Razvan Dragoi

BackgroundOngoing education of health professionals in rheumatology (HPR) is critical for high-quality care. An essential factor is education readiness and a high quality of educational offerings. We explored which factors contributed to education readiness and investigated currently offered postgraduate education, including the European Alliance of Associations for Rheumatology (EULAR) offerings.Methods and participantsWe developed an online questionnaire, translated it into 24 languages and distributed it in 30 European countries. We used natural language processing and the Latent Dirichlet Allocation to analyse the qualitative experiences of the participants as well as descriptive statistics and multiple logistic regression to determine factors influencing postgraduate educational readiness. Reporting followed theChecklist for Reporting Results of Internet E-Surveysguideline.ResultsThe questionnaire was accessed 3589 times, and 667 complete responses from 34 European countries we...

Objectives: Soft and hard tissue breakdown was histologically and radiologically assessed around implants with alternate, consecutively placed ligatures on the same edentulous dog hemimandible. The influence of ligatured implants (LI) on adjacent non-ligatured implants (NLI, as a possible naturally induced peri-implantitis) was also evaluated. Material and Methods: Three months after tooth extraction, five dental implants were placed in the dog hemimandible. Two months after abutment placement, ligatures were placed subsequently two months apart on alternate implants, while both intermediate implants were left without ligatures. Ligatures were kept in place during the entire experiment, and no plaque control measures were taken. Eleven months post-implantation, the animal was sacrificed. Undecalcified ground sections were cut, stained with Masson Goldner and MOVAT Pentachrome and evaluated by light microscopy. Soft and hard tissue loss was assessed using histomorphometric and CBCT p...

The use of tobacco products is a major global public health issue, as it is the leading cause of preventable death worldwide. In addition, nicotine (NIC) is a key component of electronic and conventional cigarettes. Although nicotine’s addictive potential is well known, its health effects are not entirely understood. Thus, the main objective of the present study was to evaluate its toxicological profile both in vitro, at the level of three healthy cell lines, and in ovo, at the level of the chorioallantoic membrane. Five different concentrations of nicotine were used in keratinocytes, cardiomyocytes, and hepatocytes for the purpose of evaluating cell viability, cell morphology, and its impact on nuclei. Additionally, the hen’s egg test on the chorioallantoic membrane (HET-CAM) method was used to assess the biocompatibility and irritant potential of the chorioallantoic membrane. Across all cell lines studied, nicotine was proven to be significantly damaging to cell viability, with th...

Background and Objectives: The consumption of dietary supplements has increased over the last decades among pregnant women, becoming an efficient resource of micronutrients able to satisfy their nutritional needs during pregnancy. Furthermore, gestational drug administration might be necessary to treat several pregnancy complications such as hypertension. Folic acid (FA) and folate (FT) supplementation is highly recommended by clinicians during pregnancy, especially for preventing neural tube birth defects, while labetalol (LB) is a β-blocker commonly administered as a safe option for the treatment of pregnancy-related hypertension. Currently, the possible toxicity resulting from the co-administration of FA/FT and LB has not been fully evaluated. In light of these considerations, the current study was aimed at investigating the possible in vitro cardio- and hepato-toxicity of LB-FA and LB-FT associations. Materials and Methods: Five different concentrations of LB, FA, FT, and their ...

Aims: Once the biologic therapies have been used, the present-day medicine trend is to homogenize the treatment of the inflammatory autoimmune rheumatic diseases, meaning rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE). But, there is still the need to find out a common assessment instrument for this pathology. Methods: The study included 120 patients (40 patients with RA, 40 patients with AS, 20 patients with PsA and 20 patients with SLE). They were assessed at the beginning and at the end of the study period by using both DAS (Disease Activity Score) and HAQ (Health Assessment Questionnaire) scales. BASDAI (Bath AS Disease Activity Index) was used for AS patients and SLEDAI (SLE Disease Activity Index) for SLE patients. Results: The RA patients had significant improvements regarding both DAS and HAQ scores (DAS mean score was initially 4.49 and finally 3.75; HAQ mean score was initially 1.78 and finally 2.15; ...

Objective: To identify a spectrum of perspectives on functioning and health of patients with primary Sjögren's syndrome (pSS) from the five European countries in order to reveal commonalities and insights in their experiences.Methods: A multicenter focus group study on the patients with pSS about their perspectives of functioning and health was performed. Focus groups were chaired by trained moderators based on an interview guide, audiotaped, and transcribed. After conducting a meaning condensation analysis of each focus group, we subsequently combined the extracted concepts from each country and mapped them to the International Classification of Functioning, Disability and Health (ICF).Results: Fifty-one patients with pSS participated in 12 focus groups. We identified a total of 82 concepts meaningful to people with pSS. Of these, 55 (67%) were mentioned by the patients with pSS in at least four of five countries and 36 (44%) emerged in all the five countries. Most concepts wer...

The most common types of crystal arthropathies are gout and calcium pyrophosphate deposition (CPPD) disease. Serum urate levels are influenced by a combination of genetic factors and the environment. There are studies estimating the heritability of urate ranging from 45% to 73%. Approximately 3% of the variance in serum urate level is explained by the locus SLC2A9. Among the Caucasian population, 10% of all gout cases may be largely attributable to locus ABCG2. Loss or reduction function of ABCG2 halves the kidney’s ability to secrete uric acid. Gain-of-function mutations in ENPP1 gene may be involved in the development of CPPD disease. Loss-of-function mutations in ANKH leads to excess calcium hydroxyapatite formation. Conclusions: There is reason to believe that studying susceptibility genes for the crystal arthropathies will contribute to our understanding of the complexity of inheritance of these disorders. At present many other genes involved in crystal arthropathies are being ...

Background: Non-adherence to medication and non-pharmacological interventions precludes reaching an optimal outcome. 30 to 80% of patients with rheumatic and musculoskeletal diseases (RMDs) do not adhere to their recommended treatment regimens. Objectives: The objective of this EULAR task force was to establish recommendations/points to consider (PtC) for the detection, assessment and management of non-adherence in people with RMDs. Methods: A EULAR task force (TF) was established, and the EULAR standardised operating procedures for the development of PtCs were followed. The TF included rheumatologists, health professionals in rheumatology (HPRs), and patient-representatives from 12 countries. A systematic literature review of reviews was conducted in advance to support the TF in formulating the PtC. Agreement was obtained by Delphi technique in three rounds (0-10 rating scale). Results: A definition of adherence, 4 overarching principles and 9 PtC were formulated (table). Conclusio...

Objective: We aimed at comparing and assessing the discriminative ability and correlation of the Bath Ankylosing Spondylitis (AS) Functional Index (BASFI) with several disease activity indexes used in ankylosing spondylitis (AS), together with other variables related to the patients (age, gender, etc.), in order to identify the relevant ones for patients and doctors. Material and methods: During a three-month period, we studied 31 patients, all diagnosed with AS at different stages with respect to the European Spondylarthropathy Study Group criteria and the Modified New York criteria for AS. The data were analyzed by statistical correlation. Results: At the baseline we found significant correlation between the functional status of the patients evaluated by the BASFI score and ASDAS ESR (r 2

Despite the reported benefits of intravenous iron therapy (IVIT) for correcting iron deficiency anemia (IDA) before any major surgery and the evidence thereof, perioperative allogenic blood transfusion (ABT) practice is still considered as the only viable option by some clinicians worldwide. As ABT increases the likelihood of infections, cardiac complications, longer hospital stays and mortality among the patients, the practice of ABT should only be reserved for critical cases (Hb level < 7 g/dl). Timely iron studies and iron replenishment (oral/IV) of prospective surgical patients could help decrease the ABT practice, and prove beneficial from both the clinical and economic standpoint. Evidence based patient blood management guidelines should be developed and standardized for use by clinicians worldwide. These guidelines should include specific instructions on timely assessment of surgical patients for correction of their IDA by either oral iron supplementation, if time permits,...

Introduction Occupational balance is an important and widely used concept in occupational therapy and occupational science. There is, however, not one unified definition in use, but several different ones, and thus instruments that measure the concept in research studies are diverse as well. Consequently, it is unclear how instruments and definitions correspond. The purpose of this study was to examine the coverage of occupational balance definitions by occupational balance instruments. Method Within a mixed-methods design we conducted a qualitative and quantitative content analysis of definitions and items of existing instruments. Definitions and items were extracted from articles identified in a systematic literature search. The extent of congruence and coverage between definitions and instruments was examined. Results The definitions used in 47 articles were structured into 19 categories. The categories which were found in most definitions were a balance of ‘various occupational ...

Objective: To evaluate the impact of inspiratory muscle training on aerobic capacity and pulmonary function in patients with ankylosing spondylitis. Design: Randomized controlled study. Setting: Rheumatic Rehabilitation Centre. Subjects: A total of 54 ankylosing spondylitis patients, all males, were randomized to a conventional exercise training associated with an inspiratory muscle training group, or to a conventional exercise training group. Interventions: Group 1 (27 patients) performed eight weeks of conventional exercise training (supervised weekly group sessions followed by a home-based exercise programme) associated with inspiratory muscle training sessions. Group 2 (27 patients) received eight weeks of conventional exercise training only. Main measures: Resting pulmonary function (forced vital capacity − FVC, forced expiratory volume in one second − FEV1); effort ventilatory efficiency (lowest ventilatory equivalent ratio for oxygen and carbon dioxide – VE/VO2 and VE/VCO2) a...

ObjectiveTo analyse how non-adherence to prescribed treatments might be prevented, screened, assessed and managed in people with rheumatic and musculoskeletal diseases (RMDs).MethodsAn overview of systematic reviews (SR) was performed in four bibliographic databases. Research questions focused on: (1) effective interventions or strategies, (2) associated factors, (3) impact of shared decision making and effective communication, (4) practical things to prevent non-adherence, (5) effect of non-adherence on outcome, (6) screening and assessment tools and (7) responsible healthcare providers. The methodological quality of the reviews was assessed using AMSTAR-2. The qualitative synthesis focused on results and on the level of evidence attained from the studies included in the reviews.ResultsAfter reviewing 9908 titles, the overview included 38 SR on medication, 29 on non-pharmacological interventions and 28 on assessment. Content and quality of the included SR was very heterogeneous. Th...

Background Non-adherence to treatment could preclude reaching an optimal outcome. Thirty to 80% of patients with rheumatic and musculoskeletal diseases (RMDs) do not adhere to the agreed treatment. Objectives The objective was to establish points to consider (PtCs) for the prevention, screening, assessment and management of non-adherence to (non-)pharmacological treatments in people with RMDs. Methods An EULAR task force (TF) was established, and the EULAR standardised operating procedures for the development of PtCs were followed. The TF included healthcare providers (HCPs), comprising rheumatologists, nurses, pharmacists, psychologists, physiotherapists, occupational therapists and patient-representatives from 12 European countries. A review of systematic reviews was conducted in advance to support the TF in formulating the PtCs. The level of agreement among the TF was established by anonymous online voting. Results Four overarching principles and nine PtCs were formulated. The Pt...

Neuromuscular electrical stimulation (NMES) is useful for muscle strengthening and for motor restoration of stroke patients. Using a portable ultrasound instrument, we developed an M-mode imaging protocol to visualize contractions elicited by NMES in the quadriceps muscle group. To quantify muscle activation, we performed digital image processing based on the Teager–Kaiser energy operator. The proposed method was applied for 35 voluntary patients (18 women and 17 men), of 63.8 ± 14.1 years and body mass index (BMI) 30.2 ± 6.70 kg/m2 (mean ± standard deviation). Biphasic, rectangular electric pulses of 350 µs duration were applied at two frequencies (60 Hz and 120 Hz), and ultrasound was used to assess the sensory threshold (ST) and motor threshold (MT) amplitude of the NMES signal. The MT was 23.4 ± 4.94 mA, whereas the MT to ST ratio was 2.69 ± 0.57. Linear regression analysis revealed that MT correlates poorly with body mass index (R2 = 0.004) or with the thickness of the subcutan...

Armoracia rusticana � horseradish is a well-known vegetable used from ancient times and consumed nowadays more for its taste than its pharmacological properties, even though it proved to be a good agent in fighting several health problems. This study focuses on a comparative assessment of several horseradish hydro-alcoholic extracts, obtained from roots and sprouts, respectively, mainly evaluating the antioxidant activity but also a potential cytotoxic effect. The DPPH evaluation revealed that horseradish extracts made from roots or sprouts exhibit a strong antioxidant activity compared to the ascorbic acid used as etalon. The in vitro evaluation established that a significant inhibitory effect on cell viability and morphology of MDA-MB-231 � breast adenocarcinoma cell line was displayed by the hydroalcoholic extracts in a dose-dependent manner.

The field of metal nanotechnology continues to draw the attention of researchers from different areas due to the outstanding properties of nanoparticles. The main aims of this research were to obtain and to study two types of gold nanoparticles; different obtaining pathways (the chemical synthesis and the biosynthesis based on an aqueous extract of lemon balm) were involved in this research. The chemically synthesized nanoparticles were loaded with lupeol. After a preliminary physico-chemical characterization, the compounds obtained were tested in order to evaluate the effects on the viability of colon cancer cells. The formulation of these new gold nanoparticles with average size between 38 and 82 nm, with a good stability against the tendency to form agglomerations according to the Zeta potential values, was confirmed by UV-Vis spectra; the particles containing lupeol have show the best activity against the colon cancer cells.

Magnetoliposomes were placed into the biomedical spotlight due to their unique structure, preserving also magnetic features valuable for biomedical applications. The present study provides a preliminary evidence of the cytotoxicity induced by betulinic acid-loaded magnetoliposomes (BA-Fe3O4@Lip) on two melanoma cell lines - A375 and B164A5 cells and one healthy cell line - mice epidermis JB6 Cl 41-5a cells, augmented by references to potential biomedical applications. BA-Fe3O4@Lip showed significant cytotoxicity on the melanoma cell lines, compared with the blank liposomal structures. In addition, the healthy cell line displayed good viability rate after exposure to BA-Fe3O4@Lip.

With time, medical and pharmaceutical research has advanced significantly. However, one of the major issues is how to administer the active substance. Among these, it counts over- or under-dosage of the active substance, low re­sponse to treatment, or increased clinical risk of the patient. An innovative method able to avoid these obstacles is represented by controlled release systems for active substances. The interest for these systems came with allowing encapsulation in the antibiotic release matrices, local anesthetics, protein or other substances. Moreover, a number of such vehicles are now available to release controlled substances used predominantly in the anesthesia and intensive care unit.

Objective: The study is aiming to demonstrate the benefit of inspiratory muscle training (IMT) on pulmonary dysfunction in ankylosing spondylitis (AS) patients. Methods: Twenty four patients (mean age: 45.6±5.6 years old, all males) who were previously diagnosed with AS stage III and IV were included in a eight weeks prospective study. The patients were evaluated at baseline and at the end of the study with respect to resting pulmonary function test (forced vital capacity - FVC, forced expiration volume in one second - FEV1) and cardiopulmonary exercise test (maximal minute ventilation - VEmax, maximal tidal volume – VTmax and maximal workload attained during the exercise test - Pmax). All patients performed IMT sessions, three times weekly for a period of eight weeks using a computer assisted TrainAir device. Each IMT session was individualized by evaluating the maximum inspiratory pressure (SMIP), the training being performed at 80% of SMIP. Results: Using paired t test to compare data at baseline and at the end of the study we noticed significant improvements of FVC (3.4%, p=0.0002); FEV1 (3.2%, p=0.0047); VEmax (5.9 L/min, p=0.0002); VTmax (0.07 L, p=0.0204); Pmax (16 Watt, p Conclusions: Inspiratory muscle training improves resting and effort pulmonary function of patients in advance stages of AS. This is mainly due to the influence of IMT on increasing strength and mobility of the diaphragm and accessory inspiratory muscles, together with the biofeedback provided by the interaction of: patient - TrainAir system – physical therapist. Improving ventilometric performance leads to an increased exercise capacity and quality of life in patients with AS.

Background Based on a literature review occupational balance (OB) is defined as the “individual’s subjective experience of having the right mix (amount and variation) of occupations in his/her occupational pattern”.(1) Occupational scientists include other occupations than paid work e.g. self-care, household activities, voluntary work, caring for others.(2) Currently there are diverse definitions of OB which are mainly given by occupational therapists.(1) Objectives With this study, we aimed to validate the existing definitions of OB, explore underlying concepts of OB in empirical data of patients with Crohn’s disease, rheumatoid arthritis, scleroderma and systemic lupus erythematosus (SLE). Furthermore we wanted to explore its change over life time and disease course. Methods We conducted a qualitative study using a narrative biographic method asking patients to tell their life stories.(3) This approach allows a conceptual analysis of the impact of chronic autoimmune diseases on people’s interpretation of their life’s experience and biography. Finally we explored the concept OB and its underlying concepts within a long-term perspective over the course of life and disease. Results 60 patients with a median age of 52 (IQR: 38.75-61.75) years and median disease duration of 10 years (IQR: 8-19) participated and were interviewed on average 2.1 hours. Occupational balance as such, was not found in the data of this study. Instead people’s life stories had in common to revolve around occupational challenges. People seek, face and/or meet occupational challenges, seek or face related appreciation, and furthermore use the handling with their occupational challenges to facilitate or inhibit their social connectivity. Furthermore occupational challenges were found to be a flexible concept, changing over different phases of life. Conclusions Occupational science should focus on occupational challenges instead of OB. The latter concept induces a kind of stability, or a “perfect point of being in balance” which has not been found in the data of this study. Additionally occupational therapists and other health professionals should take into account patients’ perspectives and concentrate more on real occupational challenges instead of reaching a conceptualized and idealized state of OB. References Wagman P, Hakansson C, Bjorklund A. Occupational balance as used in occupational therapy: A concept analysis. Scand. J Occup Ther. 2011. Oechsle M. Work-Life-Balance: Diskurse, Problematiken, Forschungsperspektiven. In: Becker R, Kortendiek B, editors. Handbuch Frauen- und Geschlechterforschung. Theorien, Methoden, Empirie. Wiesbaden: VS Verlag für Sozialwissenschaften, 2008:227-36. Rosenthal G. Reconstruction of Life Stories. Principles of Selection in Generating Stories of Narrative Biographical Interviews. In: Josselson R, Lieblich A, editors. The Narrative Study of Lives. Thousand Oaks: Sage, 1993:59-91. Disclosure of Interest None Declared

ObjectiveTo perform a systematic literature review (SLR) about the effect of non-pharmacological interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures.MethodsEight clinical questions based on two criteria guided the SLR: (1) adults≥50 years at high risk of osteoporotic fracture and (2) interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. Interventions focused on diagnostic procedures to identify risk of falling, therapeutic approaches and implementation strategies. Outcomes included fractures, falls, risk of falling and change in bone mineral density. Systematic reviews and randomised controlled trials were preferentially selected. Data were synthesised using a qualitative descriptive approach.ResultsOf 15 917 records, 43 articles were included. Studies were clinically and methodologically diverse. We identified sufficient evidence that structured exercise, incorporating progr...