherapy with physical physiotherapy methods has a favorable effect on both subjective complaints and clinical symptoms as well as the extent of restoration of affected hand functions at the end of the physiotherapy course, this tendency being maintained for 4 to 8 months after physiotherapeutical treatment .The Boston Questionnaire is a reliable tool for diagnosing, processing, analyzing and evaluating the results of one or another type of CTS treatment.The segmental demyelination of the sensory and motor fibers of n. medianus in the initial stages resulting from its compression in the carpal canal is a reversible process. A comprehensive approach to CTS treatment, including early diagnosis and prevention, is a pledge to achieve success in mild and moderate forms of the syndrome, and competent and timely medical counseling is often of great importance for shortening recovery time, improving the function of the hand, quality of life of the patient and resulting in significant socioeconomic effects

Bulgarian physicians and nurses vs. electronic health records as a major issue of e-health

Introduction. Despite the numerous e-health applications, e-health cannot be implemented without the development and implementation of electronic health records (EHRs). The main barriers to the deployment of its systems are the lack of funding, infrastructure, capacity and legal framework, as well as the insufficient computer literacy of medical staff.Aim. The aim of this article is to assess the computer literacy of Bulgarian physicians and nurses, their attitude to e-health, especially EHRs as a major issue of e-health, including the ownership of medical data.Material and Methods. An enquiry comprising 33 questions is used. Respondents of the study are physicians and nurses from five regional and university hospitals in the North-eastern region of Bulgaria. Some of the results are compared to those of a study, carried out in 1999 among the physicians in Bulgaria. Several signs are discussed: self-evaluation of the experience in using computers, general attitude to eHealth, attitude to EHRs, including ownership of medical data.Results. The overall self-evaluation in using computers is 4.16 for physicians and 3.74 for nurses (max=6.00). The greatest need for additional training is in the use of statistical (47.98% of the physicians and 39.24% of the nurses) and specialized software (48.34% of the physicians and 49.65% of the nurses). Only 17.7% of the physicians and 14.89% of the nurses are familiar with the principles of e-health. Only 21.8% of the physicians and 25.8% of the nurses consider that the country is ready for the implementation of e-health. Almost all, 90.4% of the physicians and 82% of the nurses recognize the need for EHRs. About half of the physicians (46.1%) and 22.2% of the nurses would use an EHR system if they have adequate software. Physicians and nurses are not aware of what actually EHRs are. Most (74.5%) of the physicians and 69.3% of the nurses consider the implementation of personal health cards (presumably PHR), as a prerequisite for the implementation of e-health. The two preferred suggestions for the ownership of medical data are general practitioners (preferred by 28.3% of the physicians in 1999, 30.9% - in 2013, and 40.55% of the nurses) and the patient himself, preferred by 10.4% of the physicians in 1999, 29.38% - in 2013 and 26% of the nurses.Conclusions. Bulgarian physicians and nurses need additional education and training in using specialized, graphical and statistical software. The overall computer literacy of Bulgarian physicians and nurses is not adequate for the use of EHRs. They need additional education on the principles of eHealth, including EHRs, i.e. education in health informatics

Sleep disorders in shift workers

In the modern industrialized world, 24-hour service has become a necessity for public safety, healthcare and many other services. As a result of this, every one in five workers has working hours outside of the standard 9 AM to 5 PM. Part of them develop shift work disorder (SWD) – a condition caused by the disrupted circadian rhythm, which leads to insomnia and/or excessive sleepiness. These sleep disorders can be the reason for severe health problems, a lowered quality of life, and can hinder work performances.A survey about the sleep quality and a polysomnographic exam were conducted on 20 patients with shift work (15 doctors, 1 nurse, 1 bartender, 1 labourer and 1 IT specialist). The  age of the participants ranged from 28 to 53 years (M = 36.3) and the work experience on a shift schedule was from 3 to 15 years (M = 11.5). The survey and polysomnography results worsened with increase of years on a shift schedule

Autonomic cardiovascular disorders in stroke - electrocardiographic changes and risk of sudden cardiac death

Нарушенията на кардиоваскуларните автономни функции са често срещани при мозъчно-съдова болест, имат голямо клинично значение и са най-отчетливо проявени в острата фаза на инсулта. При пациенти с мозъчен инсулт се наблюдават електрокардиографски промени; повишава се честотата на ритъмните нарушения на сърцето, плазмените нива на катехоламините и сърдечните ензими. Вариабилността на сърдечната честота (ВСЧ) предсказва в по-голяма степен ранната, внезапна смъртност.Disturbances of cardiovascular autonomic function are common in patients with cerebrovascular disease (CVDs), have great clinical importance and are most clearly manifested in the acute phase of stroke. In patients experienced stroke are observed electrocardiographic (ECG) changes, increased frequency of heart rhythm disorders, plasma catecholamine levels and cardiac enzymes. Heart rate variability (HRV) shows higher risk of sudden cardiac death

Cortical regions connected with autonomic cardiovascular regulation

Violations of the autonomic nervous system are common in patients with cerebrovascular diseases and adversely affect the quality of life. The central autonomic network combines multiple reciprocally connected cortical, subcortical and stem structures. The insular cortex is involved in visceral motor and sensory regulation, including that of the cardiovascular system. Brain lesions including insula and other prefrontal cortical areas are particularly important in provoking arrhythmia. Stroke involving insular cortex is associated with poor prognosis. The right insular cortex plays a dominant role in modulating sympathetic tone and the left insular cortex in parasympathetic tone, which clinically correlates with more frequent arrhythmias and arrhythmic death after a stroke affecting the insula in the right hemisphere. The insular cortex is located in the middle cerebral artery and its structure is exposed to a high risk of injury

The effect of working conditions on cerebrovascular disease risk factors – a literature review

Cerebrovascular diseases are socially significant diseases the morbidity and mortality rates of which have increased in recent years, including in working age adults. Due to increased workplace requirements or the nature of the work process, many workers have extended working hours, work overtime, or work in shifts. It impairs their health through a multifaceted mechanism and increases their risk of cardiovascular, cerebrovascular and other diseases. Extended working hours and shift work increase the levels of occupational stress and chronic exposure leads to pathological changes, which may be risk factors for vascular diseases or worsen the control of such. Occupational stressors are a group of various workplace psychological, physical, and organizational failures which, combined with other family or socioeconomic stressors, impair the mental and physical health of the worker. Manual labourers most often exhibit harmful habits and decreased physical activity in their free time, which increases the risk of developing cerebrovascular disease. Overtime and shift work, despite contradictory data, are associated with the emergence of cerebrovascular disease risk factors. Their negative effect is most evident in patients with an already existing illness. Evidence is more definite about the negative effects of night-time work on hypertension, diabetes, obesity, metabolic syndrome, dyslipidemia. Night shifts disrupt the secretion of melatonin, feeding and circadian rhythm, all of which lead to metabolic changes. 

Occupational risk factors in the epidemiology of stroke

Introduction: Presently there are enough data and studies related to the significance of standard stroke risk factors. The occupational risk factors in the epidemiology of stroke remain poorly studied not only globally but in Bulgaria as well.Aim: The aim of this article is to study the role of occupational risk factors in the epidemiology of stroke.Materials and Methods: In the presented data we have analyzed all of the patients of at a working age, diagnosed with a stroke, treated in Second Neurological Clinic at St. Marina University Hospital, Varna, for a period of 6 months. All the patients have filled out a questionnaire in which, apart from the standard risk factors of a cerebrovascular disease, participants were also asked about their career, its potential harmful effects on their health and stress levels.Results: All of the patients (174 total), at a mean age of 54, were divided into two groups depending on the kind of work they do (mainly physical or mainly intellectual work) and the length of their work experience (10 or less years on the job or more than 10 years). The results showed that 78% of the patients with stroke had a job that was mainly physical. The patients with more than 10 years of work experience were 86.8% with ischemic stroke, of which 90.7%—with mainly mental work.Conclusion: Occupational risk factors have a role in the epidemiology and pathogenesis of strokes

Treatment options in late Parkinson's disease: decimeter wave therapy

Late stage Parkinson's disease (PD) is characterized by significant worsening of symptoms, motor fluctuations and decrease of effectiveness of drug therapy. Decimeter wave therapy (DWT) is one option to enlarge treatment strategy in late PD. We studied the effect of DWT in 12 patients (7 males), aged 65,83± 4,02 years, with 6,42± 1,51 years disease duration. Seven were at Hoehn-Yahr stage III and remaining 5 at stage IV. Mean UPDRS total score sum was 39,25± 1,91, and mean UPDRS part III sum was 24,67± 2,1. DMW was performed according to a standard protocol with apparatus Volna - 2, 10 consecutive procedures, once daily. Evaluation of UPDRS total and part III was performed on baseline, on days 11, 31 and 61. On day 11 all patients showed decrease in their both UPDRS total and part III. We lowered the levodopa doses of 6 patients in Hoehn-Yahr stage III with greatest decrease of UPDRS. On days 31 and 61 UPDRS total and part III were still lower. Our results demonstrate substantial effect of DWT on motor symptoms in late PD patients. All patients showed improvement, assessed by UPDRS, as the effect still lasted for 2 months after the physical therapy, even slightly diminished on day 61, compared to day 11. According to our results and patients subjective satisfaction reported, we could propose DWT become a part of the treatment strategy in late PD patients

AMYOTROPHIC LATERAL SCLEROSIS AND EFFECTS OF VIBRATIONS

Amyotrophic lateral sclerosis (ALS) is a severe and fatal neurodegenerative disorder affecting both the upper and lower motor neurons. We present the clinical cases of four patients with ALS and vibration syndrome. All patients had over 20 years of exposure to general and local vibrations and common subjective complaints: pain, paresthesia, twitching and weakness of limb muscles. Evidence of ALS syndrome was demonstrated by the abnormal neurological examination (pseudobulbar syndrome and pyramidal signs) as well as by neurophysiological studies (peripheral motor neuron degeneration). We discuss the possible relationship between the exposure to general and local vibrations and the ALS syndrome in our patients, and the role of vibrations as a possible risk factor for the disease. Occupational contact with chemicals and pesticides is also discussed as a risk factor

Cardiovascular autonomic dysfunction in acute stroke - Biochemical markers

Кардиоваскуларната автономна дисфункция след инсулт има голямо клинично значение, тъй като влошава прогнозата и може до доведе до внезапна ритъмна смърт. Повишената симпатикова активност след инсулт може да доведе до абнормности в ЕКГ, сърдечни аритмии и некроза на миокарда.Наред с проявите на метаболитна ацидоза се повишават плазмените нива на редица биохимични маркери- норепинефрин, епинефрин и допамин; сърдечни ензими и маркери:креатин киназата и креатин киназата -МВ, тропонин I и B-тип натриуретичен пептид.Повишените нива накатехоламинитесанай-ясно изразенипри пациенти с лезии в територията на дясна средна мозъчна артерия и са значимо по-високи по време на острата фаза на инсулт.Cardiovascular autonomic dysfunction after stroke has great clinical importance because worse prognosis and may lead to sudden arrhythmic death. Increased sympathetic activity after a stroke may lead to abnormalities in ECG, cardiac arrhythmias and myocardial necrosis. Along with the manifestations of metabolic acidosis increased plasma levels of several biochemical markers- norepinephrine, epinephrine and dopamine; cardiac enzymes and markers: creatine kinase and creatine kinase -MV, troponin I and B-type natriuretic peptide. Elevated levels of catecholamines are most pronounced in patients with lesions in the territory of the right middle cerebral artery, and were significantly higher during the acute phase of stroke