Background: Knee osteoarthritis (KOA) is a degenerative joint disorder characterized by chronic pain, functional limitation, and low-grade inflammation. While platelet-rich plasma (PRP) has gained traction as a biologic therapy, the relationship between short-term clinical outcomes and systemic inflammatory biomarker dynamics remains poorly understood in routine clinical settings. Methods: This prospective observational study evaluated 40 patients with grade 2–3 KOA receiving a single ultrasound-guided intra-articular PRP injection. Clinical outcomes via the Visual Analog Scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 (SF-36), alongside serum inflammatory markers (IL-1β, IL-8, IL-18, TNF-α, erythrocyte sedimentation rate, and C-reactive protein), were assessed at baseline and 4 weeks post-injection using paired tests and multivariable regression. Results: At 4 weeks, clinical scores improved significantly (all p < 0.001). Circulating IL-8 and TNF-α levels decreased significantly (p = 0.009 and p = 0.014, respectively), whereas IL-1β and IL-18 variations were non-significant. Baseline cytokines did not predict clinical outcomes, but a significant association emerged between ΔIL-18 and ΔWOMAC (p = 0.032). Conclusions: A single intra-articular PRP injection was associated with short-term clinical improvements and selected reductions in circulating IL-8 and TNF-α, although the clinical significance of these biomarker changes remains uncertain. Given the observational design and short follow-up, these preliminary findings require confirmation in larger controlled trials.

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease of un-known aetiology. There are many biomarkers described in the literature that can have an altered value in AS, although there are some biomarkers that are not as intensively studied, such as IGF-1. The main objective of this study is to monitor the therapeutic ef-fects of a complex rehabilitation protocol on functional scales (ASDAS, BASDAI, BASMI, BASFI, SF-36) related to disease activity, pain, mobility, functionality and quality of life of these patients, as well as on serum markers such as platelets, lymphocytes, RDW, PLR, blood glucose, ESR, CRP and IGF-1. The study was carried out at Balneal and Rehabilita-tion Sanatorium of Techirghiol, on 25 patients suffering from ankylosing spondylitis dur-ing a 2 week course of treatment. The patients were assessed at two time intervals, at the beginning and at the end of the treament. The study showed statistically significant changes for BASFI score and in a limited number subscales of the SF-36 questionnaire. The analysed serum biomarkers, although some of them showed positive changes, overall there were no statistically significant changes.This study shows objectively measured im-provements in patients' health status, which shows the impact of combined rehabilitation treatment. More studies are needed on the effects of balneotherapy on patients with anky-losing spondylitis, on larger groups of patients, with longer follow-up periods and better validity. The effects of different types of therapeutic waters and different types of mud could also be studied to form a broader perspective.

Background and Objectives: Despite their high prevalence, sarcopenia and sarcopenic obesity remain underdiagnosed worldwide, significantly impacting the health and quality of life of aging individuals. Due to their multifactorial nature, the current management strategies do not address their underlying pathogenesis. This systematic review aims to identify single-nucleotide polymorphisms (SNPs) associated with sarcopenia and/or sarcopenic obesity in humans. Materials and Methods. This systematic literature review followed the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines and the protocol registered in PROSPERO. Extensive research was performed in six databases (PubMed, Web of Science, Cochrane Library, Scopus, ScienceDirect, and SpringerLink) using keywords such as “sarcopenia”, “sarcopenic obesity”, “single nucleotide polymorphisms”, “SNPs”, and “genetic variants”. The Q-Genie and ROBINS-E tools were utilized to assess the quality of the included studies. Results: The final analysis included 12 studies, which were classified as good-quality according to the Q-Genie assessment and indicated a low to moderate risk of bias according to the ROBINS-E evaluation, collectively identifying 43 SNPs significantly associated with sarcopenia or sarcopenic obesity. Specifically, 24 SNPs were linked to sarcopenia, while 19 were associated with sarcopenic obesity. Conclusions: Understanding the implications of SNPs provides valuable insights into individual susceptibility and the variability observed across populations, potentially leading to more targeted and effective diagnostic and treatment strategies. Advancing clinical practice requires ongoing research into the genetic aspects of sarcopenia and sarcopenic obesity.

Metabolic syndrome (MS) comprises a set of metabolic irregularities that elevate the risk of cardiovascular conditions and diabetes. The essential characteristic components are: high blood pressure and high triglyceride levels, low HDL cholesterol levels, hyperglycemia and obesity (particularly central adiposity). MS represents a major public health challenge and current intervention methods have limitations in effectiveness and long-term adherence. Intermittent hypoxia-hyperoxia therapy (IHHT) is an innovative method that involves controlled and alternating exposure to hypoxia and hyperoxia. This technique mimics the effects of altitude training and stimulates the body's adaptive mechanisms, contributing to improved mitochondrial function, increased oxidative capacity and the regulation of metabolic processes. According to the literature, IHHT is an innovative method that causes significant changes in the parameters studied in patients with MS. Body composition plays an important role in maintaining health. It is affected by multiple factors: environmental conditions, genetics and lifestyle choices. Body composition assessment is essential for evaluating nutritional status, identifying risks associated with conditions such as MS and monitoring progress during dietary and lifestyle interventions. A randomized controlled trial was carried out with 40 participants diagnosed with MS, who were split into two groups. The intervention group, consisting of 20 participants, underwent intermittent hypoxia-hyperoxia therapy (IHHT), while the control group, also with 20 participants, received a placebo therapy. The study aimed to evaluate whether IHHT could positively affect body composition. The study found no significant differences between the groups regarding the analyzed parameters. However, both groups showed progress, highlighting the relevance of medical rehabilitation, even without a notable impact of IHHT. The study results suggest that medical rehabilitation can benefit body composition in patients with MS, even without the additional contribution of IHHT. The study highlights that improvements in body composition can be influenced by factors such as discipline and active participation of patients in rehabilitation programs, emphasizing the importance of constant involvement in the medical rehabilitation process as a key factor for achieving desired outcomes. However, the lack of clear results in improving body composition could be attributed to factors such as the relatively short duration of the intervention, the small size of the study groups, or the influence of the placebo effect on patients' perceptions.

Abstract Vitamin deficiencies are a common problem worldwide, and vitamin B12 deficiency has been identified as a health concern for nearly a century. People all over the world are frequently deficient in vitamin B12. A number of 30–50% of patients with cobalamin deficiency a kind of neurological involvement, for example neuropathy, myelopathy, dementia or optic neuropathy. We present the case of a 56 years old female patient, who suddenly developed gait difficulty due to motor deficit in the lower limbs. After hospitalization in the neurology ward and specialized investigations, thoracic myelitis and axonal sensorimotor polyneuropathy due to vitamin B12 deficiency are diagnosed. The patient underwent functional evaluation at Techirghiol Rehabilitation Sanatorium, where she received individualized treatment for her motor deficit. Despite longstanding recognition of vitamin B12 deficiency, accurately diagnosing the condition and determining the most appropriate management strategy remain challenging.

Sarcopenia and sarcopenic obesity are conditions that are underdiagnosed in medical practice. Given their significant impact on quality of life with advancing age, identifying these disorders and their underlying causes, as well as developing targeted intervention strategies, are major areas of interest in current medical research. Investigating single nucleotide polymorphisms (SNPs) associated with these conditions, particularly in patients admitted to rehabilitation units, may open new avenues for diagnosis, prevention and treatment. This study conducts a rigorous review of the literature to evaluate the relationship between polymorphisms, sarcopenia and sarcopenic obesity, while also examining how the response to rehabilitation treatment may vary. Three polymorphisms were studied as having a significant influence on sarcopenia and sarcopenic obesity through their involvement in specific functional pathways. Among these, one polymorphism has been extensively studied in relation to medical rehabilitation, with notable associations observed between genotype and treatment response. Implementing screening for sarcopenia and sarcopenic obesity, along with genetic polymorphism analysis, represents a promising research direction. The findings of this preliminary study make a meaningful contribution to the current medical literature and may support the development of personalized rehabilitation interventions for affected patients.

In examining the treatment options of coxo-femoral osteoarthritis (also known as coxarthrosis), rehabilitation treatment using balneo-physical therapy could be a beneficial alternative to traditional medication. Hip osteoarthritis is characterized by chronic debilitating pain that significantly impacts patients' quality-of-life, particularly as the condition progresses, limiting daily activities that require weight-bearing or upright posture. Traditional pharmacological treatments often address only the symptoms of pain without enhancing joint functionality; they may also pose risks of cardiovascular or gastrointestinal complications. The study group was made up by patients who were radiographically diagnosed with hip osteoarthritis, and who’s other joint attainments, in any, didn’t have an impact on functionality of quality of life. They all received treatments with sapropelic mud and salt water from Techirghiol Lake in addition to physical therapies. Hip pain, functionality and its impact on the quality of life were assessed with specific instruments and forms at admission, at discharge and 1 month follow-up. 73% of the patients were female, and more than half of the total number were within the 60-69 age group. A great positive impact of the treatment was objectified with sensible pain alleviation after treatment and at 1 month follow-up with increased joint mobility and with a general overall positive impact on the quality of life. The study revealed that balneo-physical therapy has a clear, demonstrated impact on the condition of patients with hip osteoarthritis, in terms of pain, mobility, function, and most importantly, activities and perception of overall health status, and is a viable, if not even preferable, treatment of hip osteoarthritis effect.

Abstract Introduction: With multiple indications in both cardiovascular and non-cardiovascular diseases, beta-blockers exert complex effects on the cardiovascular system and energy metabolism, potentially impacting functional performance in medical rehabilitation programs. While their efficacy in controlling cardiac function is well-documented, the literature reports inconsistent results regarding the effects of this drug class on metabolic parameters and exercise tolerance. In the context of medical rehabilitation, these aspects justify the evaluation of the potential impact of beta-blockers on functional response. Materials and Methods: The study had a prospective design and included 320 patients hospitalized between January and December 2025 at the Techirghiol Balneary and Rehabilitation Sanatorium. The antihypertensive medication used was analyzed, with patients grouped based on the administration of beta-blockers or other classes of antihypertensive drugs. Clinical observations regarding exercise tolerance were noted according to the timing of beta-blocker medication administration. Body Mass Index (BMI) was calculated to compare the weight status between groups. Functional evaluation was performed at the beginning and at the end of the rehabilitation program using the Visual Analog Scale (VAS) and the Six-Minute Walk Test (6MWT). Results: Of the included patients, 179 were under treatment with beta-blockers, with metoprolol being the predominantly used active substance. In this group, 72% had BMI values above 25 kg/m², with a gender distribution of 59.7% females and 40.3% males. Comparative analysis revealed higher average BMI values in women treated with beta-blockers compared to those receiving other classes of antihypertensive drugs. Dynamic evaluation indicated a more limited functional improvement in the group of patients treated with beta-blockers. Conclusion: Differences were observed between patients treated with beta-blockers and those treated with other classes of antihypertensive drugs regarding metabolic and functional parameters. These findings highlight the importance of considering antihypertensive therapy and monitoring exercise tolerance in the context of medical rehabilitation programs.

Background and Objectives: Parkinson’s disease is the second most common neurodegenerative disorder after Alzheimer’s disease, and its incidence increases with age, being particularly high in people over 70 years of age. For patients with this condition, medical rehabilitation can have a profound impact, helping to improve mobility, preserve functional autonomy, and enhance quality of life. Focal vibration stimulation is a promising, well-tolerated, and easy-to-apply method with potential to facilitate motor activity and support the motor learning process, making it also useful in gait reeducation for patients with various neurological conditions. This systematic review aims to analyze the existing scientific evidence on the effectiveness of focal muscle vibration therapy in managing symptoms of Parkinson’s disease. Materials and Methods: This systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the protocol was registered in PROSPERO under the protocol registration number CRD420251120737. Searches were conducted in five databases (PubMed, PEDro, ScienceDirect, Cochrane Library, Web of Science). The selection criteria targeted original clinical studies, published in English between 2010 and the present, that investigated focal muscle vibration therapy in patients with Parkinson’s disease and were fully available, excluding review papers, meta-analyses, books, and articles inaccessible in full text. Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess the quality of the included studies. Results: The results of the studies were interpreted individually for each study, and the main information was synthesized in a comparative table to facilitate analysis. The final analysis included five studies that investigated the effects of focal muscle vibration in patients with Parkinson’s disease. The results suggest that this form of stimulation may offer benefits for patients with gait disorders, improving balance and stability. Among the study’s limitations are the small number of included articles (n = 5) and the restriction to English-language publications, which may limit the applicability of the results. Conclusions: Given the promising results, focal muscle vibration therapy could represent a useful option in the management of Parkinson’s disease. Integrating this method into rehabilitation plans could bring significant functional benefits, but further studies are needed to confirm its long-term effectiveness and to establish standardized application protocols. No external funding was received for the conduct of this review.

Multiple sclerosis (MS) is a chronic inflammatory disorder with an unpredictable progression that affects the central nervous system and has significant emotional, social, and professional implications. The therapeutic approach is multifactorial and requires complex management coordinated by a specialized, multidisciplinary team over the long term. Current non-pharmacological treatment strategies under study, which may improve the course of the disease, focus on the gut microbiome and include the administration of probiotics and fecal transplantation. This study presents a case of secondary progressive multiple sclerosis in a young patient, with rapidly progressive evolution despite ongoing background therapy. The study analyzed literature data regarding both medical rehabilitation programs used in secondary progressive multiple sclerosis and other therapeutic strategies that can improve the quality of life. Medical rehabilitation has no proven impact on disease progression but can enhance the quality of life for patients with multiple sclerosis through spasticity management, improved mental health, increased mobility, and muscle strength. These therapeutic strategies can improve involvement in professional activities and participation in social and family life for patients with multiple sclerosis.

Background: Cancer rehabilitation represents a series of measures adopted for the recovery of psychological, emotional, social, and financial functioning in the case of cancer patients. The purpose of this study is to identify the main elements of therapeutic management in the field of medical rehabilitation, as well as integrative, complementary medicine and holistic approaches that can be performed on the oncological patient. Methods: This systematic literature review follows the methodology outlined in the “Preferred Reporting Items for Systematic Reviews and Meta-Analysis” (“PRISMA”) statement, which is an internationally recognized and widely accepted standard. Results: Active rehabilitative therapies offer therapeutic options for improving the functioning and quality of life of oncological patients; these therapies comprehensively address both the physical and psychological aspects of the disease. This review also includes the latest novelties and nanotechnologies applied in oncological rehabilitation, for example, drugs (or supplements) inspired by nature. Conclusions: Physical and rehabilitation medicine, mostly using stimulating therapeutic methods, was recently added to the list of contraindications in the management of oncological patients, both as an approach to the pathological concept itself and as an approach to the main clinical consequences and functional aspects of oncological therapies. Integrative, complementary medicine presents an important therapeutic resource in the case of oncological patients. Advanced studies are needed in the future to further ascertain the role of these therapies.

Background: Osteoarthritis is a common chronic disease that affects quality of life and increases public health costs. Knee osteoarthritis is a frequent form, marked by joint degeneration, pain, stiffness, and functional restrictions. Factors such as age, genetics, joint injuries, obesity, and vitamin D deficiency can affect knee osteoarthritis progression. While the exact link between vitamin D and osteoarthritis is still being studied, recent research indicates that low vitamin D levels might influence the articular cartilage’s structure and function, potentially accelerating osteoarthritis. This review aims to analyze the last decade of research on vitamin D’s role in osteoarthritis. Methods: A systematic review of the literature was conducted in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Relevant studies from the last ten years were included to evaluate the association between vitamin D levels and knee osteoarthritis. The inclusion criteria were studies examining the role of vitamin D in cartilage health and osteoarthritis progression and the potential clinical implications for disease management. Results: This review identified a variety of studies exploring the connection between vitamin D and osteoarthritis, with mixed findings. Conclusions: The relationship between vitamin D and knee osteoarthritis remains inconclusive, highlighting the need for further research. An updated evaluation of the literature is crucial for osteoarthritis management strategies and to potentially include vitamin D supplementation in therapeutic protocols.

Introduction Obesity is a complex condition characterized by excessive accumulation of body fat, which can have multiple causes, including genetic factors, inadequate diet, lack of physical exercise, and socioeconomic factors. Obesity can cause significant respiratory changes, so obese patients present pulmonary complications more frequently than individuals with normal weight. Improving respiratory function is an important aspect of obesity management, as it can reduce the risk of pulmonary complications and improve patients' quality of life. Material and method We conducted a randomized controlled, single-center study that included 70 obese patients, aiming to evaluate the effectiveness of intermittent hypoxia-hyperoxia therapy (IHHT) on metabolic and respiratory effects. Patients were randomly allocated into two equivalent groups: an intervention group, consisting of 35 patients who received IHHT, and a control group, consisting of 35 patients who did not receive this therapy. Results Patients in the intervention group showed a significant increase in exercise tolerance (p < 0.001), improvement in renal function parameters (p = 0.047 for uric acid; p = 0.006 for creatinine), and liver function (p = 0.001 AST; p = 0.030 ALT), compared to the control group. An improvement in the Tiffeneau index was also observed in the intervention group (p < 0.001), indicating an improvement in respiratory function and lung capacity. Conclusions The approach to obesity requires a holistic perspective that takes into account the physical, psychological, and social aspects of this condition. IHHT represents an integrative therapeutic approach that addresses both the metabolic and respiratory aspects of obesity and metabolic syndrome, offering promising prospects for improving patients' health and quality of life. The study results suggest that IHHT may be effective in improving physical performance, renal and hepatic function, as well as respiratory function, with the potential to provide significant benefits in the management and treatment of obese and/or metabolic syndrome patients.

Background: The purpose of this study was to investigated cases of spinal cord injury (SCI) during the years 2017-2021, in Constanta County (Romania) to update the data on SCI and thus identify the SCI trends in this region of Romania. Methods: The study retrospectively analysed patients with SCI in Constanța County, whose data (medical records) were provided to us by the Romania Motivation Foundation. This analysis was made for the period January 1, 2017 - August 31, 2021. Results: Ninety-six new traumatic cases of SCI were reported between 2017 and 2021 in Constanța County. It was found that the annual incidence is 2.48 per hundred thousand inhabitants. The male / female ratio was 5:1 and the mean age at injury was 33.52 ± 15.1 (33.41 ± 14.80 for men and 33.92 ± 16.01 for women). The most common cause of injury was unintentional fall (48.95%), followed by road accidents (39.58%), stab wounds (4.16%), gunshot wounds (3.12%) and injuries caused by diving 2.08%). Fifteen patients (15.62%) were quadriplegic, and 81 patients (84.37%) were paraplegic. The most common level of lesions was C4 (33.33%) in tetraplegics and T12 (25.92%) in paraplegics. The most common associated injury was head trauma (15.8%), followed by limb fractures (9.5%). The incidence rate of SCI in Constanta County increased (p <0.05) and the highest increase in the incidence of spinal cord injuries was observed among patients in the age groups 29 - 49 years. Conclusions: Due to the existence of limitations, it is difficult to obtain accurate epidemiological data for SCI. Therefore, more studies are needed to provide a large amount of data and evidence. Our data indicate the need to take measures both for prevention and to provide specialized care for this type of traumatic pathology.

Les modifications morphométriques des structures osseuses de l'articulation coxo-fémorale devraient entraîner des modifications de la cinématique de la marche, si les structures conjonctives ne parviennent pas à compenser les incongruités. Dans la littérature, il est mentionné que les changements de dynamique n'apparaissent que lorsqu'il existe également une symptomatologie locale, et en fait cela pourrait être la cause de la déviation du schéma de marche [1], [2], [3], [4]. L'étude a été réalisée sur un nombre de 37 volontaires, femmes et hommes, âgés de 20 à 60 ans, sans symptômes de la hanche. Ils ont réalisé une analyse informatisée de la marche et une radiographie du bassin. Après avoir effectué l'analyse de la marche, certains des volontaires ont signalé des douleurs ou des crépites locales, un fait qu'ils n'avaient pas remarqué jusqu'à présent, sans rapport avec l'âge. Des modifications radiologiques des structures osseuses ont été retrouvées chez la plupart des patients qui présentaient des modifications du schéma de marche. Tous ceux qui avaient des modifications radiologiques n'avaient pas de troubles de la dynamique coxo-fémorale. Aucune relation n'a été déterminée entre le degré de changements structurels et dynamiques de l'os. En ce qui concerne les troubles dynamiques, un affect à prédominance féminine a été observé. Habituellement, lorsqu'un trouble apparaissait, il était bilatéral, mais pas totalement symétrique, ce qui peut signifier qu'une des hanches en est en fait la cause, l'autre étant adaptée pour refléter ses mouvements, pour maintenir une marche constante. Les changements morphométriques déterminent dans la plupart des cas des troubles coxo-fémoraux dynamiques, mais ne provoquent pas nécessairement de symptômes. Tous ceux qui se sont plaints de symptômes après les tests avaient des troubles dynamiques sans modifications osseuses. L'étude doit être approfondie en réalisant des IRM sur ceux qui ont présenté des changements dynamiques sans changements osseux afin d'étudier les structures conjonctives, pour déterminer la cause exacte.