THE USE OF FITNESS WRIST BANDS IN CHRONIC PAIN PATIENTS – ADVANTAGES AND LIMITATIONS

Uvod: Tehnologija se sve više koristi za promicanje tjelesne aktivnosti (TA) i smanjenje sjedilačkog načina života u općoj populaciji, no upotreba nosive tehnologije u bolesnika s kroničnom boli (KB) još uvijek je rijetka. KB je globalni zdravstveni problem koji pogađa petinu svjetske populacije, s neizmjer-nim negativnim utjecajem na sve aspekte života bolesnika. TA je presudna za poboljšanje kvalitete živo-ta bolesnika s KB, no dugoročni ciljevi povećanja TA ipak uvelike ovise o percepciji boli, stvarnom ili predviđenom pogoršanju boli i nedostatku samopouzdanja za vrijeme TA. Ova studija želi utvrditi u-činkovitost, motivacijske mogućnosti i ograničenja Fitbit 2 fitness narukvice koja je korištena za praće-nje TA i obrasca spavanja kod pacijenata s KB koji su uključeni u četverotjedni multidisciplinarni pro-gram liječenja KB. Ispitanici i metode: Analiza je provedena na podacima za 41 od 42 bolesnika koji su završili program (podaci za jednog bolesnika nisu dostupni). Usporedili su se obrasci TA i spavanja bolesnika tijekom intervencije (0-4 tjedna) s podacima dobivenim 4 tjedana nakon završetka intervencije (4-8 tjedana). Fitness narukvice prikupile su sljedeće podatke: broj dana TA, prosječno dnevno vrijeme trajanja TA, prosječni broj koraka dnevno, prosječno vrijeme dubokog sna dnevno, prosječno vrijeme provedeno budno na dan, broj buđenja tijekom noći. Ti su podaci povezani s antropometrijskim mjerenjima pacije-nata. Protokol je dostupan u registru kliničkih istraživanja (NCT 03837080). Rezultati: Povećao se broj koraka i prosječno vrijeme TA dnevno, kao i vrijeme dubokog spavanja dne-vno, ali bez postizanja statističke važnosti. Međutim, uočeno je nekoliko prednosti: pacijenti dobivaju aktivnu ulogu u upravljanju KB-om pri čemu narukvice djeluje motivirajuće, potiču postavljanje ciljeva u TA, konkurenciju s drugim pacijentima i socijalnu podršku unutar KB skupine, a u klini-čkim/istraživačkim uvjetima pružaju bolji, kontinuirani nadzor nad TA i obrascima spavanja pacijenata koji su vrlo korisni za promjenu ponašanja i individualizirane edukacijske strategije. Ipak, narukvice imaju nekoliko nedostataka. Prvo, zahtijevaju mobilnu aplikaciju i osnovno znanje o tome kako koristiti pametni telefon (prosječna dob pacijenata je 55,6±12,5 godina), pojava iznenadne neispravnosti uređaja (2 od 16) i/ili softvera (2 od 16). Također, uočene su razne prepreke na individualnoj osnovi (tj. demo-grafija, psihosocijalni faktori, nedostatak motivacije) koje mogu biti razlog koji ne ide u prilog korište-nju narukvica. Pored toga, utvrđeno je značajno smanjenje opsega struka, omjera struk-bokovi i omjera struk-visina u pacijenata koji su imali dulje vrijeme dubokog sna. Ovi rezultati potvrđuju ulogu sna na stanje uhranje-nosti i metaboličke rizike. Zaključci: Pokazalo se da su fitness narukvice prikladne za promicanje TA kod bolesnika s KB, no uz ograničenja koja su poglavito povezana s neophodnom osnovnom informatičkom pismenošću.Introduction: Technology is increasingly used to promote physical activity (PA) and reduce sedentary behaviour in the general population, but the possibility of using it to support PA in chronic pain (CP) patients is still sparse. CP is a global health concern affecting fifth of the global population, with im-mense adverse impact on all aspects of a patient’s life. PA is crucial for improving quality of life of CP patients. However, long-term PA goals widely depend on pain perception, actual or anticipated pain exacerbation, and lack of confidence when doing PA. This study aims to determine effectiveness, mo-tivating opportunities and limitations of Fitbit 2 fitness bands used to measure PA and sleep pattern in CP patients enrolled in the 4-week CP management programme. Participants and Methods: Out of 42 CP patients who completed the programme, the analysis was performed on the data for 41 patients (one patient had no data). We compared PA and sleep pattern of CP patients between the intervention (0-4 weeks) and follow-up (4-8 weeks). Wrist band collected the following data: number of days of the activity measured, average time of activity per day, average steps per day, average deep sleep time per day, average time spent awake per day, number of wakening per day. These data were correlated to patients’ anthropometric measurements. Full protocol is available in the Clinical Trials Registry (NCT 03837080). Results: The number of steps and average time of activity per day increased, as well as deep sleep time per day but without reaching statistical significance. However, we observed several advantages: pa-tients are getting active role in their CP management which is self-motivating, encourages goal-setting, competition and social support within the CP group, and in clinical/research setting bands provide bet-ter, continuous oversight of patient’s PA and sleeping patterns which are very useful for behavioural change and individualized educational strategies. Still, wrist bands have several disadvantages. Firstly, they require a mobile app and some knowledge of how to use a smart phone (patients’ mean age is 55.6 ± 12.5 years). Sudden malfunction of the band (2 out of 16) and/or the software (2 out of 16). Also, various obstacles on an individual basis (i.e., demographics, psychosocial factors, lack of motivation) might be a reason not in favour of the band. In addition, we found significant improvement in waist circumference and waist-to-hip ratio and waist-to-height ratio were found in CP patients with longer deep sleep time. These results confirm the role of sleep on state of nourishment and metabolic risks. Conclusion: Fitness bands were found to be suitable for the promotion of PA in CP patients, but re-strictions apply, mainly due to required IT literacy

Perkutana laserska dekompresija diska zbog lumbalne radikularne boli: sistemski pregled PubMeda zadnjih pet godina

The most common causes of lumbar radicular pain are pathological changes in the intervertebral disc. Lumbar disc herniation (LDH) is the most common cause of lumbosacral radicular syndrome. It affects 1-2% of the general population, burdening health services and the economy worldwide. Excessive scar tissue after lumbar microdiscectomy can increase postoperative pain. Postoperative fibrosis is one of the most important causes of failed back surgery syndrome after lumbar disc surgery. Percutaneous laser disc decompression (PLDD) is a minimally invasive procedure in which thermal energy produced by a LASER probe is used to reduce the intervertebral disc herniation located within the annulus fibrosus. Evaporation of a small volume in a closed hydraulic space (nucleus pulposus) leads to decreased intradiscal pressure. It causes a thermal “shrinkage effect” with the retreat of the herniated disc and the decompression of the nerve root, which reduces lumbar radicular pain. Previous research has shown effective reduction of pain after PLDD and only a small number of complications of the procedure itself. PLDD is a safe and effective procedure in well-selected patients. Unfortunately, there is still a need for extensive, randomized prospective studies on PLDD in lumbar radicular pain in order to confirm or dispute the results obtained so far.Najčešći uzrok lumbalne radikularne boli su patološke promjene intervertebralnog diska. Lumbalna diskus hernija (LDH) je najčešći uzrok lumbosakralnog radikularnog sindroma i pogađa 1-2% opće populacije, stavljajući značajan teret na zdravstvene usluge i gospodarstvo u cijelom svijetu. Prekomjerna količina ožiljnog tkiva nakon lumbalne mikrodiscektomije može povećati postoperativnu bol. Postoperativna fibroza je jedan od najvažnijih uzroka sindroma neuspjele operacije leđa nakon operacije lumbalnog diska. Perkutana laserska dekompresija diska (PLDD) je vrsta minimalno invazivnog zahvata u kojem se toplinska energija proizvedena LASER sondom koristi za smanjenje hernije interverterbralnog diska koja se nalazi unutar fibroznog prstena. Isparavanje malog volumena u zatvorenom hidrauličkom prostoru (nucleus pulposus) dovodi do smanjenja intradiskalnog tlaka i implicira termički „učinak skupljanja“ sa povlačenjem hernije diska i dekompresiju živčanog korijena što ima za posljedicu smanjenja lumbalne radikularne boli. Dosadašnja istraživanja pokazala su učinkovito smanjenje boli poslije PLDD, te mali broj komplikacija samog zahvata. PLDD je siguran i djelotvoran zahvat kod dobro probranih bolesnika. Nažalost, ne postoje još velike, randomizirane prospektivne studije iz PLDD kod lumbalne radikularne boli, te su navedena istraživanja potrebna u budućnosti kako bi potvrdila ili osporila dosadašnje rezultate

Peritoneal exudate cells from long-lived rats exhibit increased IL-10/IL-1 beta expression ratio and preserved NO/urea ratio following LPS-stimulation in vitro

In humans, usual aging, differently from successful aging, is associated with deregulation of proinflammatory/anti-inflammatory cytokine balance. The corresponding data from rat studies are limited. Therefore, we examined (i) cytokine messenger RNA (mRNA) profile of fresh peritoneal cells from 6-(adult), 24-(old), and 31-month-old (long-lived) AO rats and (ii) proinflammatory (IL-1 beta and IL-6) and antiinflammatory (IL-10) cytokine, NO, and urea production in their LPS-stimulated cultures. Comparing with adult rats, cells from old ones expressed lower amount of TNF-alpha and IL-6 mRNAs, but greater amount of IL-1 beta mRNA. On the other hand, cells fromlong-lived rats exhibited a dramatic increase in IL-10 mRNA expression followed by diminished TNF-alpha and IL-6 mRNA expression, and comparable expression of IL-1 beta mRNA relative to adult rats. Consequently, IL-10/IL-1 beta mRNA ratio was greater in cells from long-lived rats than in adult and old rats. In LPS-stimulated peritoneal cell cultures (contained = 95 % macrophages) from old rats, concentration of common proinflammatory cytokines was higher than in those from adult rats. Comparing with adult and old rats, in LPS-stimulated macrophage cultures from long-lived rats, TNF-alpha and IL-6 concentrations were lower; IL-1 beta concentration was comparable or greater (in respect to adult rats), whereas that of IL-10 was strikingly higher. Consistently, in macrophage cultures from long-lived rats, NO (iNOS activity marker)/urea (arginase activity marker) ratio was less and not different from that in old and adult rats, respectively. The study suggests that macrophages from longlived rats, differently from those of old ones, have substantial ability to limit proinflammatory mediator production, which may contribute to their longevity

Serratus anterior plane blok za analgeziju kod mastektomije

The incidence of breast cancer in women is on the rise, but the survival rate has increased due to the progress of medicine, especially if the disease is detected early. One of the imperatives is the patient’s quality of life after treatment. Inadequately treated acute postoperative pain leads to a worse treatment outcome and the development of chronic pain. The incidence of chronic pain after surgical treatment of breast cancer is high and negatively affects the quality of life of patients in the long term. Serratus anterior plane block (SAPB) is a relatively new ultrasound-guided regional analgesia technique. SAPB represents an alternative to an epidural, and to paravertebral and intercostal blocks. This review aims to describe serratus anterior plane block for breast surgery and emphasize their short- and long-term benefit. For this review, we searched MEDLINE in November 2022 to identify metanalyses, randomized controlled trial systemic reviews, and reviews published in the last five years. The search for metanalyses yielded 4 results; 12 results were found for randomized controlled trials; 5 results for reviews; and 4 results for systematic reviews. When employing SAPB in patients after mastectomy, good analgesia is achieved in the early postoperative period and the incidence of chronic pain is reduced, thus improving quality of life.Incidencija karcinoma dojke kod žena je u porastu ali napretkom liječenja povećana je stopa preživljena naročito ako se bolest otkrije u ranom stadiju. Jedan od imperativa je kvaliteta života bolesnice nakon liječenja. Neadekvatno liječena akutna poslijeoperacijska bol dovodi do lošijeg ishoda liječenja i razvoja kronične boli. Incidencija kronične boli nakon operativnog liječenja karcinoma dojke je visoka i dugoročno negativno utječe na kvalitetu života bolesnica. Serratus anterior plane block (SAPB) je relativno nova ultrazvukom vođena tehnika regionalne analgezije a predstavlja alternativu epiduralnim, paravertebralnim i interkostalnim blokovima.Cilj ovog pregleda je opisati serratus anterior plane block za mastektomiju i naglasiti njegovu kratkoročnu i dugoročnu korist. Za potrebe ovog rada proveli smo pretragu MEDLINE baze do studenog 2022. kako bismo identificirali meta-analize, sistemske preglede, randomizirana kontrolirana ispitivanja i preglede objavljene u posljednjih pet godina. Pretraživanjem meta-analiza dobili smo 4 rezultata, za randomizirano kontrolirano ispitivanje 12 rezultata, za preglede 5 rezultata i za sustavni pregled 4 rezultata. Primjenom SAPB kod bolesnica nakon mastektomije postiže se dobra analgezija u ranom poslijeoperacijskom periodu te se smanjuje pojavnost kronične boli i na taj način poboljšava se kvaliteta života

Impact of depression on gait variability in Parkinson's disease

Objective The goal of this study was to analyze how depression associated with Parkinson’s disease (PD) affected gait variability in these patients using a dual-task paradigm. Additionally, the dependency of the executive functions and the impact of depression on gait variability were analyzed. Patients and Methods Three subject groups were included: patients with PD, but no depression (PD-NonDep; 14 patients), patients with both PD and depression (PD-Dep; 16 patients) and healthy controls (HC; 15 subjects). Gait was recorded using the wireless sensors. The participants walked under four conditions: single-task, motor dual- task, cognitive dual-task, and combined dual-task. Variability of stride length, stride duration, and swing time was calculated and analyzed using the statistical methods. Results Variability of stride duration and stride length were not significantly different between PD-Dep and PD-NonDep patients. The linear mixed model showed that swing time variability was statistically significantly higher in PD-Dep patients compared to controls (p = 0.001). Hamilton Disease Rating Scale scores were significantly correlated with the swing time variability (p = 0.01). Variability of all three parameters of gait was significantly higher while performing combined or cognitive task and this effect was more pronounced in PD-Dep group of patients. Conclusions Depression in PD was associated with swing time variability, and this effect was more prominent while performing a dual-task. Significance Diagnosing and treating depression might be important for gait improvement and fall reduction in PD patients

Klinička primena fibrinske membrane u lečenju recesija gingive

Introduction. Fibrin, fibronectin, platelet derived growth factor, and transforming growth factors from platelet concetrate are crucial for tissue reparation and regeneration. Objective. This study was designed to evaluate clinical effectiveness of activated platelet-rich fibrin (PRF) membrane in treatment of gingival recession. Methods. 19 gingival recessions Miller class I or II were treated with a coronally advanced flap and the PRF membrane (PRF group). Following the elevation of the flap, bone and root surfaces were covered with the PRF membrane. After suturing, the PRF membrane was covered with a coronally advanced flap. In the same patients, 19 other gingival recessions were treated with CTG in combination with the coronally advanced flap (the CTG group). Clinical recordings were made of vertical recession depth (VRD), probing depth (PD), clinical attachment level (CAL) and keratinized tissue width (KTW) before and 12 months after mucogingival surgical treatment. Clinical evaluation of healing events was estimated with recordings of the healing index (HI). Recordings of HI were performed in the 1st, 2nd and 3rd week post-surgically. Results. Mean root coverage was significant in both groups (the PRF group 79.94% and the CTG group 88.56% %; p lt 0.01). The difference between the two tested groups was not statistically significant. Results of the keratinized tissue width showed significant increase (p lt 0.05) 12 months after the surgery in both, the PRF and CTG groups. Results of KTW showed statistical significance of recorded differences obtained in the two evaluated groups (p lt 0.05). There was no statistical significance in reduction of PD and CAL recorded in the PRF and CTG groups. The values of HI recorded in the 1st and 2nd week postoperatively were significantly enhanced in the PRF group (p lt 0.05). Conclusion. Results of this study confirm both procedures as effective with equivalence of clinical results in solving gingival recession problems. The utilization of the PRF resulted in a decreased postoperative discomfort and advanced tissue healing.Uvod. Fibrin, fibronektin, faktor rasta poreklom iz trombocita i transformišući faktor rasta imaju presudnu ulogu u regeneraciji i reparaciji tkiva. Cilj rada. Ispitati i utvrditi značaj primene membrane od fibrina bogatog trombocitima (engl. plateletrich fibrin - PRF) u lečenju recesija gingive. Metode rada. Devetnaest obostranih gingivalnih recesija klase I ili II po Mileru lečeno je sa dva različita terapijska modaliteta. U eksperimentalnoj grupi recesija je, nakon odizanja mukoperiostnog režnja, preko izložene alveolarne kosti i korena zuba postavljena PRF membrana kao augmentacioni materijal, koja je zatim pokrivena koronarno pomerenim režnjem. U kontrolnoj grupi su izložena alveolarna kost i koren zuba prekriveni transplantatom vezivnog tkiva (TVT) uz koronarno pomereni režanj. Kod obe grupe recesija posmatrani su sledeći parametri: veličina recesije gingive, širina keratinizovane gingive, nivo pripojnog epitela i dubina sondiranja. Parametri su mereni neposredno pre hirurškog zahvata i 12 meseci kasnije. Zabeležen je i indeks zarastanja rane tokom prve tri nedelje posle operacije. Rezultati. Kod obe grupe recesija postignuto je značajno prekrivanje ogoljenog korena zuba (PRF membrana 79,94% i TVT 88,56%; p lt 0,01), dok između dve ispitivane grupe nije uočena statistički značajna razlika. Rezultati ispitivanja širine keratinizovane gingive su pokazali značajno povećanje u obe ispitivane grupe dvanaest meseci nakon hirurškog lečenja (p lt 0,05). Takođe je uočena statistički značajna razlika između posmatranih grupa (p lt 0,05) kod parametra širina keratinizovane gingive. Statističke značajnosti kada je reč o smanjenju nivoa pripojnog epitela i dubine sondiranja, kako u okviru grupa, tako i između obe ispitivane grupe (p>0,05), nije bilo. Merenjem indeksa zarastanja rane uočeni su značajno bolji rezultati u eksperimentalnoj grupi nakon prve i druge nedelje nego u kontrolnoj (p lt 0,05). Zaključak. Oba postupka pokazala su se adekvatnim u lečenju gingivalnih recesija. U kontrolnoj grupi bili su bolji rezultati u dobitku keratinizovanog tkiva, dok se eksperimentalna procedura pokazala jednostavnijom i komfornijom za samog bolesnika, uz značajno bolji postoperacioni tok

Catastrophizing, Anxiety, and Depression in Patients with Chronic Non-Malignant Pain

Cilj ovog istraživanja bio je utvrditi razinu anksioznosti i depresivnosti te intenziteta boli kod pacijenata s kroničnom nemalignom boli, povezanost katastrofizacije s navedenim faktorima te djelovanje multidisciplinarnoga programa za liječenje kronične boli na razinu katastrofizacije, anksioznosti, depresivnosti i intenzitet boli. Istraživanje je provedeno na uzorku od 44 sudionika od 32 do 80 godina koji su sudjelovali u multidisciplinarnom programu za liječenje kronične boli Zavoda za liječenje boli KBC-a Osijek. Intenzitet boli mjeren je vizualno-analognom skalom VAS (eng. Visual- -Analog Scale), za mjerenje anksioznosti i depresivnosti uzeta je Skala depresivnosti, anksioznosti i stresa DASS-21 (eng. The Depression Anxiety Scale), dok je katastrofizacija mjerena Skalom katastrofizacije boli PCS (eng. The Pain Catastrophizing Scale). Utvrđeno je postojanje umjerene pozitivne povezanosti između anksioznosti, depresivnosti i intenziteta boli kod pacijenata s kroničnom nemalignom boli, pozitivne povezanosti između anksioznosti, depresivnosti, intenziteta boli i faktora katastrofizacije te smanjenje anksioznosti, depresivnosti, intenziteta boli i katastrofizacije na kraju multidisciplinarnoga programa za liječenje kronične boli.The aim of this study was to determine the level of anxiety and depression and the intensity of pain in patients with chronic non-malignant pain, the correlation of catastrophizing with these factors, and the interaction of a multidisciplinary program for the treatment of chronic pain and the level of catastrophizing, anxiety, depression and pain intensity. The study was conducted on a sample of 44 participants aged 32 to 80 years who participated in the multidisciplinary program for chronic pain management at the Institute for Pain Management of the Clinical Medical Center Osijek. Pain intensity was measured using the Visual Analog Scale (VAS); the Depression, Anxiety and Stress Scale (DASS-21) was used to measure anxiety and depression; while catastrophizing was measured using the Pain Catastrophizing Scale (PCS). There was a moderate positive correlation between anxiety, depression, and pain intensity in patients with chronic non-malignant pain; a positive correlation between anxiety, depression, pain intensity, and catastrophic factors; and a reduction of anxiety, depression, pain intensity and catastrophization at the end of a multidisciplinary chronic pain treatment program. The findings contribute to a better understanding of the relation between emotional distress, cognitions and pain intensity in patients with chronic non-malignant pain

The coronally advanced flap in combination with platelet-rich fibrin (PRF) and enamel matrix derivative in the treatment of gingival recession: a comparative study.

The main objective of this study was to evaluate the clinical effectiveness of platelet-rich fibrin membrane used in combination with a coronally advanced flap (CAF) and to compare it with the use of an enamel matrix derivative (EMD) in combination with a coronally advanced flap in gingival recession treatment. 20 split-mouth cases of maxillary anterior teeth or bicuspids presenting with Miller Class I or II gingival recession were treated with a CAF combined with a platelet-rich fibrin membrane (PRF group) or with EMD (EMD group) placed under a CAF. The following parameters were measured at baseline and at 12 months post treatment: gingival recession (GR), apicocoronal width of the keratinized tissue (WKT), and probing depth (PD). Complete rot coverage in the PRF group was 65% (13 out of 20 recessions) and 60% in the EMD group (12 out of 20 recessions). GR was 4.10 ± 1.05 mm in the PRF group and 3.90 ± 1.00 mm in the EMD group at baseline, and 1.05 ± 0.45 mm in the PRF group and 1.15 ± 0.65 mm in the EMD group at 12 months. The difference observed between the tow groups at 12 months was statistically significant. Average root coverage was 70.5% in the EMD group and 72.1% in the PRF group. WKT was 1.30 ± 0.56 mm in the EMD group and 1.45 ± 0.86 mm in the PRF group at baseline, and 1.90 ± 0.81 mm in the EMD group and 1.62 ± 0.28 mm in the PRF group at 12 months. The difference observed between the two groups at 12 months was not statistically significant. Twelve-month changes in PD were not significantly different between the two groups. The pain intensity was statistically different between the two groups. The pain intensity was statistically different between groups for the first 5 days, favoring the PRF group. The present study did not succeed in demonstrating any clinical advantage of the use of PRF compared to EMD in the coverage of gingival recession with the CAF procedure. The EMD group showed a higher success rate in increasing WKT than did the PRF group

FIZIOTERAPIJA U MULTIMODALNOM I MULTIDISCIPLINARNOM PRISTUPU LIJEČENJA KRONIČNE KRIŽOBOLJE

Uvod: Križobolja velikom broju kliničara zbog svoje kompleksnosti predstavlja izazov. Cilj ovog rada bio je analiza učinaka fizioterapijskih postupaka u multidisciplinarnom i multimodalnom pristupu u liječenja kronične križobolje. Metode: Podaci su prikupljeni fizioterapijskom procjenom funkcionalno motoričkih testova i vrijednosti dobivenih primjenom numeričke ljestvice procjene boli. Istraživanje je provedeno na uzorku od 105 ispitanika (N=105). Rezultati: Rezultati ukazuju na postojanje statistički značajnog poboljšanja rezultata funkcionalno motoričkih testova i statistički značajnog smanjenja intenziteta boli na numeričkoj ljestvici boli. Zaključak: Multimodalni i multidisciplinaran pristup u liječenju kronične križobolje može poboljšati funkcionalne sposobnosti te smanjiti intenzitet boli