Journal articles on the topic 'Asthma Nutritional aspects'

Developed nations are experiencing a marked increase in prevalence of the familial allergic diseases including asthma, allergic rhinitis, atopic dermatitis, and allergic gastroenteropathy, which are often called atopic diseases. No satisfactory explanation for this epidemic is known, but it has been proposed that some facets of modern life tend to bias immune responses away from the Th1 cellular immune responses that protect against many infections and toward Th2 responses that favor atopy. There are 2 hypotheses to explain why this epidemic is occurring now. Hypothesis 1 suggests that nutritional patterns have changed or that we are exposed to environmental toxicants that were not previously present. Hypothesis 2 holds that some aspects of modern lifestyles in affluent nations have minimized exposure to infectious agents or to their by-products, such as endotoxin. This feature of contemporary lifestyle, it is suggested, has favored the development of Th2 immune responses to environmental allergens and the development of the attendant atopic diseases. This latter theory has been designated the “hygiene hypothesis.” Although there is evidence both for and against both hypotheses, evidence for hypothesis 2 is stronger and more convincing.

Lepidium sativum Linn. (family Cruciferae) is an edible herb that is botanically related to watercress and mustard, having their peppery, tangy taste and odour. Traditionally L. sativum seeds are used to treat wounds, sprains, asthma, bronchitis, cough and is considered useful as abortifacient, aphrodisiac, antibacterial, diuretic, expectorant, gastrointestinal stimulant, gastroprotective, laxative and stomachic. Many of these traditional uses have been scientifically validated using different in vitro and in vivo studies and in this review are compiled in an inclusive manner. Seeds are reported to be rich in carbohydrates, vitamins, amino acids, proteins, triterpenoids, steroids and saponin glycosides possessing different pharmacological activities. Aim of the study: This study is an effort to collate complete scientific literature published till March 2021 in order to generate a succinct summation on the distribution, traditional beneficial potential, chemical constituents, phytochemistry, pharmacology and toxicology of this coveted species of genus Lepidium. Materials and Methods: Exploring assorted scientific databases. Results: The present methodically compiled review article accentuates medicinal and nutritional significance of this highly valued plant by focusing on various aspects of the plant such as the, physicochemical characterisation and pharmacological studies that validates folklore uses. Thus, this annotated script on L. sativum would be a handy tool to explore the future prospective of research on this traditional plant.

Asthma and obesity are serious medical and social world problems, and their combined course is characterized by a decrease in the quality of life, an increase in the frequency and duration of hospitalization. The present review summarizes the current views on the mechanisms of formation of asthma phenotype combined with obesity, role of leptin and adiponectin imbalance in the development of systemic inflammation in obesity in the pathophysiology of asthma, its interrelations with metabolic syndrome. We present data that shows that syndrome is closely related not only to the debut of asthma, but also to a decrease in its control. Along with obesity, the role of other components of metabolic syndrome, in particular insulin resistance, as a predictor of asthma development is considered. Insulin resistance may be the most likely factor in the relationship between asthma and obesity, independent of other components of the metabolic syndrome. Insulin resistance associated with obesity can lead to disruption of nitric oxide synthesis. We reveal common mechanism of metabolic disorders of nitric oxide and arginine in metabolic syndrome and asthma and show that insulin resistance treatment can be therapeutically useful in patients with asthma in combination with obesity.

Dear editor, This letter is in response to Chaudhary, Shrestha, and Pathak, who highlighted various aspects of our previous manuscript "Prevalence of Anaemia in Children Diagnosed with Pneumonia in a Tertiary Hospital in Quito, Ecuador." I want to respond to each point referred to in a similar extension as used by the authors. We agreed on the fact that it is prompt to conclude in nutritional deficiencies as a risk factor to suffer pneumonia in Ecuadorian children that is why we express this conclusion as a possibility. Nevertheless, as evidenced in the meta-analysis presented by Jackson et al., the Odds Ratio (OR) meta-estimate for under nutrition as a risk factor for acute lower respiratory infections was 4.5 (95% CI 2.1-9.5)1. To add, in the same paper, the OR meta-estimate for anaemia, vitamin D deficiency, and zinc supplementation, was 3.9 (95% CI 2.4-6.3), 7.3 (95% CI 2.5 to 21.5), and 0.5 (95% CI 0.3 to 0.9), respectively 1. Moreover, in a study conducted in Malawi including 9 533 children, severe malnutrition and moderate malnutrition were associated not only with a pneumonia risk but with an increased risk of inpatient mortality, with Odds Ratios (OR) of 4.63 (3.08, 6.97) and 1.73 (1.21, 2.48) respectively. Therefore, there is supporting evidence globally of the suggested risk 2. I am glad that the authors in the letter bring to the table a discussion of pneumonia diagnosis. In our study, the evaluation of pneumonia started with the clinical assessment including parameters with an acceptable sensitivity (Sen%) or specificity (Spe%), such as; fever on examination (Sen% 47, Spe% 68), history of fever (Sen% 92, Spe% 21), tachypnoea (Sen% 13, Spe% 95), rhonchi (Sen% 26, Spe% 98), crackles (Sen% 43, Spe% 73), wheezing (Sen% 4, Spe% 98) (3). However, as referred to in the original paper, the evaluation was not limited to these factors "Hypoxemia, defined as a sustained saturation of peripheral oxygen (SpO2) <90 %, was used as criteria for hospitalization, along with criteria for respiratory distress, which includes: tachypnoea, dyspnoea, retractions (suprasternal, intercostal, or subcostal), grunting, nasal flaring, apnoea and altered mental status. Furthermore, CBC, acute-phase reactants and chest radiography were performed" (4). Nonetheless, I should remark two factors; firstly, pneumonia severity assessment is based on clinical parameters as presented in the New South Wales Government guideline (5). So, minimizing the utility of the clinical evaluation may be a mistake, especially in institutions without prompt access to the radiologic test. Secondly, even we knew that the patients included in this study were evaluated in other differential diagnoses like bronchiolitis, asthma or cardiac diseases which can mimic pneumonia, this was a cross-sectional study using retrospective data collection. Regarding the exclusion criteria, concomitant conditions that could affect anthropometric measurements include any congenital disease, which compromises a normal growth independently of the nutritional intake (Examples; Down syndrome, achondroplasia). Conditions that could affect the haemoglobin measurement or other parameters in the complete blood count include haematological, infectious or any disease which physiopathology may influence the interpretation of these results in the context of our study (Examples; Sickle cell disease, thalassemia, haemolytic anaemia, solid tumour cancers, haematological neoplasm, paludism), and conditions that could predispose to pneumonia include diseases which may produce an increased risk of infections (Examples; haematological neoplasm, inherited and acquired immunodeficiencies, immunosuppressive therapy) It is true that without specific evaluation of iron profile is not possible to establish with a high certainty iron deficiency. However, in our study are some relevant considerations; we excluded patients with a current diagnosis of other types of anaemia (haemolytic anaemia), chronic inflammatory conditions, cancer, and haematological neoplasms. All these factors reduce the possible causes of anaemia, and in the light that nutritional anaemia is the most frequent type in Latin America, it is reasonable to think that iron deficiency may be the leading cause in our patients. When we think about microcytic anaemia, as this was the most frequent type in our study, and as we excluded thalassemia, chronic inflammatory disease, and was no evidence of lead poisoning or newly diagnosed thalassemia in our patients, the possibility of iron deficiency increases. Although, at the end of our paper, we recommend the use of iron profile in new studies. I should highlight that we did not report cases of macrocytic anaemia. The question regarding the use of nutritional supplements is interesting, especially considering that in Ecuador, the governmental normative of micronutrients supplementation with the product "Chis Paz" consider children between 6 and 24 months of age. In our study, there was no possibility to know if the patients receive any supplementation. But, it would be useful to include this variable in prospective studies. Subclinical infections and iron deficiency anaemia have been described extensively in subclinical malaria, in other types of subclinical infections and even acute infections, there are still debate.

ABSTRACT Background Asthma is the most common childhood chronic health condition. Maternal antenatal diet has been associated with offspring asthma risk, but studies investigating maternal whole diet quality and inflammatory potential with long-term offspring follow-up (&gt;5 y) are rare. Objectives We aimed to elucidate these associations in a prospective cohort study in Ireland. Methods Early pregnancy diets were assessed using a validated FFQ from which energy-adjusted Dietary Inflammatory Index (E-DII) and Healthy Eating Index (HEI)-2015 scores were computed. Doctor-diagnosed offspring asthma status (general practitioner or parent reports) for the first 10 y of life was collected at 3-y, 5-y, and 9-y follow-up. A total of 862 mother–child pairs with information on maternal diet and ≥1 offspring asthma data points were included. The longitudinal associations between maternal E-DII and HEI scores and offspring asthma status were assessed using generalized estimating equations. Results Cumulative offspring asthma incidence was 21% over the 10-y period. In the main models, adjusted for maternal lifestyle and sociodemographic factors, a higher E-DII score, indicating a more proinflammatory diet, was associated with higher risk of offspring asthma (OR: 1.35; 95% CI: 1.10, 1.65; per 1-SD score increment), whereas a higher HEI-2015 score, indicating better dietary quality, was associated with lower risk (OR: 0.77; 95% CI: 0.64, 0.93) (both P &lt; 0.01). Results persisted with further adjustment for childhood factors (e.g., breastfeeding, diet, and childcare attendance) and parental asthma history. Similar associations were observed when E-DII and HEI-2015 scores were modeled in quartiles (both P-trend &lt; 0.05). Associations for HEI-2015 were attenuated after adjustment for E-DII, suggesting the importance of anti-inflammatory pathways. Conclusions Our results suggest that a proinflammatory and low-quality diet during pregnancy is associated with a higher risk of offspring asthma. Pending confirmation from other studies, optimizing these aspects of maternal diet can be a promising strategy for reducing childhood asthma risk. This prospective observational study was registered at the ISRCTN Registry as ISRCTN16537904.

Abstract Rationale Lifestyle interventions are known to improve many medical conditions. We are documenting the effect that a, 18-day residential medical lifestyle program has on the fitness of asthma patients using metabolic equivalent (MetS), which correlate to exercise capacity. Methods The program included 3 daily buffet-like whole food plant-based meals with no snacks, 2 to 3 times a day sessions of exercise (aerobic and anaerobic), massage, hydrotherapy, medical and spiritual interventions. The program is called NEWSTART program and takes place in Weimar, California. NEWSTART means: Nutrition, Exercise, Water, proper Sunlight exposure, fresh Air, Rest and Trust (relational, spiritual, and psychological aspects). Board certified physicians monitored patient progress. Nutritionist, exercise physiologist, psychological, and chaplaincy care is also provided. From 2282 patients that completed the 18-day NEWSTART program in 13 years we found 66 that had the starting diagnosis of asthma. From those 66, 39 had a pre and post stress test to determine MetS. These 39 patients had an average age of 59, SD 14.9. Results At baseline, asthmatics had on average a MetS of 8.38, SD 3.3, median 9, mode 10, min 2 and max 16. At the end of the program the stress test reported a MetS of 9.6, SD 3.8, median 10, mode 9, min 2 and max of 18. Asthmatic crises decreased during the program. Conclusions The lifestyle Program seems to improve fitness of asthma patients. The end MetS of 9.6 is important since a 10 to 11 MetS is considered good exercise capacity and may decrease mortality.

Background Although a significant number of the clinical features and pathophysiologic mechanisms of chronic rhinosinusitis (CRS) have been described, only a few studies have been published on characterization of CRS in the field of aging. Objective We investigated the prevalence and risk factors of CRS in elderly (≥65 years old) Koreans using large-scale nationwide epidemiological data and compared the risk factors of elderly with those of younger adult participants (19–64 years old). Methods Data from 25 529 participants who completed the 2008–2012 Korean National Health and Nutrition Examination Survey were analyzed. Diagnosis of CRS was done according to the EP3OS 2012 guideline for epidemiologic study. Risk factors of CRS were compared in the aspects of sociodemographics, general health behaviors, clinical characteristics, and comorbidities of participants. Results The prevalence of CRS was significantly higher in 5590 elderly than in 19 939 younger adults (6.55% vs 5.69%; P = .016. Some variables of socioeconomic status and mental health in the adult group were associated with increased risk of CRS but did not show association in the elderly group. We observed a significant association between CRS prevalence and comorbid allergic rhinitis, asthma, and atopic dermatitis in both groups ( P < .05). However, in the elderly group, the associations were significantly weaker with regard to allergic rhinitis ( P-interaction = .03) and asthma ( P-interaction = .002). Conclusion These results suggest that elderly populations have distinct pathophysiology and clinical presentations from adult CRS, and management for elderly patients with CRS may require different or additional therapeutic approaches.

Climate change has become a topic of concern around the world. Many aspects of human well-being are affected by climate change. The social, economic, political, ecological and cultural development was influenced directly or indirectly. This paper has examined the role of climate change during the current period of the COVID-19 pandemic. The documentary analysis method was chosen. Various books, research reports, WHO databases and internet sources have been used extensively. Various literature shows that climate change may have played a significant role in the widespread effects of the COVID-19 pandemic. COVID-19 affects people with compromised immunity. The weakened immunity results from some diseases and treatments that weaken the body’s immunity. These include chronic lung diseases such as chronic asthma, some cancers, high blood pressure (hypertension), HIV / AIDS, and some developmental diseases. As a result, people become vulnerable to COVID-19. Poor diet also causes people to have weak immunity and become less resistant to the coronavirus. Poor nutrition results from changes in the climate pattern; Unavailability of sufficient and high-quality food, low production of sufficient food, and inaccessibility of high-quality food due to poverty. The world must take serious steps to stop excessive greenhouse gas emissions. If not, the human species will die as new diseases and viruses will emerge to take our lives as COVID-19 did.

Introduction: Asthma exacerbation is one of the most common causes of hospitalization among children. It was observed that severe asthma exacerbation is increasing in children with asthma. Objectives: The main objective of the study is to find the continuous versus intermittent nebulization of salbutamol in acute severe asthma. Material and methods: This randomized control trial study was conducted pulmonology department of DHQ Hospital Faisalabad and the duration of this study was from January 2019 to July 2019. Data was collected with the permission of ethical committee of hospital. The data was collected through random sampling technique. Patients were allocated by means of random table to receive salbutamol either by continuous or intermittent nebulization. Results: The data was collected from 100 asthma patients of both genders. The mean age of patients continuous nebulization was 34.56±2.34 years and in intermittent nebulization 39.89±4.76 years. Hypoxemia was present in all patients with a mean PaO2 is 198±78 mmHg in continuous nebulization. Demographic and clinical values are presented in table 01. Practical implication: We can easily apply this method in hospital treatment of continuous and intermittent nebulization of salbutamol in acute severe asthma. Conclusion: It is concluded that there is no difference in continuous and intermittent nebulization of salbutamol in acute severe asthma. In this regard, repeated nebulizations of salbutamol at 20-minute intervals should be regarded as almost identical to continuous nebulization. keywords: Nebulization, Intermittent, Patients

Background: Histidine is an important amino acid with important properties that enable it to play a vital part in many activities in the human body, such as proton buffering, metal ion chelation, scavenging of reactive oxygen and nitro-gen species, erythropoiesis and the histaminergic system. This review presents the impact of histidine level fluctuation on the body function, the physiological role and metabolic pathway of histidine in various parts of the human's body. Also, we investigated that histamine produc-tion by Histidine decarboxylase gene and there is relationship between histidine food intake and level of Histamine in blood, which resulting in the obesity, anemia and other nutrition issues. In addition, a neurotrans-mitter is included oin histamine that is widely distributed throughout the human brain; its deficiency could cause problems in the nervous system. This study revealed that deficiency of histidine contributed to mental problems like Parkinson's disease (PD), schizophrenia (SCZ), kidney and prion disease as well. As a result, histidine is important to keep hu-man body healthy, and it is also found that hisidine is used as a suitable drug for people who have schizophrenia. This review revealed that the correlation between histamine and asthma is still not well understood. So, this review will open way for researchers to focuses on this aspect. Keywords: Histidine, Histamine, physiological role, Parkinson's disease and human disease

ABSTRACT The human microbiota is a key contributor to many aspects of human health and its composition is largely influenced by diet. There is a growing body of scientific evidence to suggest that gut dysbiosis (microbial imbalance of the intestine) is associated with inflammatory and immune-mediated diseases (e.g., inflammatory bowel disease and asthma). Regular consumption of fermented foods (e.g., kimchi, kefir, etc.) may represent a potential avenue to counter the proinflammatory effects of gut dysbiosis. However, an assessment of the available literature in this research area is lacking. Here we provide a critical review of current human intervention studies that analyzed the effect of fermented foods on the composition and/or function of the human gut microbiota. A total of 19 human intervention studies were identified that met this search criteria. In this review, we discuss evidence that consumption of fermented foods may modify the gut microbiota in humans. Further, there is cursory evidence to suggest that gut microbiota compositional changes mediate associations between fermented food consumption and human health outcomes. Although promising, there remains considerable heterogeneity in the human populations targeted in the intervention studies we identified. Larger longitudinal feeding studies with longer follow-up are necessary to confirm and enhance the current data. Further, future studies should consider analyzing microbiota function as a means to elucidate the mechanism linking fermented food consumption with human health. This review highlights methodologic considerations for intervention trials, emphasizing an expanse of research opportunities related to fermented food consumption in humans.

Aim: To provide a review on the implications of different physiotherapy techniques for improving breathing patterns, lung capacities and volumes for management of Chronic Asthma COPD patients. Methodology: It was review on physical therapy interventions and results were formatted based.All the Randomized clinical/controlled trial published in last 5 years was selected. To trace articles, article searching was executed electronically using the following search terms: “Physiotherapy interventions”, “Asthma” and Medical Subject Headings (Mesh) on the following databases: PubMed and Web of Science. Only the full text available were selected and documented as per PICOS (Population, Interventions, Comparators, Outcomes, Study designs) model and PEDro Scale. Results: 1,594 articles were traced. After the application of inclusion and exclusion criteria, only 21 studies were analysed. Out of them16 were evaluated as physiotherapy intervention for asthmatic patients. Conclusion: The results evaluated by this study suggested that physical therapy provides an extensive choice of treatment for asthma patients and all of them shown improvements in quality of life and clinical symptoms. Different protocols of physiotherapy provide a massive range of variety of rehabilitation for asthmatic patient to cope with this situation and make them under control. Keywords: COPD, physiotherapy technique, PICOS, asthma

Background: Simplifying dose schedules may improve adherence and morbidity associated with asthma. There is limited data on the effects of once-daily budesonide treatment using a metered dosage inhaler (MDI) and a spacer on asthma symptoms and lung function in children, however. Method: This study was conducted in POF Hospital Wah Cantt Pediatrics Department between Jan 2022 to March 2022.This Study compared the impact of inhaled budesonide doses given once daily versus twice daily on asthmatic children's symptoms, lung function, and bronchial hyperresponsiveness. This research uses a randomised, single-blind, parallel clinical trial. Budesonide was administered to individuals using an MDI at a daily dose of either 800 mg or a fractionated dose of 400 mg twice a day for 12 weeks. For the statistical analysis, we employed both independent and paired sample tests. Results: Asthma symptoms significantly decreased in both groups. However, the once-daily group considerably outperformed the twice-daily group in terms of treatment adherence, reduction in BHR, and improvement in asthma symptoms (p <0.05). No significant variations in spirometric characteristics, morning peak expiratory flow, or plasma cortisol levels were discovered between the two groups. Conclusion: It has been shown that treating symptoms and improving BHR with one daily dose of 800g of inhaled budesonide delivered by MDI + spacer is more effective than dividing it into two doses of 400g each. The differences found in this study may have resulted from patients in the once-daily group adhering to their treatment more closely. Keywords: asthma, once, twice budesonide, wheezing

Objetivo: Determinar la presencia de enfermedades en niños menores de cinco años que fueron lactados durante 6 meses o más, en relación a los que recibieron lactancia materna durante menos de 6 meses. Materiales y métodos: El estudio se realizó en un jardín infantil de la ciudad de Manizales (Colombia), en 115 niños. Se evaluaron variables demográficas, de lactancia materna, y presencia anterior de algunas patologías. Resultados: La edad promedio de la población seleccionada fue de 31,35 meses, 54,8% de género femenino. El 7,8% recibieron lactancia materna exclusiva, el 51,8% fueron lactados durante 6 meses o más, tiempo promedio de lactancia materna 5.88 meses, inicio de alimentación complementaria 7,93 meses, suplementaria 4,91, duración alimentación suplementaria 10,22 meses. El 49,6% presentó diarrea, 20,9% bronquiolilitis, 9,6% asma, 23,5% dermatitis, 41,7% otitis media, 15,7% faringo-amigdalitis. Con relación a lactancia materna hasta los 6 meses, se encontró relación significativa (p<0,05) con haber padecido diarrea, faringitis, otitis y bronquiolitis. También se encontraron relaciones significativas entre la presencia de diarrea, bronquiolitis, dermatitis, otitis y faringitis, con tiempo de lactancia, edad de inicio y duración de la alimentación suplementaria y edad de inicio de la alimentación complementaria. Conclusiones: Se probó una vez más la importancia de la lactancia materna por lo menos hasta los 6 meses de edad. También se evidenció la importancia que tienen para la presentación de algunas patologías la edad de inicio, y tiempo de duración de la alimentación suplementaria, y la edad de inicio de la alimentación complementaria.Objective: To determine the prevalence of diseases in children under five years whowere breastfed during 6 months or more, in relation with those who were breastfed forless than 6 months. Materials and methods: The study was conducted on 115 childrenof a children garden in Manizales. Demographic variables and aspects such as exclusivebreastfeeding, complementary and supplementary feeding, diarrhea, bronchiolitis,otitis media, dermatitis among others where analyzed. Results: The average age ofthe selected population was of 31.35 months, 51.8% where girls. 7.8% were exclusivelybreastfed, 51.8% were breastfed during 6 months or more, the average durationof breastfeeding was of 5.88 months. Start of complementary nutrition 7.93 months,and supplementary nutrition 4.91 months, duration of supplementary nutrition 10.22months. 49.6% presented diarrhea, 20.9% bronchitis, 9.6% asthma, 23.5% dermatitis,41.7% medium otitis, 15.7% pharyngitis. In relation with breastfeeding until 6 months,a significant relation was found (p<0.05) with suffering from diarrhea, bronchiolitis,dermatitis, otitis and pharyngitis, with the duration of breastfeeding, age and durationof supplementary nutrition and age when complementary nutrition started. Conclusion:The importance of duration of exclusive breastfeeding until at least 6 months isrelevant as a protective factor for diseases such as diarrhea, pharyngitis, bronchiolitis,and other prevalent diseases in children under 5 years as atopic dermatitis. An earlystart in the complementary and supplementary feeding was associated with a greaterdiseases presence such as bronchiolitis, diarrhea and otitis media

AbstractNoncommunicable diseases (NCDs), also known as chronic diseases, are not passed from person to person. They are of long duration and generally slow progression. The four main types of NCDs are cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes. The rapid demographic and epidemiologic transition that India is facing today is paralleled by a massive increase in NCD prevalence, of which diabetes remains the most dominant. Besides genetic and environmental factors, an increase in life expectancy, urbanization, influenced unhealthy lifestyle changes, affluence associated with dietary excess, and reduced physical activity appear to be major drivers for increased burden of diabetes in India. Inappropriate nutrition and physical inactivity lead to obesity, a positive predictor for diabetes. Moreover, early onset of diabetes accompanied by prevailing poverty, low awareness, and poor health consciousness across socioeconomic and demographic strata is reflected in the large burden of undiagnosed cases of diabetes. In addition, reversal of socioeconomic gradient of disease burden observed in India can have serious health and financial implications on individual and healthcare system, which, if left unaddressed, may result in an adverse impact on the nation's economy. Keeping in view, a major shift in India's burden of disease, there is an imperative need for robust, systematic measures for data reporting supported by effective public healthcare interventions to reduce the burden of diabetes. Comprehensive multisectoral actions prioritizing identification of risk factors, early diagnosis, and effective implementation of cost-effective interventions can curb the epidemic of diabetes. A multifaceted approach for implementation of evidence-based policy measures involving various departments of the government and nongovernmental agencies is required to address both preventive and curative aspects of diabetes management. Policies that ensure better surveillance and increase in access to affordable and essential medicines providing universal health coverage should be developed. Policymakers should take lead in the development or strengthening the existing policies and see that they are not only implemented but also evaluated for their effectiveness. A strong commitment from both public and private sectors toward implementation and intensification of population-based prevention strategies through proven programs and policies is required to address the growing burden of diabetes.

Introduction Methods Resuts Discussion Conclusions Acknowledgments Authors' contributions Competing interests Ethical approval References Effect of Methotrexate and Omega-3 Combination on Cytogenetic Changes of Bone Marrow and Some Enzymatic Antioxidants: An Experimental Study Inaam N. Ali1, Muthana M. Awad2, Alaa S. Mahmood2,* 1 Water and Environment Directorate, Ministry of Sciences and Technology, Baghdad, Iraq 2 Department of Biology, College of Science, University of Anbar, Anbar, Iraq * Corresponding author: A. S. Mahmood (alaashm91@gmail.com) Abstract: Objective: To assess the effect of methotrexate and omega-3 combination on cytogenetic changes of bone marrow and activities of some enzymatic antioxidants. Methods: Fifty-six mature male Wistar rats were divided into two experimental groups and a control group. The first experimental group was sub-divided into three sub-groups depending on the concentration of methotrexate (MTX): X1 (0.05 mg/kg MTX), X2 (0.125 mg/kg MTX) and X3 (0.250 mg/kg MTX), which were given intraperitoneally on a weekly basis for eight weeks. The second experimental group (MTX and omega-3 group) was also sub-divided into three sub-groups (Y1, Y2 and Y3), which were injected intraperitoneally with 0.05, 0.125 and 0.25 mg/kg MTX, respectively, weekly for eight weeks accompanied by the oral administration of 300 mg/kg omega-3. The rats of the control group were given distilled water. The enzymatic activity of catalase (CAT), superoxide dismutase (SOD) and glutathione reductase (GR) were measured in the sera of rats. In addition, the mitotic index (MI) and chromosomal aberrations of bone marrow were also studied. Results: MTX resulted in a significant decrease in the activities of CAT, SOD and GR compared to the controls. It also increased the MI and chromosomal aberrations of rat bone marrows. On the other hand, omega-3 significantly increased the activities of the investigated enzymatic antioxidants and reduced the MI and chromosomal aberrations in treated mice when given in combination with MTX. Conclusions: MTX has a genotoxic effect on the bone marrow by increasing the MI and all types of chromosomal aberrations and decreasing the enzymatic activity of CAT, SOD and GR. The addition of omega-3 can lead to a protective effect by reducing the toxic and mutagenic effects of MTX. Keywords: Methotrexate, Omega-3, Antioxidant, Wistar rat, Chromosomal aberration, Mitotic index 1. Introduction Methotrexate (MTX) is a folic acid antagonist because of their chemical similarity [1]. Vezmar et al. [2] showed that MTX affects the synthesis of nucleic acids deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) by interfering with the biosynthesis of thymine and purines. It also directly affects the rapidly dividing and intact cells, especially those in the mucous membranes of the mouth, intestine and bone marrow [3]. Omega-3 is a type of unsaturated fats, which are classified as essential fatty acids that cannot be manufactured by the body and should be taken with food [4]. Sources of omega-3 include fish oils, such as salmon, sardines and tuna, as well as soybeans, walnuts, raisins and linseed, almonds and olive oils [5]. Omega-3 is used in the prevention of a number of diseases such as rheumatoid arthritis, ulcerative colitis, asthma, atherosclerosis, cancer, and cardiovascular diseases [6]. A large amount of evidence indicates that omega-3 fatty acids have significant health benefits, including anti-inflammatory and antioxidant properties besides their effect on blood cholesterol levels [7]. Antioxidants retard the oxidation process by different mechanisms such as the removal of free radicals [8]. Enzymatic antioxidants include catalase (CAT), which is the first line of defense in the cell that removes hydrogen peroxide formed during biological processes by converting it into an aldehyde, and superoxide dismutase (SOD). There are three major families of SOD enzymes: manganese SOD (Mn-SOD) in the mitochondria and peroxisomes, iron SOD (Fe-SOD) in prokaryote cells and copper/zinc SOD (Cu-Zn SOD) in the cytoplasm of eukaryote cells [9]. Therefore, changes in the metal co-factors (manganese, iron, copper and zinc) can alter the effectiveness of SOD and may lead to diseases as a result of oxidative stress [10]. Glutathione reductase (GR) is also an enzymatic antioxidant that converts the oxidized glutathione to the reduced glutathione in the presence of NADPH, which is oxidized to NADP [11]. Therefore, the aim of the present study was to assess the effects of MTX and omega-3 on the cytogenetic changes of bone marrow as well as the activities of CAT, SOD and GR enzymatic antioxidants in male rats. 2. Method 2.1. Laboratory animals and experimental design Fifty-six mature male Wistar rats (Rattus norvegicus), aged 10–12 weeks old and weighing 250–300 gm, were used in the present study. The rats were kept in separate cages, with natural 13- hour light and 11-hour dark periods in a contamination-free environment with a controlled temperature (28.0 ± 1.0°C). In addition, rats were maintained on a standard diet and tap water ad libitum. The rats were randomly allocated to two experimental groups and a control group. The first experimental group (MTX group) included 24 rats injected intraperitoneally with different MTX dilutions with distilled water [12]. It was sub-divided into three sub-groups (eight rats per sub-group) according to MTX concentration as follows: X1 (0.05 mg/kg MTX), X2 (0.125mg/kg MTX) and X3 (0.25 mg/kg MTX). All rats were given a single dose of the specified MTX concentration weekly for eight weeks. The second experimental group (MTX and omega-3 group) included 24 rats allocated to three sub-groups (Y1, Y2 and Y3), which were injected intraperitoneally with 0.05, 0.125 and 0.25 mg/kg MTX, respectively, weekly for eight weeks accompanied by the oral administration of 300 mg/kg omega-3. The control group included eight rats that were intraperitoneally injected with distilled water and given a single dose of distilled water orally weekly for eight weeks. 2.2. Blood collection and processing After the end of the dosing period, 5 ml of blood were withdrawn from the heart (by cardiac puncture) using a 5 cc disposable syringe. The collected blood was immediately poured into a clean sterile screw-capped tube (plain tube) and left for coagulation in a water bath at 37°C for 15 minutes. After coagulation of blood, the plain tube was centrifuged for 5 minutes at 1500 rpm. Then the samples were stored at -20°C for subsequent analysis. 2.3. Measurement of the activity of antioxidant enzymes The antioxidant activities of CAT, SOD and GR were measured using enzyme-linked immunosorbent assay kits purchased from Kamiya Biomedical Company (Seattle, WA, US), according to the manufacturer's instructions. 2.4. Cytogenetic study of bone marrow Rats were killed by cervical dislocation, and their hip bones were cleaned from surrounding muscles and then dissected by cutting both ends of the bone. Five milliliters of physiological buffered saline were injected inside the bone to withdraw bone marrow into a test tube. Tubes were centrifuged at 2000 rpm/10 minutes. The supernatant was then removed, and 10 ml of KCL solution (0.075 M) were added to the sediment. The mixture was then incubated at 37 °C in a water bath for 30 minutes, with shaking from time to time. The tubes were then centrifuged at 2000rpm/10 minutes to remove the supernatant. However, 5 ml of a freshly prepared fixative solution (methanol: glacial acetic acid 1:3) were added gradually in the form of droplets into the inner wall of the tube with constant mixing. After that, the tubes were placed at 4 °C for half an hour to fix the cells. This process was repeated for three times, and the cells were then suspended in 2 ml of the fixative solution. The tubes were centrifuged at 2000 rpm for 5 minutes, and the supernatant was then removed while the cells were re-suspended in 1-2 ml of cold fixative solution. After shaking the tubes, 4–5 drops were then taken from each tube onto a clean slide from a height of about three feet to provide an opportunity for the cells and nuclei to spread well. The slides were stained with acridine orange solution (0.01%) for 4–5 minutes, incubated in Sorensen’s buffer (0.06M, pH 6.5) for a minute. and then examined using a fluorescence microscope Olympus BX 51 America at a wavelength of 450–500 nm [13, 14]. A total of 1000 cells were examined, and both dividing and non-dividing cells were calculated [13]. Mitotic index (MI) was calculated according to the following formula [13]: MI= No. of dividing cells / 1000 × 100 2.5. Analysis of chromosomal aberrations of bone marrow cells A total of 1000 dividing cells were examined on the stained slides under a fluorescence microscope at a wavelength of 45–500 nm. The examined cells were at the first metaphase of the mitotic division, where chromosomal aberrations are clear and can be easily seen [13]. 2.6. Statistical analysis Data were analyzed using the Statistical Analysis System (SAS®) software, version 9.1 (Cary, NC, USA) [15]. Effects were expressed as mean ± standard error (SE) and statistically compared using a completely randomized design analysis of variance and least significant differences. Differences at P values <5 were considered statistically significant. 3. Results 3.1. Effects of MTX and MTX-omega-3 combination on antioxidant enzymatic activities Table (1) shows significantly lower SOD activities among rats treated with MTX or MTX-omega-3 compared to controls. Moreover, sera of rats receiving relatively high doses of MTX (sub-groups X2 and X3) showed the lowest enzymatic activities of 4.29 ± 0.01 IU and 3.93 ± 0.11 IU, respectively. On the other hand, CAT activity differed significantly between treated and control rats as well as among treated rats themselves, In this respect, the controls showed the highest activity of 39.38 ±0.02 IU, while those receiving the highest MTX concentration, either alone or in combination with omega-3 (sub-groups X3 and Y3), showed the lowest activities of 30.97 ± 0.03 IU and 32.12± 0.06 IU, respectively. Regarding GR activity, control rats showed a higher activity of 53.09± 0.05 IU compared to treated ones; however, the differences in GR activities in rats given low doses of MTX, either alone or in combination with omega-3 (sub-groups X1 and Y1), were not statistically significant. On the other hand, rats in sub-groups X3 and Y3 showed the lowest GR activities of 34.59 ± 0.63 IU and 37.15 ±0.01, respectively, with statistically significant differences from other sub-groups. 3.2. Effects of MTX and MTX-omega-3 combination on mitotic index of bone marrow cells Figure (1) shows a significant decrease in the MI in all treated groups compared to control. In addition, there was a reverse association between MTX concentration and MI, where rats treated with the highest dose of MTX (sub-group X3) showed a significant decrease in MI compared to all other treated rat sub-groups. In addition, rats in sub-groups treated with MTX and omega-3 (sub-groups Y1, Y2 and Y3) showed a significant increase in MI compared to their counterpart rats receiving MTX only. Table 1. Activity of antioxidant enzymes in rats treated with MTX and MTX-omega-3 Group Enzymatic activity (mean± SE) SOD (IU) CAT (IU) GR (µmol) Control 6.41±0.02 a 39.38±0.02 a 53.09±0.05 a X1 (0.05 mg MTX/ kg) 5.33±0.01 b 37.81±0.01 c 51.12±0.06 a Y1 (0.05 mg MTX + 300 mg omega-3/ kg) 6.08±0.04 a 38.40±0.02 b 51.97±0.03 a X2 (0.125 mg MTX/ kg) 4.29±0.01 cd 33.13±0.01 e 42.34±0.03 b Y2 (0.125 mg MTX + 300 mg omega-3/ kg) 4.99±0.40 b 36.68±0.02 d 43.02±3.04 b X3 (0.25 mg MTX/ kg) 3.93±0.11 d 30.97±0.03 g 34.59±0.63 c Y3 (0.25 mg MTX + 300 mg omega-3/ kg) 4.47±0.02 c 32.12±0.06 f 37.15±0.01 c SE, Standard error; IU, international unit; SOD, superoxide dismutase; CAT, catalase; GR, glutathione reductase; *statistically significant at P < 0.05; **statistically significant at P < 0.01. Means with different letters within the same column showed a statistically significant difference. 3.3. Effects of MTX and MTX-omega-3 combination on chromosomal aberrations of bone marrow cells Rats receiving higher concentrations of MTX (sub-group X3) showed a significant increase in all types of chromosomal aberrations, i.e., chromatid gaps, chromosome gaps, chromatid breaks, chromosome breaks, deletions and simple fragments (Figure 2 and Table 2) than those of the control group or other treated sub-groups. All rats treated with MTX-omega-3 combination showed a significant decrease in almost all types of chromosomal aberrations compared to their counterpart rats receiving MTX alone (Table 2). Figure 1. Effect of MTX and MTX-omega-3 on the MI of bone marrow cells of treated rats compared to the controls. The groups X1 (0.05 MTX), X2 (0.125 MTX) and X3 (0.250 MTX) were compared to the control group, while the groups Y1 (0.05 MTX+ omega-3), Y2 (0.125 MTX+ omega-3) and Y3 (0.25 MTX+ omega-3) were compared to X1, X2 and X3, respectively. Figure 2. Effect of MTX and MTX-omega-3 on chromosomal aberration as seen under fluorescence microscope after staining with acridine orange: (1) a simple fragment; (2) a chromatid gap; (3) a chromosomal gap (A) and a chromosomal break (B). 4. Discussion The present experiment reveals that the addition of omega-3 to MTX alleviates its effects on the activities of the antioxidant enzymes CAT, SOD and GR, and decreases the MI as well as all types of chromosomal aberrations in the bone marrow cells. Daham et al. [16] showed that the decline in antioxidants associated with chemotherapy is attributed to the increase in lipid peroxidation caused by these kinds of drugs, which increase the level of free radicals. In addition, Weijl et al. [17] showed that some chemotherapeutic drugs have a negative effect on the antioxidant levels such as GR, whose activity decreases as a result of its involvement in many cellular processes such as cell defenses against the toxicity of some compounds. Al-Dalawy et al. [18] found that the decrease in the level of SOD is an evidence of its increased activity due to the increased release of free radicals. MTX causes an increase in the release of free radicals, including the OH radical that causes direct damage to DNA [16]. Al-Helaly [19] showed that the amount of food taken has an effect on antioxidants, where nutritional deficiency decreases the antioxidant levels, thus increasing free radicals that cause damage to DNA. Table 2. Chromosomal aberrations of bone marrow cells in rats treated with MTX and MTX-omega-3 Group Type of chromosomal aberration(mean ± SE) Chromatid gap Chromosome Gap Chromatid breaks Chromosome breaks Deletion Simple Fragments Chromosomal aberration (%) Control 1.33±0.33 e 0.00±0.00 e 1.67±0.33 c 0.33±0.15 c 0.00±0.00 0.67±0.33 cd 0.04±0.005 f X1 2.75±0.47 cd 1.50±0.28 cd 2.50±0.64 bc 1.00±0.41 bc 0.50±0.28 bc 0.75±0.25 bcd 0.09±0.02 de Y1 1.75±0.47 de 0.75±0.25 de 1.50±0.28 c 1.00±0.00 bc 0.75±0.25 abc 0.75±0.25 abc 0.065±0.005 ef X2 4.67±0.33 b 2.67±0.33 ab 2.67±0.33 bc 1.67±0.33 ab 0.67±0.33 abc 1.67±0.33 ab 0.14±0.006 bc Y2 3.00±0.00 c 2.00±0.00 bc 3.00±0.057 bc 1.33±0.33 b 0.67±0.33 abc 0.33±0.15 d 0.106±0.003 cd X3 6.80±0.37 a 3.00±0.31 a 4.60±0.74 a 2.40±0.24 a 1.40±0.24 a 1.80±0.37 a 0.20±0.017 a Y3 5.60±0.40 ab 2.40±0.24 ab 3.60±0.24 ab 1.80±0.20 ab 1.20±0.20 ab 1.40±0.24 abc 0.16±0.003 b LSD 1.231** 0.814** 0.602** 0.841** 0.774* 0.941** 3.499* SE, Standard error; * statistically significant at P < 0.05; ** statistically significant at P < 0.01. Means with different letters within the same column showed a statistically significant difference. X1 (0.05 mg MTX/ kg); X2 (0.125 mg MTX/ kg); X3 (0.25 mg MTX/ kg); Y1 (0.05 mg MTX + 300 mg omega-3/ kg); Y2 (0.125 mg MTX + 300 mg omega-3/ kg); Y3 (0.25 mg MTX + 300 mg omega-3/ kg). In the present study, the intraperitoneal administration of MTX to rats also caused a decrease in the MI of bone marrow and a significant increase in the rate of abnormal chromosomal aberration compared to the control rats. This finding is consistent with those reported previously [20], [21]. The effect of MTX can be attributed to its ability to interfere with the genetic material, leading to the appearance of toxic and mutagenic consequences. Rushworth et al. [22] reported that MTX leads to a lack of dihydrofolate reductase, which is the key to the growth and cell division processes. This, in turn, leads to a reduction of the nucleotides involved in the building of DNA and, therefore, to a stop or obstruction of the repair mechanisms of the damaged DNA. In addition, Wong and Choi [23] concluded that MTX inhibits the action of enzymes controlling the purine metabolism, which leads to the accumulation of adenosine in addition to the damage of the molecule itself and to the occurrence of chromosomal aberrations. Jafer et al. [24] reported the ability of MTX to induce chromosomal aberration in humans or animals by preventing the repair of DNA and affecting the proteins found in chromosomes. These findings were also confirmed by Hussain et al. [25], who found that MTX causes an increase in chromosomal aberrations. In the present study, the MI showed a significant increase in rat sub-groups treated with MTX-omega-3 combination, but there was a decrease in the rate of chromosomal aberration, which confirms the role of omega-3 unsaturated fatty acids in protecting the cell from the impact of free radicals [26], [27]. Attia and Nasr [28] reported the antioxidant effect of omega-3, which was attributed to the reduction in lipid peroxidation and the increase in SOD and CAT or the stimulation of GR. It is noteworthy that GR leads to the synthesis of reduced glutathione, which is important in the defense of the cell against toxic substances and the prevention of the occurrence of mutations [29]. 5. Conclusions MTX significantly decreases the activity of enzymatic antioxidants, reduce the MI and increase the chromosomal aberrations of all types in bone marrow. This gives further evidence on the genotoxic effects of MTX on the bone marrow. 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Introduction Methods Resuts Discussion Conclusions Acknowledgments Authors' contributions Competing interests Ethical approval References Effect of Methotrexate and Omega-3 Combination on Cytogenetic Changes of Bone Marrow and Some Enzymatic Antioxidants: An Experimental Study Inaam N. Ali1, Muthana M. Awad2, Alaa S. Mahmood2,* 1 Water and Environment Directorate, Ministry of Sciences and Technology, Baghdad, Iraq 2 Department of Biology, College of Science, University of Anbar, Anbar, Iraq * Corresponding author: A. S. Mahmood (alaashm91@gmail.com) Abstract: Objective: To assess the effect of methotrexate and omega-3 combination on cytogenetic changes of bone marrow and activities of some enzymatic antioxidants. Methods: Fifty-six mature male Wistar rats were divided into two experimental groups and a control group. The first experimental group was sub-divided into three sub-groups depending on the concentration of methotrexate (MTX): X1 (0.05 mg/kg MTX), X2 (0.125 mg/kg MTX) and X3 (0.250 mg/kg MTX), which were given intraperitoneally on a weekly basis for eight weeks. The second experimental group (MTX and omega-3 group) was also sub-divided into three sub-groups (Y1, Y2 and Y3), which were injected intraperitoneally with 0.05, 0.125 and 0.25 mg/kg MTX, respectively, weekly for eight weeks accompanied by the oral administration of 300 mg/kg omega-3. The rats of the control group were given distilled water. The enzymatic activity of catalase (CAT), superoxide dismutase (SOD) and glutathione reductase (GR) were measured in the sera of rats. In addition, the mitotic index (MI) and chromosomal aberrations of bone marrow were also studied. Results: MTX resulted in a significant decrease in the activities of CAT, SOD and GR compared to the controls. It also increased the MI and chromosomal aberrations of rat bone marrows. On the other hand, omega-3 significantly increased the activities of the investigated enzymatic antioxidants and reduced the MI and chromosomal aberrations in treated mice when given in combination with MTX. Conclusions: MTX has a genotoxic effect on the bone marrow by increasing the MI and all types of chromosomal aberrations and decreasing the enzymatic activity of CAT, SOD and GR. The addition of omega-3 can lead to a protective effect by reducing the toxic and mutagenic effects of MTX. Keywords: Methotrexate, Omega-3, Antioxidant, Wistar rat, Chromosomal aberration, Mitotic index 1. Introduction Methotrexate (MTX) is a folic acid antagonist because of their chemical similarity [1]. Vezmar et al. [2] showed that MTX affects the synthesis of nucleic acids deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) by interfering with the biosynthesis of thymine and purines. It also directly affects the rapidly dividing and intact cells, especially those in the mucous membranes of the mouth, intestine and bone marrow [3]. Omega-3 is a type of unsaturated fats, which are classified as essential fatty acids that cannot be manufactured by the body and should be taken with food [4]. Sources of omega-3 include fish oils, such as salmon, sardines and tuna, as well as soybeans, walnuts, raisins and linseed, almonds and olive oils [5]. Omega-3 is used in the prevention of a number of diseases such as rheumatoid arthritis, ulcerative colitis, asthma, atherosclerosis, cancer, and cardiovascular diseases [6]. A large amount of evidence indicates that omega-3 fatty acids have significant health benefits, including anti-inflammatory and antioxidant properties besides their effect on blood cholesterol levels [7]. Antioxidants retard the oxidation process by different mechanisms such as the removal of free radicals [8]. Enzymatic antioxidants include catalase (CAT), which is the first line of defense in the cell that removes hydrogen peroxide formed during biological processes by converting it into an aldehyde, and superoxide dismutase (SOD). There are three major families of SOD enzymes: manganese SOD (Mn-SOD) in the mitochondria and peroxisomes, iron SOD (Fe-SOD) in prokaryote cells and copper/zinc SOD (Cu-Zn SOD) in the cytoplasm of eukaryote cells [9]. Therefore, changes in the metal co-factors (manganese, iron, copper and zinc) can alter the effectiveness of SOD and may lead to diseases as a result of oxidative stress [10]. Glutathione reductase (GR) is also an enzymatic antioxidant that converts the oxidized glutathione to the reduced glutathione in the presence of NADPH, which is oxidized to NADP [11]. Therefore, the aim of the present study was to assess the effects of MTX and omega-3 on the cytogenetic changes of bone marrow as well as the activities of CAT, SOD and GR enzymatic antioxidants in male rats. 2. Method 2.1. Laboratory animals and experimental design Fifty-six mature male Wistar rats (Rattus norvegicus), aged 10–12 weeks old and weighing 250–300 gm, were used in the present study. The rats were kept in separate cages, with natural 13- hour light and 11-hour dark periods in a contamination-free environment with a controlled temperature (28.0 ± 1.0°C). In addition, rats were maintained on a standard diet and tap water ad libitum. The rats were randomly allocated to two experimental groups and a control group. The first experimental group (MTX group) included 24 rats injected intraperitoneally with different MTX dilutions with distilled water [12]. It was sub-divided into three sub-groups (eight rats per sub-group) according to MTX concentration as follows: X1 (0.05 mg/kg MTX), X2 (0.125mg/kg MTX) and X3 (0.25 mg/kg MTX). All rats were given a single dose of the specified MTX concentration weekly for eight weeks. The second experimental group (MTX and omega-3 group) included 24 rats allocated to three sub-groups (Y1, Y2 and Y3), which were injected intraperitoneally with 0.05, 0.125 and 0.25 mg/kg MTX, respectively, weekly for eight weeks accompanied by the oral administration of 300 mg/kg omega-3. The control group included eight rats that were intraperitoneally injected with distilled water and given a single dose of distilled water orally weekly for eight weeks. 2.2. Blood collection and processing After the end of the dosing period, 5 ml of blood were withdrawn from the heart (by cardiac puncture) using a 5 cc disposable syringe. The collected blood was immediately poured into a clean sterile screw-capped tube (plain tube) and left for coagulation in a water bath at 37°C for 15 minutes. After coagulation of blood, the plain tube was centrifuged for 5 minutes at 1500 rpm. Then the samples were stored at -20°C for subsequent analysis. 2.3. Measurement of the activity of antioxidant enzymes The antioxidant activities of CAT, SOD and GR were measured using enzyme-linked immunosorbent assay kits purchased from Kamiya Biomedical Company (Seattle, WA, US), according to the manufacturer's instructions. 2.4. Cytogenetic study of bone marrow Rats were killed by cervical dislocation, and their hip bones were cleaned from surrounding muscles and then dissected by cutting both ends of the bone. Five milliliters of physiological buffered saline were injected inside the bone to withdraw bone marrow into a test tube. Tubes were centrifuged at 2000 rpm/10 minutes. The supernatant was then removed, and 10 ml of KCL solution (0.075 M) were added to the sediment. The mixture was then incubated at 37 °C in a water bath for 30 minutes, with shaking from time to time. The tubes were then centrifuged at 2000rpm/10 minutes to remove the supernatant. However, 5 ml of a freshly prepared fixative solution (methanol: glacial acetic acid 1:3) were added gradually in the form of droplets into the inner wall of the tube with constant mixing. After that, the tubes were placed at 4 °C for half an hour to fix the cells. This process was repeated for three times, and the cells were then suspended in 2 ml of the fixative solution. The tubes were centrifuged at 2000 rpm for 5 minutes, and the supernatant was then removed while the cells were re-suspended in 1-2 ml of cold fixative solution. After shaking the tubes, 4–5 drops were then taken from each tube onto a clean slide from a height of about three feet to provide an opportunity for the cells and nuclei to spread well. The slides were stained with acridine orange solution (0.01%) for 4–5 minutes, incubated in Sorensen’s buffer (0.06M, pH 6.5) for a minute. and then examined using a fluorescence microscope Olympus BX 51 America at a wavelength of 450–500 nm [13, 14]. A total of 1000 cells were examined, and both dividing and non-dividing cells were calculated [13]. Mitotic index (MI) was calculated according to the following formula [13]: MI= No. of dividing cells / 1000 × 100 2.5. Analysis of chromosomal aberrations of bone marrow cells A total of 1000 dividing cells were examined on the stained slides under a fluorescence microscope at a wavelength of 45–500 nm. The examined cells were at the first metaphase of the mitotic division, where chromosomal aberrations are clear and can be easily seen [13]. 2.6. Statistical analysis Data were analyzed using the Statistical Analysis System (SAS®) software, version 9.1 (Cary, NC, USA) [15]. Effects were expressed as mean ± standard error (SE) and statistically compared using a completely randomized design analysis of variance and least significant differences. Differences at P values <5 were considered statistically significant. 3. Results 3.1. Effects of MTX and MTX-omega-3 combination on antioxidant enzymatic activities Table (1) shows significantly lower SOD activities among rats treated with MTX or MTX-omega-3 compared to controls. Moreover, sera of rats receiving relatively high doses of MTX (sub-groups X2 and X3) showed the lowest enzymatic activities of 4.29 ± 0.01 IU and 3.93 ± 0.11 IU, respectively. On the other hand, CAT activity differed significantly between treated and control rats as well as among treated rats themselves, In this respect, the controls showed the highest activity of 39.38 ±0.02 IU, while those receiving the highest MTX concentration, either alone or in combination with omega-3 (sub-groups X3 and Y3), showed the lowest activities of 30.97 ± 0.03 IU and 32.12± 0.06 IU, respectively. Regarding GR activity, control rats showed a higher activity of 53.09± 0.05 IU compared to treated ones; however, the differences in GR activities in rats given low doses of MTX, either alone or in combination with omega-3 (sub-groups X1 and Y1), were not statistically significant. On the other hand, rats in sub-groups X3 and Y3 showed the lowest GR activities of 34.59 ± 0.63 IU and 37.15 ±0.01, respectively, with statistically significant differences from other sub-groups. 3.2. Effects of MTX and MTX-omega-3 combination on mitotic index of bone marrow cells Figure (1) shows a significant decrease in the MI in all treated groups compared to control. In addition, there was a reverse association between MTX concentration and MI, where rats treated with the highest dose of MTX (sub-group X3) showed a significant decrease in MI compared to all other treated rat sub-groups. In addition, rats in sub-groups treated with MTX and omega-3 (sub-groups Y1, Y2 and Y3) showed a significant increase in MI compared to their counterpart rats receiving MTX only. Table 1. Activity of antioxidant enzymes in rats treated with MTX and MTX-omega-3 Group Enzymatic activity (mean± SE) SOD (IU) CAT (IU) GR (µmol) Control 6.41±0.02 a 39.38±0.02 a 53.09±0.05 a X1 (0.05 mg MTX/ kg) 5.33±0.01 b 37.81±0.01 c 51.12±0.06 a Y1 (0.05 mg MTX + 300 mg omega-3/ kg) 6.08±0.04 a 38.40±0.02 b 51.97±0.03 a X2 (0.125 mg MTX/ kg) 4.29±0.01 cd 33.13±0.01 e 42.34±0.03 b Y2 (0.125 mg MTX + 300 mg omega-3/ kg) 4.99±0.40 b 36.68±0.02 d 43.02±3.04 b X3 (0.25 mg MTX/ kg) 3.93±0.11 d 30.97±0.03 g 34.59±0.63 c Y3 (0.25 mg MTX + 300 mg omega-3/ kg) 4.47±0.02 c 32.12±0.06 f 37.15±0.01 c SE, Standard error; IU, international unit; SOD, superoxide dismutase; CAT, catalase; GR, glutathione reductase; *statistically significant at P < 0.05; **statistically significant at P < 0.01. Means with different letters within the same column showed a statistically significant difference. 3.3. Effects of MTX and MTX-omega-3 combination on chromosomal aberrations of bone marrow cells Rats receiving higher concentrations of MTX (sub-group X3) showed a significant increase in all types of chromosomal aberrations, i.e., chromatid gaps, chromosome gaps, chromatid breaks, chromosome breaks, deletions and simple fragments (Figure 2 and Table 2) than those of the control group or other treated sub-groups. All rats treated with MTX-omega-3 combination showed a significant decrease in almost all types of chromosomal aberrations compared to their counterpart rats receiving MTX alone (Table 2). Figure 1. Effect of MTX and MTX-omega-3 on the MI of bone marrow cells of treated rats compared to the controls. The groups X1 (0.05 MTX), X2 (0.125 MTX) and X3 (0.250 MTX) were compared to the control group, while the groups Y1 (0.05 MTX+ omega-3), Y2 (0.125 MTX+ omega-3) and Y3 (0.25 MTX+ omega-3) were compared to X1, X2 and X3, respectively. Figure 2. Effect of MTX and MTX-omega-3 on chromosomal aberration as seen under fluorescence microscope after staining with acridine orange: (1) a simple fragment; (2) a chromatid gap; (3) a chromosomal gap (A) and a chromosomal break (B). 4. Discussion The present experiment reveals that the addition of omega-3 to MTX alleviates its effects on the activities of the antioxidant enzymes CAT, SOD and GR, and decreases the MI as well as all types of chromosomal aberrations in the bone marrow cells. Daham et al. [16] showed that the decline in antioxidants associated with chemotherapy is attributed to the increase in lipid peroxidation caused by these kinds of drugs, which increase the level of free radicals. In addition, Weijl et al. [17] showed that some chemotherapeutic drugs have a negative effect on the antioxidant levels such as GR, whose activity decreases as a result of its involvement in many cellular processes such as cell defenses against the toxicity of some compounds. Al-Dalawy et al. [18] found that the decrease in the level of SOD is an evidence of its increased activity due to the increased release of free radicals. MTX causes an increase in the release of free radicals, including the OH radical that causes direct damage to DNA [16]. Al-Helaly [19] showed that the amount of food taken has an effect on antioxidants, where nutritional deficiency decreases the antioxidant levels, thus increasing free radicals that cause damage to DNA. Table 2. Chromosomal aberrations of bone marrow cells in rats treated with MTX and MTX-omega-3 Group Type of chromosomal aberration(mean ± SE) Chromatid gap Chromosome Gap Chromatid breaks Chromosome breaks Deletion Simple Fragments Chromosomal aberration (%) Control 1.33±0.33 e 0.00±0.00 e 1.67±0.33 c 0.33±0.15 c 0.00±0.00 0.67±0.33 cd 0.04±0.005 f X1 2.75±0.47 cd 1.50±0.28 cd 2.50±0.64 bc 1.00±0.41 bc 0.50±0.28 bc 0.75±0.25 bcd 0.09±0.02 de Y1 1.75±0.47 de 0.75±0.25 de 1.50±0.28 c 1.00±0.00 bc 0.75±0.25 abc 0.75±0.25 abc 0.065±0.005 ef X2 4.67±0.33 b 2.67±0.33 ab 2.67±0.33 bc 1.67±0.33 ab 0.67±0.33 abc 1.67±0.33 ab 0.14±0.006 bc Y2 3.00±0.00 c 2.00±0.00 bc 3.00±0.057 bc 1.33±0.33 b 0.67±0.33 abc 0.33±0.15 d 0.106±0.003 cd X3 6.80±0.37 a 3.00±0.31 a 4.60±0.74 a 2.40±0.24 a 1.40±0.24 a 1.80±0.37 a 0.20±0.017 a Y3 5.60±0.40 ab 2.40±0.24 ab 3.60±0.24 ab 1.80±0.20 ab 1.20±0.20 ab 1.40±0.24 abc 0.16±0.003 b LSD 1.231** 0.814** 0.602** 0.841** 0.774* 0.941** 3.499* SE, Standard error; * statistically significant at P < 0.05; ** statistically significant at P < 0.01. Means with different letters within the same column showed a statistically significant difference. X1 (0.05 mg MTX/ kg); X2 (0.125 mg MTX/ kg); X3 (0.25 mg MTX/ kg); Y1 (0.05 mg MTX + 300 mg omega-3/ kg); Y2 (0.125 mg MTX + 300 mg omega-3/ kg); Y3 (0.25 mg MTX + 300 mg omega-3/ kg). In the present study, the intraperitoneal administration of MTX to rats also caused a decrease in the MI of bone marrow and a significant increase in the rate of abnormal chromosomal aberration compared to the control rats. This finding is consistent with those reported previously [20], [21]. The effect of MTX can be attributed to its ability to interfere with the genetic material, leading to the appearance of toxic and mutagenic consequences. Rushworth et al. [22] reported that MTX leads to a lack of dihydrofolate reductase, which is the key to the growth and cell division processes. This, in turn, leads to a reduction of the nucleotides involved in the building of DNA and, therefore, to a stop or obstruction of the repair mechanisms of the damaged DNA. In addition, Wong and Choi [23] concluded that MTX inhibits the action of enzymes controlling the purine metabolism, which leads to the accumulation of adenosine in addition to the damage of the molecule itself and to the occurrence of chromosomal aberrations. Jafer et al. [24] reported the ability of MTX to induce chromosomal aberration in humans or animals by preventing the repair of DNA and affecting the proteins found in chromosomes. These findings were also confirmed by Hussain et al. [25], who found that MTX causes an increase in chromosomal aberrations. In the present study, the MI showed a significant increase in rat sub-groups treated with MTX-omega-3 combination, but there was a decrease in the rate of chromosomal aberration, which confirms the role of omega-3 unsaturated fatty acids in protecting the cell from the impact of free radicals [26], [27]. Attia and Nasr [28] reported the antioxidant effect of omega-3, which was attributed to the reduction in lipid peroxidation and the increase in SOD and CAT or the stimulation of GR. It is noteworthy that GR leads to the synthesis of reduced glutathione, which is important in the defense of the cell against toxic substances and the prevention of the occurrence of mutations [29]. 5. Conclusions MTX significantly decreases the activity of enzymatic antioxidants, reduce the MI and increase the chromosomal aberrations of all types in bone marrow. This gives further evidence on the genotoxic effects of MTX on the bone marrow. On the other hand, omega-3 shows a protective effect by reducing the toxic and mutagenic effects of MTX. Acknowledgments The authors thank the staff of the Water and Environment Directorate, Ministry of Science and Technology, Baghdad, Iraq for their cooperation. They also thank Dr. Jasim Al-Niami for his technical and scientific guidance. Authors' contributions INA, MMA and ASM contributed to the study design and analyzed data. All authors contributed to the manuscript drafting and revising and approved the final submission. Competing interests The authors declare that they have no competing interests associated with this article. Ethical approval The ethical clearance of this study was obtained from the Ethics Committee of the College of Science, University of Anbar (Reference No. A. D. 51 in 30/8/2015). References Yuen CW, Winter ME. Methotrexate (MTX). In: Basic clinical pharmacokinetics, Winter ME, editor. Philadelphia, USA: Lippincott Williams & Wilkins; 2010. p.p. 304–25. 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Abstract: Plants are used by almost 80% of the world's population for health and healing, and medicinal and aromatic plants account for 25% of all integrated pharmaceuticals. Moringa oleifera is a multi-purpose herbal plant that is utilized as a portion of human food and a therapeutic alternative all over the world. According to studies, it has been discovered as a plant with a wide range of health benefits, including nutritional and medicinal characteristics. It can live on nutrient-depleted soils and is drought-resistant, and it flourishes in wet tropics and scorching dry regions. With a pH of 5.0–9.0 and a minimum annual rainfall need of 250 mm and a maximum annual rainfall demand of over 3000 mm, it can endure a wide variety of rainfall. Moringa is a plant that can aid in the fight against climate change. Moringa’s ability to respond to water stress and its tolerance to it were investigated in this study. Moringa is used in traditional medicine all over the world for a variety of ailments, including skin infections, anemia, anxiety, asthma, blood impurities, bronchitis, chest congestion, cholera, infections, fever, glandular, swelling, headaches, abnormal blood pressure, hysteria, pain in joints, pimples, psoriasis, respiratory disorders, scurvy, semen deficiency, sore throat, sprain, tuberculosis, for intestinal worms, lactation, diabetes, and pregnancy. Moringa oil is prized in the cosmetic business because of its unique properties. Moringa oil is light and easily absorbed by the skin. It's ideal for massage and aromatherapy purposes. Although M. oleifera's nutritional value is lower than that claimed by popular nutritional claims, its abundance in food-insecure areas and wide range of nutrients keep it viable as a nutritious food source for populations in low- and middle-income countries. Malnutrition, which includes undernutrition, micronutrient deficiency, and overnutrition, is more widespread than hunger per se and affects most nations around the world. The diversity and quality of food produced and consumed are crucial in reducing the triple burden of malnutrition. In this climate, fruit, vegetables, and nuts are quickly becoming the focus of the nutrition community. Moringa's diet is higher in polyunsaturated fatty acids (PUFAs) than in saturated fatty acids (SFAs).

: Medicinal plants have been globally exploiting as an alternative to chemical drugs in the treatment of several diseases due to low unwanted side effects, environmentally friendly nature and low production costs, therefore, it is important to analyze the therapeutic properties of various medicinal plants to understand their potential bioactivity. Uncaria tomentosa is one of these medicinal plants with many health-promoting effects. Although the geographical resources of cat's claw go back to the remote tropics of the Amazon, industrialized countries use the plant extensively in trade. Various parts of the plants such as flowers, leaves, Stem, hook, and seed are mainly used medicinally to treat inflammation, asthma, allergies, skin impurities, microbial infections, neurodegenerative diseases, cancer, cirrhosis, gastrointestinal disorders, arthritis, heart disease, rheumatism, and fever. The end point of this review article is to prospectively scrutinize in vitro and in vivo the therapeutic potential of this plant, especially in terms of its nutritional applications and health beneficial effects.

Studies focusing on obesity and asthma frequently consider the weight at a given time; thus, modeling pathways through lifetime overweight may contribute to elucidate temporal aspects in this relationship. This study modeled the pathways in the association of lifetime overweight with asthma in adult life, using data from the 1978/1979 Birth Cohort, Ribeirão Preto, São Paulo, Brazil (n = 2,063) at birth (baseline), school age (9/11 years) and adult age (23/25 years). A theoretical model was proposed to explore the effects of lifetime overweight on asthma in adult life analyzed by structural equation modeling. Parental obesity (SC - standardized coefficenttotal = 0.211, p < 0.001; SCdirect = 0.115, p = 0.007) and overweight at school age (SCtotal = 0.565, p < 0.0001; SCdirect = 0.565, p < 0.0001) were associated with overweight in adult life. Parental obesity (SCdirect = 0.105, p = 0.047) and nutritional status at birth (SCtotal = -0.124, p = 0.009; SCdirect = -0.131, p = 0.007) were associated with asthma in adult life. A higher “current adult socieconomic situation” was inversely associated to overweight (SCdirect = -0.171, p = 0.020) and to asthma in adult life (SCtotal = -0.179, p = 0.041; SCdirect = -0.182, p = 0.039). Parental obesity showed a transgenerational effect in weight, triggering to childhood and adulthood overweight. Parallel to underweight at birth, parental obesity was also a risk to asthma in adult life. While, the socioeconomic status in adult life protected from both, overweight and asthma.

With the rising trend toward the use of natural substances in medicines, the utilization of cress seed mucilage (Lepidium sativum L.) has gained significant importance.Since the Vedic period, the subcontinent has employed garden cress (Lepidium sativum) for medical reasons. There are several ecological and industrial uses of garden cress that are summarized in this paper. The emerging evidence revealed that in the Unani school of medicine, the seeds and leaves of this plant might be used to treat inflammation, bronchitis, rheumatoid arthritis, and muscle discomfort. Asthma, cough, and peptic ulcers are also said to benefit from their usage. Anti-hemagglutinating, hypoglycemic, antihypertensive, diuretic, and fracture-healing qualities are also attributed to the plant. A special emphasis was placed in the study on the nutritional content of the leaves, which revealed that they are an excellent source of macroelements such as potassium and sodium, but also of calcium and trace minerals such as iron, magnesium and zinc. Conclusion:The current study also discusses the culinary items that have been created by combining garden cress seed powder with other ingredients. As an underused oilseed crop, garden cress seeds should be promoted for their production and consumption.

Ajwain, dried mature seed like fruits are well known by names such as thymol seeds, caraway, carom, ajowan, or bishop's weed, belongs to the Apiaceae family. Carum copticum is the Latin name for this spice. Trachyspermum ammi (L.) Sprague ex Turrill is scientific name. This spice is indigenous to Egypt, although it is also cultivate in India, Iran, Pakistan, Iraq, Afganistan, other nations in South and West Asia as well as Europe. Gujarat and Rajasthan are Indian states noted for their ajwain cultivation. It is known as Zenyan or Nankhah in medical and pharmaceutical manuscript of medieval Persia. As Traditional Persian Medicine, Ajwain was well known from thousands of years in unani as well as ayurveda. It is used as a spice world-widely. This plant contains a variety of bioactive compunds of pharmacological importance, involving carbohydrates, fat, fibre, glycosides, protein, phenolic compounds, volatile oil (thymol, γ-terpinene, para-cymene, and α-and β-pinene), saponins and mineral content are found in this plant. The ajwain extract is known as "Admoda Arka" in Ayurveda. Ethnopharmacological values added by Vaidya gurus for coughs, colds, pain, headaches, heartburn, asthma, diarrhoea, painful menstruation, cholera, stomach discomfort, and smooth respiratory and kidney function. It has been used in modern medicine due to clinical findings of its pharmacological activities involving Bronchodilator, Cardiac Stimulant, Carminative, Digestive Stimulant, Diuretic, Galactagogue, Hypo-glycemic, Antioxidant, Antifungal, Anthelmintic, Anti-arthritic, Anti-inflammatory, Antiflatulent, Analgesic, Antimicrobial, Antihypertensive, Antifilarial. In this paper we primarily focused on Detailed phytochemistry along with Pharmcognostical and Nutritional values, also traditional and modern pharmacological role along with its safety measurement.

AbstractBeijing will host the 2022 Winter Olympics, and China strengthens research on various aspects to allow their athletes to compete successfully in winter sport. Simultaneously, Government-directed initiatives aim to increase public participation in recreational winter sport. These parallel developments allow research to advance knowledge and understanding of the physiological determinants of performance and health related to winter sport. Winter sport athletes often conduct a substantial amount of training with high volumes of low-to-moderate exercise intensity and lower volumes of high-intensity work. Moreover, much of the training occur at low ambient temperatures and winter sport athletes have high risk of developing asthma or asthma-related conditions, such as exercise-induced bronchoconstriction. The high training volumes require optimal nutrition with increased energy and dietary protein requirement to stimulate muscle protein synthesis response in the post-exercise period. Whether higher protein intake is required in the cold should be investigated. Cross-country skiing is performed mostly in Northern hemisphere with a strong cultural heritage and sporting tradition. It is expected that innovative initiatives on recruitment and training during the next few years will target to enhance performance of Chinese athletes in classical endurance-based winter sport. The innovation potential coupled with resourcing and population may be substantial with the potential for China to become a significant winter sport nation. This paper discusses the physiological aspects of endurance training and performance in winter sport highlighting areas where innovation may advance in athletic performance in cold environments. In addition, to ensure sustainable development of snow sport, a quality ski patrol and rescue system is recommended for the safety of increasing mass participation.

Background of the problem Non-communicable diseases (NCDs) have replaced communicable diseases as the most common causes of 1 morbidity and premature mortality worldwide. Of 56.4 million global deaths in 2015, 70% (39.5 million) were due to noncommunicable diseases (NCDs). In 2015, over three quarters of NCD deaths i.e., 30.7 million occurred in low and middle income countries with about 48% of deaths occurring before the age of 70 years in these countries. The leading causes of NCD deaths in 2015 were cardiovascular diseases (17.7 million deaths, or 45% of all NCD deaths), cancers (8.8 million, or 22% of all NCD deaths), and respiratory diseases, including asthma and chronic obstructive pulmonary 2 diseases (3.9 million). Deaths due to Non communicable diseases are projected to increase from 38 million in 2012 to 52 1 million by 2030.

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STAVRICĂ, Luminiţa Nirlu, Laura Georgiana Popescu, Ana Carmen Albeşteanu, Gelu ONOSE - 12 minutes DIAGNOSTIC AND THERAPEUTIC APPROACHES IN REHABILITATION CORRELATED TO A CASE OF TETRAPARESIS (WITH PREDOMINANCE OF PARAPARESIS) AFTER SEVERE CCT - BIFRONTO - BASAL AND BITEMPORAL CONTUSION. Link L19 Ana Maria Bumbea, Otilia Rogoveanu, Carmen,Albu Rodica Traistaru, Catalin,Bostina, Bogdan Stefan Bumbea, Roxana Dumitrascu, Borcan Madalina MANAGEMENT OF SPASTICITY IN NEUROLOGICAL PATIENTS Link L20 Laura Georgiana Popescu, Luminița Nirlu, Ana Carmen Albeșteanu, Ali Osman Saglam, Gelu Onose - 12 minutes PARTICULARITIES OF COMPLEX THERAPEUTICALLY-REHABILITATIVE MANAGEMENT, STEPWISE, IN A PATIENT WITH POST-CCT PSYCHO-COGNITIVE IMPAIRMENT IN A LARGE POLYTRAMATIC CONTEXT - CASE REPORT Link L21 Adrian MELNIC, Oleg PASCAL - 12 minutes DEVELOPING STRATEGIES TO ADDRESS COMORBIDITY IN STROKE REHABILITATION. Link L22 Dorin-Gheorghe TRIFF, Simona POP - 12 minutes MONOGENIC DISEASES WITH MUSCULO ARTICULAR LAXITY. DIAGNOSTIC CRITERIA AND PRINCIPLES OF RECOVERY THERAPY Link L23 Catalin Ionite, Dragos Arotaritei, Mihai Ilea, Mariana Rotariu - 12 minutes THE USE OF ELASTIC BANDS IN THE RECOVERY OF ANKLE SPRAINS Link L24 Mariana Rotariu, Marius Turnea, Calin Corciova, Catalin Ionite - 12 minutes THE EFFECTS OF CUBE THERAPY IN THE RECOVERY OF THE ARTHROSIS HAND IN GERIATRICS Link L25 Cristian Ştefan LIUŞNEA - 12 minutes FITNESS AND WELLNESS. CONCEPTUAL DELIMITATIONS Link L26 Adriana LUPU - 12 minutes NSAID THERAPY OF MUSCULOSKELETAL PAINS AND ITS PARTICULARITIES IN THE PATIENTS SUFFERING FROM CARDIOVASCULAR DISORDERS Link L27 Q & A – 12 minutes Authors Title Abstract Mihaela MANDU, Cristinel Dumitru BADIU, Raluca PETCU, Cosmin OPREA, Gelu ONOSE - 12 minutes CLINICAL-EVOLUTIVE PARTICULARITIES AND A MULTIMODAL THERAPEUTIC-REHABILITATIVE, AS WELL AS THROUGH CONNECTED CARES, APPROACH, IN A CASE OF HEMIPLEGIA AFTER ISCHEMIC CARDIO-EMBOLIC STROKE WITHIN A POLYPATHOLOGICAL CONTEXT Link L28 Ana Carmen Albesteanu, Laura Georgiana Popescu, Luminița Nirlu, Ali Osman Saglam, Gelu Onose - 12 minutes MULTIMODAL - REHABILITATIVE THERAPEUTICAL APPROACHES IN A COMPLEX OF PATHOLOGY INCLUDING POSSIBLY EVOLVING DISCARIOTIC TYPE - CASE REPORT Link L29 Liliana PADURE, Cristian Adam, Laura Fierbinteanu - 12 minutes ATTACHMENT - PROGNOSTIC FACTOR IN MEDICAL RECOVERY Link L30 Prof. Alexandru Vlad Ciurea - 20 minutes MOTILITY OR MORBIDITY IN NEUROSURGERY Link L31 Valerica CREANGA-ZARNESCU, Ana-Maria FATU, Anamaria CIUBARA, Violeta SAPIRA,Aurelia ROMILA, Mihaela LUNGU - 12 minutes EXERCISES PROGRAM AND REHABILITATION IN PARKINSON’S DISEASE Link L32 Irina VERINCEANU,Alice MUNTEANU, Andreea STOICA, Stefan ISPAS - 12 minutes THE CARDIAC REHABILITATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION Link L33 Marius Turnea, Catalin Ionite, Mihai Ilea, Dragos Arotaritei - 12 minutes STATISTICAL ANALYSIS OF PHYSIOTHERAPEUTIC MEANS USED IN THE RECOVERY OF MUSCLE INJURIES IN ATHLETES Link L34 Mihaiela CHICU, Eugen BITERE - 10 minutes THE ROLE OF IL1β IN CARTILAGINOUS DISTRUCTION IN RHEUMATOID ARTHRITIS Link L35 Mihaiela CHICU, Eugen BITERE - 10 minutes THE ROLE OF THE INFLAMMASOMS IN THE PATHOGENESIS OF INFLAMMATORY REACTION Link L36 Q & A – 8 minutes Authors Title Abstract Prof. Dr. Gelu Onose, (Keynote Speaker) Vlad Ciobanu, Corina Sporea - 20 minutes A TOPICAL SYSTEMATIC LITERATURE REVIEW AND REAPPRAISAL ON ESSAYS TOWARDS SYSTEMATIZING CLINICAL ASSESSMENT INSTRUMENTS USED TO EVALUATE NEURO-functional deficits after spinal cord injuries, mainly in adults, including through the ICF(-DH) conceptual framework Link L37 Diana-Elena SERBAN, Aurelian ANGHELESCU, Elena CONSTANTIN, Gelu ONOSE - 12 minutes THE ACQUISITION OF SELF-DEFENSE TECHNIQUES AND PROCEDURES AGAINST THE ACT OF AGGRESSION IN THE PACIENT WITH PARAPLEGIA, WHEEL-CHAIR INDEPENDENT Link L38 Aurelian Anghelescu, Elena Constantin, Anca Sanda Mihaescu, Gelu Onose - 12 minutes “PREVENTION IS CURE, EDUCATION IS ESSENTIAL” - RESPONSIBLE IMPLICATION OF YOUNG PEOPLE IN EDUCATIONAL AND PROPHYLACTIC ACTIONS AGAINST ACCIDENTAL CERVICAL SPINAL CORD INJURY AND SEVERE DISABILITIES BY DIVING IN UNVERIFIED WATERS. Link L39 Alexandra SPORICI, Irina ANGHEL, Lapadat MAGDALENA, Gelu ONOSE - 12 minutes RECOVERABLE RESULTS AT A PATIENT WITH AIS/FRANKEL D INCOMPLETE TETRAPLEGIA / POST SPINAL CORD INJURY BY FALLING FROM A HEIGHT, ON AN ANKYLOSING SPONDYLITIS BACKGROUND Link L40 Ioana ANDONE, Carmen CHIPĂRUȘ, Andreea FRUNZA, Aura SPÎNU, Simona STOICA, Liliana ONOSE, George PATRASCU, Gelu ONOSE -12 minutes CLINICAL, PARACLINICAL ASPECTS AND COMPLEX THERAPEUTICAL APPROACHES IN A PATIENT WITH INCOMPLETE PARAPLEGIA, POST THORACIC MENIGIOMA SURGICALLY TREATED, IN NEUROFIBROMATOSIS CONTEXT Link L41 Cristina Octaviana DAIA, Alina-Elena Gherghiceanu, Helene Ivan, Gelu ONOSE - 12 minutes RESEARCH ON NEUROREHABILITATION RESULTS IN VERTEBRO-MEDULLARY POST-TRAUMATIC CONDITIONS ASSOCIATING FRACTURES, IN A POLITRAMATIC CONTEXT Link L42 Ali-Osman Saglam, Alexandru G. Stavrica, Ana Carmen Albeşteanu, Laura Georgiana Popescu, Luminita Nirlu, Gelu Onose - 12 minutes MEDICAL-REHABILITATION ENDEAVORS, CARE INTERVENTIONS AND CONNOTATIONS OF A MEDICO-SOCIAL TYPE, IN A COMPLEX POLYPATHOLOGICAL CASE: PARAPLEGIA, SPONDYLODISCITIS, KIDNEY FAILURE IN THE HAEMODIALYSIS STAGE AND BILATERAL NEPHROSTOMIES AFTER SURGICALY TREATTED BLADDER NEOPLASM. Link L43 Sorina Petrușan-Dunca, Liviu Lazăr, Tiberiu-Dorin Corha - 12 minutes INDICATIONS AND LIMITIS OF REHABILITATION TREATMENT FOR LUMBAR DISCOPATHY IN PREGNACY Link L44 Q & A – 8 minutes Authors Title Abstract Elena Silvia SHELBY, Mihaela AXENTE, Liliana PĂDURE - 12 minutes CHARCOT MARIE TOOTH DISEASE. CASE PRESENTATION. GENETIC DISEASES WHICH REQUIRE physical rehabilitation Link L45 Link L46 Simona Carniciu - 12 minutes Influence of nutrition and exercise on the use of different energy substrates in the prevention of metabolic diseases Link L81 Simona-Isabelle STOICA, Carmen Elena CHIPĂRUȘ, Magdalena Vasilica LAPADAT, George PĂTRAȘCU, Gelu ONOSE - 12 minutes CLINICAL-THERAPEUTIC AND RECUPERATORY FEATURES IN A PATIENT WITH PLURIPATOLOGY: ISCHEMIC STROKE, ISCHEMIC HEART DISEASE (SECHELAR MYOCARDIAL INFARCTION), CHRONIC KIDNEY DISEASE AND MONSTROUS GOUT- CASE PRESENTATION Link L47 Eugen BITERE, Mihaiela CHICU - 12 minutes PATHOPHYSIOLOGY OF ATHEROGENESIS AND CARDIOVASCULAR RISK IN CHRONIC INFLAMMATORY DISEASES Link L48 Victoria CHIHAI, Alisa TĂBÎRȚĂ, Anastasia ROTĂREANU, Vladlena MIHAILOV, Mihail CÎRÎM - 12 minutes THE IMPACT OF ACTIVE KINETIC PROGRAMS ON CLINICAL AND FUNCTIONAL STATUS ADRESSED TO PEOPLE WITH DIABETIC ANGIOPATHY Link L49 Ana-Maria Fătu, Ana Maria Pâslaru, Valerica Creangă-Zărnescu, Alexandru Nechifor, Mădălina Verenca, Mihaela Lungu, Anamaria Ciubară - 12 minutes THE IMPACT OF COGNITIVE DECLINE ON STROKE REHABILITATION Link L50 Alisa TĂBÎRŢĂ, Victoria CHIHAI - 12 minutes THE USE OF TRINITY AMPUTATION AND PROSTHESIS EXPERIENCE SCALES IN THE COMPLEX REHABILITATION OF PERSONS WITH LOWER LIBM AMPUTATION Link L51 Ilie ONU, Mariana ROTARIU, Elvina MIHALAȘ, Călin CORCIOVĂ - 12 minutes STUDY ON EFFICIENCY OF ELECTROTHERAPY AND PHYSIOTHERAPY MANAGEMENT ON HERNIATED LUMBAR DISC Link L52 María G. Souto Figueroa, Antonio Freire Magariños RESEARCH - SURVEY TO 142 THERMALIST WHO HAVE PERFORMED A THERMAL CURE AT THE BATHS OF BAÑOS DE MOLGAS (OURENSE) AND AUGAS SANTAS (LUGO) - GALICIA – SPAIN Link L53 Q & A – 12 minutes Authors Title Abstract Irina Ionica - 12 minutes ACUPUNCTURE IN REHABILITATION - A GENERAL VIEW Link L54 Denisa COAJĂ, Gabriela DOGARU - 12 minutes THE HEALTH BENEFITS OF FINNISH SAUNA BATHING Link L55 Otilia ROGOVEANU, Florin GHERGHINA , Rodica TRAISTARU - 12 minutes SPINA BIFIDA – FUNCTIONAL REHABILITATION METHODS IN CHILDREN Link L56 Mihaela DUTESCU, Raluca OLTEAN, Petru NENADICI - 12 minutes GEOAGIU BAI RESORT - OUR EXPERIENCE OF MEDICAL REHABILITATION TREATMENT Link L57 Dumitru MIHĂILĂ, SILISTEANU Sinziana Calina, ȚICULEANU Mihaela (Ciurlică) - 12 minutes THE METEOROLOGICAL COMPLEX AND THE HUMAN PATHOLOGY. CASE STUDY – SUCEAVA COUNTY Link L58 Mariana VARODI, Gabriela DOGARU - 12 minutes EFFICACY OF NATURAL THERAPEUTIC FACTORS FROM OCNA SIBIULUI SPA RESORT IN GONARTHROSIS Link L59 Boróka-Panna GÁSPÁR, Gabriela DOGARU - 12 minutes BONE HYDRATION AND MINERAL WATERS Link L60 CALIN BOCHIS, LIVIU LAZAR, HORAȚIU URECHESCU, CARMEN NISTOR-CSEPPENTO, FELICIA CIOARA, NICOLETA PASCALAU, ALIN BOCHIS , DIANA IOVANOVICI - 12 minutes CORRELATION OF VAS PAIN SCORE WITH FUNCTION AT THE PACIENTS WITH TEMPOROMANDIBULAR OSTEOARTHRITIS Link L61 Marian Romeo CALIN, Ileana RADULESCU, Mihaela Antonina CALIN, Elena Roxana ALMASAN - 12 minutes RADIOMETRIC ASSESSMENT OF PELOID AND SALT WATER USED FOR THERAPY AND BALNEARY TRATAMENT FROM TECHIRGHIOL LAKE, ROMANIA Link L62 Q & A – 12 minutes Authors Title Abstract Cristina PETRESCU - 12 minutes EFFICACY NATURAL THERAPEUTIC FACTORS FROM BAILE GOVORA IN BRONCHIAL ASTHMA Link L63 PARASCHIVA POSTOLACHE - 12 minutes PULMONARY REHABILITATION SAVES LIVES AND IMPROVES LIFE Link L64 DOINA-CLEMENTINA COJOCARU, PARASCHIVA POSTOLACHE - 12 minutes ASSESSMENT OF DYSPNEA IN PULMONARY REHABILITATION PRACTICE Link L65 PARASCHIVA POSTOLACHE, CRISTINA LACATUSI - 12 minutes HELIOTHERAPY, CLIMATOTHERAPY AND PATIENTS WITH RESPIRATORY DISEASES Link L66 CONSTANTIN MUNTEANU, DIANA MUNTEANU, MIHAIL HOTETEU - 12 minutes BIOLOGICAL INSIGHTS OF SPELEOTHERAPY Link L67 PARASCHIVA POSTOLACHE, CRISTINA LACATUSI, DOINA-CLEMENTINA COJOCARU - 12 minutes AEROSOLS AND BREATHING Link L68 PARASCHIVA POSTOLACHE, MADALINA ZEBEGA - 12 minutes RESPIRATORY MUSCLE TRAINING AND RESPIRATORY REHABILITATION Link L69 CRISTI FRENȚ, GEORGETA MAIORESCU - 12 minutes DEVELOPMENTS AND INVOLUTIONS OF TOURISM IN THE SPA RESORTS IN ROMANIA AND THE CASE STUDY FOR LACUL SĂRAT RESORT Link L70 Dragos Arotaritei, Andrei Gheorghita, Mariana Rotariu, Marius Turnea - 12 minutes MATHEMATICAL MODEL OF SULPHUR ABSORPTION PROCESS, A POSSIBLE APPLICATION IN CURE WITH SULPHUROUS MINERAL WATER Link L71 Q & A – 12 minutes Authors Title Abstract Mihai Ciocanu, Anișoara Cimil - 12 minutes THE EFFICIENCY OF THE REHABILITATION SERVICE IN HOSPITAL CONDITIONS Link L72 Sinziana Calina SILIȘTEANU, Andrei Emanuel SILIȘTEANU - 12 minutes TRIAL ON THE WATER CONSUMPTION BY THE PERSONS IN THE GROUP AGED 19-30 YEARS Link L73 Liviu Lazăr, Florin Marcu, Felicia Cioară, Carmen Nistor Csepentö - 12 minutes MANAGEMENT OF SPECIAL ARTERIAL DISEASES Link L74 Mihaela-Carmen SUCEVEANU, Paul-Nicolae SUCEVEANU - 12 minutes EVOLUTION OF CARDIOVASCULAR RISK FACTORS AFTER MORE THAN 2 PERIODIC HOSPITALIZATIONS IN THE COVASNA HOSPITAL FOR CARDIOVASCULAR REHABILITATION Link L75 Mihaela DUTESCU, Adina TRAILA, Margit SERBAN, Emilia URSU, Dorina MIU, Ioana MALITA, Bianca CIRESAN - 12 minutes THE EFFICIENCY OF MEDICAL REHABILITATION TREATMENT IN PATIENTS WITH HEMOPHILIA AFTER SURGICAL ORTHOPEDIC INTERVENTIONS - THE EXPERIENCE OF "CRISTIAN SERBAN" BUZIAS CENTER Link L76 Dorin-Gheorghe TRIFF, Simona POP - 12 minutes PRECURSORS OF BALENOLOGY EDUCATION IN ROMANIA Link L77 Dr. Eugenia Dumitrescu, Dr. Carmen Enescu - 12 minutes ANTIALLERGIC PROCEDURES MOST COMMONLY USED IN PHYSICAL RECOVERY MEDICINE AND BALNEOLOGY Link L78 Mihail HOTETEU, Constantin MUNTEANU, Diana MUNTEANU, Gabriela DOGARU - 12 minutes PELOIDS - PERSPECTIVES ON RESEARCH AND FUTURE PLANS Link L79 Liliana Stanciu, Daniela Profir, Viorica Marin, Doinița Oprea, Elena Ionescu, Elena Almășan, Carmen Oprea - 12 minutes THE SCIENCE OF AGING WELL Link L80 Q & A – 12 minutes POSTER SESSION Authors Title Abstract Andra Pintilie, Liliana Pădure, Andrada Mirea, Corina Sporea Proprioceptive Functional Vibration Stimulation as therapeutic tool in spasticity management of jump gait pattern of spastic diplegic children with cerebral palsy Poster 1 Andra Pintilie, Liliana Pădure, Andrada Mirea, Corina Sporea Modern computerized techniques for gait’s functional evaluation through a specialized wireless inertial sensor – premise for orthopedic corrective shoes wear in children with gait disorders secondary to Cerebral Palsy Poster 2 Ana Maria PÂSLARU, Ana Maria FĂTU, Anamaria CIUBARĂ The role of medical recovery in oncology Poster 3 Maria Veronica MORCOV, Liliana PADURE, Cristian Gabriel MORCOV, Gelu ONOSE Exercises availed by sensor-based computer advanced devices: part of the interactive cognitive recovery – adjuvant of the therapy applied in the Centrul National Clinic de Recuperare Neuropsihomotorie Copii “Dr. N. Robanescu” Poster 4 Avram Mihai, Liliana Padure, Gelu Onose Theoretical fundamentals and conceptual premise for advanced proprioceptive and sensory stimulus apparatus, with sequential evaluation for the treatment of the recuperator in the equilibrium disorder, from Cerebral Palsy (PC) casuistry. Poster 5 Andrada MIREA, Gelu ONOSE, Madalina LEANCA, Florin-Petru GRIGORAS, Mihaela AXENTE, Liliana PADURE, Corina SPOREA Respiratory management in patients with rare progressive neuromuscular diseases Poster 6 Mihaela MANDU, Elena CONSTANTIN, Cristinel Dumitru BADIU, Cosmin Daniel OPREA, Cristina DAIA, Gelu ONOSE Presentation od the Fugl Meyer Assesment scale and related suggesttion in order to enhance its level of implementation in inner neurorehabilitation units Poster 7 ALEXANDRU BOGDAN-CĂTĂLIN, ALINA SIMONA ȘOVREA, ANNE-MARIE CONSTANTIN, ADINA BIANCA BOȘCA, CARMEN GEORGIU, MONICA POPA Complex oral rehabilitation in an elderly patient with periodontal disease who exercises regularly Poster 8 Dorin-Gheorghe TRIFF, Simona POP MORBIDITY BY OSTEO-MUSCULO-ARTICULAR DISEASES IN THE OCCUPATIONAL ENVIRONMENT IN MARAMURES COUNTY. THE IMPORTANCE OF MEDICAL RECOVERY AND RECORDS THROUGH ELECTRONIC DATA MANAGEMENT SYSTEMS Poster 9 Authors Title Abstract Mihaela Antonina CALIN, Marian Romeo CALIN, Constantin Munteanu New evidence on the effects of pelotherapy on local microcirculation Poster 10 Izabela Lazar, Gabriela Dogaru The effectiveness of balnear treatment in the management of psoriasis Poster 11 Dorin-Gheorghe TRIFF, Mușata Dacia BOCOȘ CORRELATIONS OF OSTEOMUSCULO-ARTICULAR DISEASES WITH WORK ABILITY, PERCEIVED SELF EFFICACY AND OCCUPATIONAL STRESSORS AT A REGULAR MEDICAL CHECK-UP IN PRE-UNIVERSITY EDUCATION UNITS Poster 12 Doroteea Teoibas-Serban, Valentin Stan, Dan Blendea PREVENTION OF LUMBAR DISC HERNIATION IN YOUNG ADULT POPULATION: A PRACTICAL APPROACH Poster 13 Călin Corciovă, Cătălina Luca, Robert Fuior, Flavia Corciovă Development a Monitoring Device for Arm Rehabilitation Poster 14 Simona Daniela Zavalichi, Marius Andrei Zavalichi, Sorin Stratulat, Florin Mitu Cardiovascular rehabilitation: challenges in a case of acute myocardial infarction and familial hypercholesterolemia Poster 15 Simona-Isabelle STOICA, Ioana TANASE, Gelu ONOSE Influences and consequences resulting in addictions in general and to chronic alcoholism, especially for patients with spinal cord injury Poster 16 Roxana Dumitrascu, Ana Maria Bumbea, Carmen Albu, Otilia Rogoveanu, Catalin Bostina, Rodica Traistaru, Borcan Madalina BIOMECHANICAL DYSFUNCTIONS OF THE FOOT – MAJOR IMPACT ON THE KINETIC CHAIN Poster 17 Otilia Rogoveanu, Gherghina Florin, Caimac Dan, Trifu Ramona, Cruceru Andra, Beldie C Medical rehabilitation in post-stroke spastic hemiparesis in young patients Poster 18 Ana Maria Bumbea, Otilia Rogoveanu, Roxana Dumitrascu, Bogdan Stefan Bumbea, Catalin Bostina, Albu Carmen, Borcan Madalina PERIPHERAL MAGNETIC STIMULATION - A CHALLENGE IN VERTEBRAL POSTTRAUMATIC RECOVERY Poster 19 Authors Title Abstract Dănuţ PĂCURAR, Mihaela Ramona PĂCURAR KNEE ARTHROPLASTY RECOVERY OF AN CANCER PATIENT Poster 20 Dănuţ PĂCURAR, Mihaela Ramona PĂCURAR THE IMPACT OF OSTEOARTICULAR PATHOLOGY IN POSTSTROKE RECOVERY Poster 21 Borcan Madalina, Bumbea Ana Maria, Bostina Catalin, Radoi Georgeta, Bumbea Bogdan EFFICIENT REHABILITATION TREATMENT IN A CASE WITH MAV-RUPTA MALFORMATION Poster 22 Demirgian Sibel, Nan Simona, Lulea Adela, Lascu Ioana, Marin Viorica Is possible the management of synovial chondromatosis of the hip by arthroscopy or complex balneal treament? Poster 23 Mădălina Codruța Verenca, Sorina Mierlan, Claudiu Elisei Tanase The Efficiency of Medical Treatment of Scoliosis – Paediatrics Poster 24 Florentina NASTASE¹, Alin Laurentiu TATU², Madalina Codruta VERENCA¹ Orthopaedic manifestations of Neurofibromatosis type 1 – case report Poster 25 Simona CARNICIU, Anatolie BACIU, Vasile FEDAS The attenuation of energy metabolic misbalance by means of aerobic, hypoxic, hypothermal adaptation and environment optimization at recreation resort center Poster 26 Irina Anghel, Alexandra Sporici, Magdalena Lapadat, Gelu Onose Complex clinical and therapeutic rehabilitation approach of a patient with Complete AIS/Frankel A quadriplegia post cervical spinal cord injury after accidental fall off a trailer and multiple complications occurring during disease progression - case study Poster 27 Ana-Maria Pelin , Monica Georgescu , Cristina Stefanescu , Costinela Georgescu Molecular treatment strategies in osteoporosis Poster 28