Multimodal Non-Pharmacological Interventions for Fibromyalgia: Targeting Emotional and Cognitive Symptoms

Fibromyalgia (FM) is a chronic condition characterized by widespread pain, emotional distress, and cognitive impairments, significantly impacting quality of life. This study evaluated the effectiveness of three non-pharmacological interventions—stretching-based kinetic therapy, cognitive-behavioral therapy (CBT), and occupational therapy (OT)—on emotional and cognitive symptoms in FM patients. A prospective controlled study included 126 FM patients divided into four groups: CBT, stretching, OT, and a control group (CG) receiving only general education. Emotional outcomes were assessed using the Hospital Anxiety and Depression Scale (HADS) and Positive and Negative Affect Schedule (PANAS), while cognitive function was measured through Symbols and Digits tests. A follow-up assessment was conducted six months post-intervention to evaluate sustainability. CBT significantly reduced anxiety and sustained positive affect (p = 0.01). Stretching therapy provided long-term symptom relief (p = 0.02), while OT improved information processing speed (p < 0.001). The CG showed minimal changes. Despite observed benefits, adherence variability and the lack of randomization were study limitations. Conclusions: Multimodal non-pharmacological interventions demonstrated distinct yet complementary effects, supporting their integration into FM management. Stretching exercises contributed to sustained symptom relief, CBT was effective for emotional regulation, and OT improved cognitive function. Clinicians should consider patient-specific needs when designing rehabilitation strategies. Future studies should explore long-term adherence and comparative effectiveness across diverse FM populations

Advancing Personalized Care in Rheumatoid Arthritis: A Novel Framework Using NNT, ARR, and Quality of Life Metric

This study evaluates the efficacy of monotherapy versus combination therapy in rheumatoid ar-thritis (RA) using advanced quantitative metrics such as Number Needed to Treat (NNT), Absolute Risk Reduction (ARR), Relative Risk Reduction (RRR), and Control and Experimental Event Rates (CER and EER). The goal is to provide a structured, clinically relevant framework for op-timizing RA management and bridging the gap between clinical research and real-world appli-cation. A prospective cohort study included 160 RA patients, stratified by age, gender, and dis-ease activity. Patients received either monotherapy (MTX or LEF) or combination therapy (MTX/SSZ/HCQ). Outcomes were assessed over 24 months using statistical significance measures such as confidence intervals, t-tests, ANOVA, and non-parametric alternatives. The findings provide a direct clinical application, guiding treatment selection based on quantifiable response metrics. NNT, ARR, RRR, CER, and EER were calculated to evaluate treatment effectiveness. Combination therapy (MTX/SSZ/HCQ) demonstrated superior efficacy with an NNT of 3, compared to 25 for monotherapy. ARR and RRR were 71% and 90%, respectively, for combination therapy versus MTX/HCQ. Quality of life scores significantly improved in the combination therapy group, correlating with sustained remission over 24 months. This study presents a practical tool for clinicians by integrating longitudinal metrics and patient-specific NNT to personalize RA treatment decisions. By integrating longitudinal metrics and patient-specific NNT, it provides a novel, evidence-based approach to improving treatment outcomes in RA

Insulin Resistance and Chronic Kidney Disease in Patients with Type 1 Diabetes Mellitus

Background and Aims. Diabetes mellitus (DM) is a chronic disease which can evolve towards devastating micro- and macrovascular complications. DM is the most frequent cause of chronic kidney disease (CKD). Insulin resistance plays an important role in the natural history of type 1 diabetes. The purpose of the study was to determine the prevalence of CKD in T1DM and the correlation with insulin resistance (IR) in patients with CKD. Materials and Methods. The study was conducted over a period of three years (2010–2013) and included patients with DM registered in the Clinical Centre of Diabetes, Nutrition and Metabolic Diseases of Dolj county. The study design was an epidemiological, transversal, noninterventional type. Finally, the study group included 200 subjects with type 1 DM. Insulin resistance (IR) was estimated by eGDR. The subjects with eGDR ≤ 7.5 mg/kg/min were considered with insulin resistance. Results. CKD was found in 44% of the patients. Analyzing statistically the presence of CKD, we found highly significant differences between patients with CKD and those without CKD regarding age and sex of the patients, the duration of diabetes, glycosylated hemoglobin (HbA1c), the estimated glucose disposal rate (eGDR), and the presence of hypertension, dyslipidemia, and hyperuricaemia. In patients with CKD, age and diabetes duration are significantly higher than in those who do not have this complication. CKD is more frequent in males than in females (50.9% men versus 34.5% women, p=0.022). From the elements of metabolic syndrome, high blood pressure, hyperuricemia, and dyslipidemia are significantly increased in diabetic patients with CKD. eGDR value (expressed as mg·kg−1·min−1) is lower in patients with CKD than in those without CKD (15.92 versus 6.42, p<0.001) indicating the fact that patients with CKD show higher insulin resistance than those without CKD. Conclusions. This study has shown that insulin resistance is associated with an increased risk of CKD, but, due to the cross-sectional design, the causal relationship cannot be assessed. However, the existence of this causality and the treatment benefit of insulin resistance in type 1 diabetes are issues for further discussion

Gait Analysis Technologies for Evaluating Biomechanical Deviations: Insights from a Pilot Study on Healthy Athletes and Foot Deformities

Gait analysis is an essential tool for assessing musculoskeletal function and identifying biomechanical abnormalities. This study aimed to establish normative reference values for gait parameters in young, physically active individuals and to identify deviations associated with foot deformities. Methods: A cross-sectional observational study was conducted on 102 healthy young adults engaged in performance sports. Gait parameters were recorded using the RSscan plantar pressure distribution platform. Outlier identification methods were applied to exclude 12 participants with significant deviations, resulting in a final sample of 90 subjects. Descriptive statistics and comparative analyses were used to evaluate maximum force, impulse, load rate, and contact area across ten anatomical foot regions. Results: The final normative dataset established baseline values for plantar pressure distribution and biomechanical force dynamics. Among excluded participants, 33% exhibited pes planus (flatfoot), and one case presented pes cavus (high arch), both associated with altered pressure distributions and deviations in temporal gait parameters. Statistical comparisons confirmed significant variations in foot loading patterns and pressure maps (p<0.05). Conclusions: This study provides a comprehensive reference for gait parameters in young, healthy adults and highlights the clinical relevance of individualized gait assessments. The findings underscore the utility of plantar pressure analysis for early detection of biomechanical abnormalities that could contribute to musculoskeletal dysfunction. These insights can aid in the optimization of rehabilitation strategies, sports performance assessments, and orthopedic interventions. Clinical Implications: The results emphasize the need for targeted interventions in individuals with foot deformities to prevent long-term functional impairments. Future research should explore longitudinal implications of biomechanical deviations in active populations

Comprehensive Gait Analysis and Kinetic Intervention for Overweight and Obese Children

Background/Objectives: Childhood obesity is a critical public health issue associated with biomechanical and functional impairments that influence gait and physical performance. This study aimed to evaluate the impact of a six-month personalized kinetic program on gait parameters and pelvic kinematics in overweight and obese children. Methods: The prospective observational study included 100 children aged 8 to 15, divided into a study group (SG, n = 50) and a control group (CG, n = 50). The SG participated in a tailored kinetic program focusing on flexibility, strength, and coordination exercises, while the CG maintained their usual activities. The program consisted of 60 min sessions conducted three times per week over a six-month period. Gait parameters and pelvic symmetry indices were assessed using the BTS G-WALK system. Ethical approval was granted by the Ethics Committee of the University of Medicine and Pharmacy, Craiova, under approval no. 38/1 March 2022. Results: Significant improvements were observed in the SG, with increases in cadence (steps/min), walking speed (m/s), and pelvic symmetry indices across all planes (sagittal, frontal, and transverse) (p p > 0.01). The Spearman correlation matrix and heatmaps highlighted a strong correlation between improved gait parameters and participation in the kinetic program (correlation coefficient over 0.45). Conclusions: The findings demonstrate that a targeted kinetic program can significantly improve gait mechanics and pelvic kinematics in overweight and obese children. These results emphasize the importance of personalized exercise interventions in managing obesity-related gait abnormalities and improving functional mobility

Inflammation and Physical Performance in Overweight and Obese Schoolchildren

Obesity represents a critical public health concern, often linked to low-grade chronic inflammation starting in childhood. This study aimed to evaluate the impact of a 12-week kinesiotherapy program on physical performance and levels of leptin and C-reactive protein (CRP) in overweight and obese children. Methods: Conducted at the Filantropia Municipal Clinical Hospital, 160 children aged 6 to 15 were randomly assigned to a study group (SG, n = 80) and a control group (CG, n = 80). The SG engaged in a tailored kinesiotherapy program, while the CG maintained their usual activities. All children and their families learned five key principles for preventing and managing obesity. Results: Results indicated significant improvements in the SG, with enhancements in the 6 min walking distance, Timed Up and Go test, and walking cadence (all p-values &lt; 0.001). Notably, leptin and CRP levels (23.02 &plusmn; 7.17 to 16.62 &plusmn; 7.83, 4.13 &plusmn; 1.00 to 3.90 &plusmn; 0.95 mg/l, respectively) decreased significantly in the SG, contrasting with no significant changes in the CG. Regression analysis revealed a positive correlation between leptin levels and physical activity in the SG (coefficient: 0.5642, R-squared: 0.266). Conclusions: These findings suggest that targeted exercise programs can effectively enhance physical performance and reduce inflammation markers in overweight children, highlighting the importance of tailored interventions in managing obesity

The Efficiency of Kinesiotherapy versus Physical Modalities on Pain and Other Common Complaints in Fibromyalgia

Due to its variety of signs and symptoms, there have been numerous attempts to treat fibromyalgia (FM), but a cure has yet to be established. The aim of this study was to evaluate the effects of a complex kinetic therapy program and a combined physical modality program on pain and other common symptoms of FM. Patients and methods: A total of 78 female patients were included in this study; 39 subjects underwent a kinesiotherapy (KT) intervention (combining aerobic and Pilates exercises), and 39 participated in a physical modality (PM) program (including electrotherapy (TENS and low-laser therapy) and thermotherapy). Results: Regarding the parameter of pain assessment, kinesiotherapy demonstrated its superiority both during the treatment period and in the evaluation 3 months after therapy cessation. Both in terms of patient-reported pain (inter-group comparisons: p = 0.000 at T3) and the examination of tender points (inter-group comparisons: p = 0.000 at T3), as well as the algometric assessment, pain was alleviated by the two forms of applied kinetic therapy. The observed functional impairment was statistically significantly influenced (p = 0.001) at the end of the kinetic program application, while for the perceived functional impairment, neither therapy proved superiority over the other at any point of evaluation (inter-group comparisons: p = 0.715 at T3). Regarding the influence of the emotional consequences implied by fibromyalgia, neither the forms of kinesiotherapy nor the chosen physical modalities proved superiority at any point of evaluation (HAQ anxiety inter-group comparisons: p = 0.000 at T3). In conclusion, even though kinesiotherapy had superior influences on fibromyalgia pain in the studied group, the current research lends credence to the significance of non-pharmacological therapy in managing fibromyalgia. Participants demonstrated positive advancements in subjective and objective pain assessments, as well as improvements in functional and emotional well-being

Insulin Resistance and Chronic Kidney Disease in Patients with Type 1 Diabetes Mellitus

Background and Aims. Diabetes mellitus (DM) is a chronic disease which can evolve towards devastating micro- and macrovascular complications. DM is the most frequent cause of chronic kidney disease (CKD). Insulin resistance plays an important role in the natural history of type 1 diabetes. The purpose of the study was to determine the prevalence of CKD in T1DM and the correlation with insulin resistance (IR) in patients with CKD. Materials and Methods. The study was conducted over a period of three years (2010–2013) and included patients with DM registered in the Clinical Centre of Diabetes, Nutrition and Metabolic Diseases of Dolj county. The study design was an epidemiological, transversal, noninterventional type. Finally, the study group included 200 subjects with type 1 DM. Insulin resistance (IR) was estimated by eGDR. The subjects with eGDR ≤ 7.5 mg/kg/min were considered with insulin resistance. Results. CKD was found in 44% of the patients. Analyzing statistically the presence of CKD, we found highly significant differences between patients with CKD and those without CKD regarding age and sex of the patients, the duration of diabetes, glycosylated hemoglobin (HbA1c), the estimated glucose disposal rate (eGDR), and the presence of hypertension, dyslipidemia, and hyperuricaemia. In patients with CKD, age and diabetes duration are significantly higher than in those who do not have this complication. CKD is more frequent in males than in females (50.9% men versus 34.5% women, p=0.022). From the elements of metabolic syndrome, high blood pressure, hyperuricemia, and dyslipidemia are significantly increased in diabetic patients with CKD. eGDR value (expressed as mg·kg−1·min−1) is lower in patients with CKD than in those without CKD (15.92 versus 6.42, p<0.001) indicating the fact that patients with CKD show higher insulin resistance than those without CKD. Conclusions. This study has shown that insulin resistance is associated with an increased risk of CKD, but, due to the cross-sectional design, the causal relationship cannot be assessed. However, the existence of this causality and the treatment benefit of insulin resistance in type 1 diabetes are issues for further discussion

A Comparative Study on the Pain Threshold Experienced by Fibromyalgia Patients Following Acute SARS-CoV-2 Infection

Significant gaps remain in the understanding of the etiology and pathogenesis of fibromyalgia (FM), and the COVID-19 pandemic has introduced even more unknowns. Social factors specific to that period, the viral infection itself, and/or vaccination are additional elements that can complicate the progression of the disease or the response to treatment. Aim: The primary hypothesis to be evaluated in this study is that an acute COVID-19 infection, even when considered recovered, may induce changes in the response to non-pharmacological treatment in FM patients, particularly concerning pain. Results: We included 128 patients diagnosed with FM before the pandemic began. The patients were divided based on their history of acute SARS-CoV-2 infection and COVID-19 vaccination status. All patients followed the same rehabilitation program (cognitive therapy, kinesitherapy). Perceived pain: The non-COVID-19 patient groups showed a statistically significant reduction in pain at the final evaluation compared to patients with a history of acute SARS-CoV-2 infection (p &lt; 0.001). Algometric evaluation: Patients without COVID-19 infection and that were vaccinated exhibited the best improvement in pain threshold, both across evaluation times (p &lt; 0.001) and compared to any of the other three groups studied (p &lt; 0.001). Using the WHYMPI questionnaire, the same group of patients (those not having experienced acute COVID-19 and who were vaccinated) was the only group with a statistically significant improvement in pain severity (p = 0.009). In conclusion, to control and improve FM pain symptoms, in addition to appropriate medication, we propose paying additional attention to the history of acute SARS-CoV-2 infection and the COVID-19 vaccination status

Triglyceride and Glucose Index as a Screening Tool for Nonalcoholic Liver Disease in Patients with Metabolic Syndrome

Background: Nonalcoholic fatty liver disease (NAFLD) is regarded as a component of metabolic syndrome, which has insulin resistance (IR) as the primary physiopathological event. The aim of study was to establish the association between IR, assessed using triglyceride and glucose index (TyG), and histopathological features of NAFLD lesions. Methods: The study included patients with metabolic syndrome. Fasting plasma glucose (FPG), fasting lipid profiles and liver enzymes were measured. IR was assessed by TyG index. Liver biopsy was performed for assessment steatosis and fibrosis. Results: TyG index had a mean value of 8.93 &amp;plusmn; 1.45, with a higher value in the patients with overweight (p=0.002) and obesity (p=0.004) than in the patients with normal weight. TyG index mean value of 8.78 &amp;plusmn; 0.65 in subjects without NASH, 8.91 &amp;plusmn; 0.57 in patients with borderline NASH and 9.13 &amp;plusmn; 0.55 in patients with definite NASH. Significant difference was found between subjects without NASH and the ones with definite NASH (p=0.004). The analysis of the area under the ROC curve proved that TyG index is a predictor for NASH (p=0.043). Conclusion: TyG index is a facile tool used to identify individuals at risk for NAFLD, but not for the progression of liver lesions.</jats:p