Florina Ligia Popa

Background/Objectives: Clinical assessment of post-stroke spasticity may not fully distinguish neural contributions from structural and mechanical muscle changes. This systematic review examined associations between B-mode ultrasonographic and elastography-derived muscle parameters and the presence or severity of post-stroke spasticity. Methods: PubMed, Scopus, and Web of Science Core Collection were searched from inception to 18 July 2026. Eligible studies investigated ultrasound-derived skeletal muscle parameters in adults after stroke in relation to spasticity status or severity. Methodological quality was assessed using the Joanna Briggs Institute checklist, and certainty of evidence was evaluated using the GRADE approach. Findings were synthesized narratively because of substantial heterogeneity. Results: Eighteen studies were included, six contributing B-mode structural data and twelve elastography-derived mechanical data. B-mode findings were inconsistent across muscles and measurement conditions. Elastography more frequently identified increased stiffness-related parameters in paretic or spastic muscles, although associations with clinical spasticity severity were not consistently observed. The certainty of evidence was very low across the assessed outcome domains, reflecting methodological limitations, small sample sizes, and inconsistency in the reported associations. Conclusions: B-mode ultrasound and elastography provide complementary information on muscle changes after stroke, but neither can currently serve as a stand-alone measure of spasticity severity. Elastography may help characterize the mechanical component of post-stroke hypertonia alongside clinical examination. Larger, standardized longitudinal studies are needed to establish the clinical utility of these techniques.

Nail-patella syndrome (NPS) is a rare autosomal dominant multisystem disorder characterized by a variable combination of nail abnormalities, patellar hypoplasia or dysplasia, elbow involvement, and iliac horns, with possible renal, ophthalmological, neurological, and skeletal manifestations. Recognition may be substantially delayed when individual abnormalities are assessed separately or attributed to age-related and degenerative musculoskeletal disease. We report the case of a 76-year-old woman evaluated for progressive bilateral knee pain, gait impairment, and chronic multisite musculoskeletal symptoms. Congenital thumbnail abnormalities and long-standing restriction of elbow extension had been present since childhood. Suspicion of NPS was first raised at the age of 43 years after bilateral iliac horns were identified radiographically in one of her grandsons. Clinical examination demonstrated bilateral thumbnail hypoplasia with partial absence of the ulnar nail plate, triangular lunulae, reduced dorsal distal interphalangeal creases, bilateral fifth-finger flexion contractures, marked limitation of elbow extension with restricted pronation and supination, and clinically hypoplastic patellae. Bilateral Lester sign and glaucoma were also documented. Radiographic assessment revealed bilateral patellar hypoplasia, lateral displacement of the left patella, bilateral knee osteoarthritis, and characteristic bilateral iliac horns. Additional findings included bilateral hip osteoarthritis, lumbar degenerative changes, pes planus, a bifid configuration of the left fifth metatarsal, osteopenia, and sensory abnormalities. Walking pain was 70 mm on a 100-mm visual analogue scale, and the WOMAC score was 42/96. Following a 10-day rehabilitation program, walking pain decreased from 70 to 50 mm on the visual analogue scale, while the WOMAC total score improved from 42/96 to 37/96, indicating short-term symptomatic and functional improvement. Routine urinalysis showed no proteinuria or hematuria. Molecular testing for a pathogenic LMX1B variant was not performed. The diagnosis was established on the basis of the highly characteristic integrated clinical and radiographic phenotype. This case illustrates how NPS may remain incompletely recognized for decades despite congenital manifestations and emphasizes the clinical value of pattern recognition across multiple organ systems. In particular, the coexistence of characteristic nail changes, patellar abnormalities, elbow involvement, and bilateral iliac horns should prompt consideration of NPS and appropriate multidisciplinary surveillance.

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

Background and Objectives: Post-traumatic lower limb injuries are frequently associated with gait impairment, reduced functional independence, and delayed recovery due to weight-bearing restrictions. Dynamic body weight support (DBWS) refers to rehabilitation technologies that provide real-time, adaptive unloading of body weight during functional tasks such as walking, enabling safer and more effective gait training. Although these robotic systems have been extensively investigated in neurological pathologies, there is a lack of evidence regarding their use in post-traumatic lower limb injuries. Therefore, this systematic review aimed to evaluate the clinical effectiveness of robotic systems incorporating DBWS in the rehabilitation of post-traumatic lower limb pathologies. Materials and Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the protocol was registered in PROSPERO (CRD420261294273). Seven major databases (PubMed, Scopus, ScienceDirect, Cochrane, Web of Science, Springer, and Wiley) were searched from inception to October 2025. Studies that were considered included patients with recent post-traumatic pathologies in the lower limbs. The methodological quality and risk of bias of the included studies were evaluated using the PEDro scale and the RoB 2 tool. Results: Seven studies involving 265 participants with recent post-traumatic lower limb injuries were included. The rehabilitation systems reviewed enabled early, intensive gait and balance training by reducing lower limb loading and facilitating safe performance of functional walking tasks. However, substantial heterogeneity in intervention protocols and outcome measures limited direct comparisons across studies. Conclusions: The findings of this systematic review suggest that DBWS interventions may enhance gait and balance recovery in individuals with post-traumatic lower limb injuries. Despite the small number of participants included, the available evidence indicates that these technologies can facilitate functional improvements during the early stages of rehabilitation and may represent a valuable adjunct to conventional therapeutic approaches. Nevertheless, further well-designed studies with larger sample sizes, standardized intervention protocols, and long-term follow-up are required to establish optimal clinical implementation strategies and to confirm the durability of treatment effects.

Background: Peripheral neuropathy (PN) refers to a spectrum of symptoms resulting from dysfunctions of the peripheral sensory, motor, and autonomic neurons. PN is associated with significant balance impairments and an increased risk of falls, contributing to reduced functional independence and quality of life. Although diabetic PN has been extensively investigated, there remains a lack of synthesized evidence regarding rehabilitation approaches for individuals with non-diabetic PN. This systematic review aims to evaluate the effectiveness of stabilometric platforms incorporating virtual reality (VR) and feedback (FB) in improving balance and related outcomes in patients with PN of various etiologies. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the protocol registered in PROSPERO (CRD420251086625). Seven major databases (PubMed, Scopus, ScienceDirect, Cochrane, Web of Science, Springer, and Wiley) were searched from inception to April 2025. Studies including adult patients with non-diabetic PN undergoing balance rehabilitation using stabilometric platforms with VR and FB were considered. The methodological quality of the included studies was assessed using the PEDro scale, RoB2, and ROBINS-I V2 tools. Results: A total of six studies met the inclusion criteria, encompassing 133 participants with non-diabetic PN. Interventions involving specialized balance training platforms incorporating VR and FB demonstrated significant improvements in both static and dynamic balance and postural control, as well as a reduction in the risk of falling. These systems also showed favorable adherence rates to rehabilitation programs. However, variability in intervention protocols and outcome measures limited the ability to perform direct comparisons across studies. Conclusions: The use of stabilometric platforms appears to be a promising approach for balance rehabilitation in patients with non-diabetic PN. Despite the limited number of included studies, the results support their integration into rehabilitation programs for this patient population. Further large-scale, high-quality studies are needed to establish standardized protocols and confirm long-term efficacy.

Background/Objectives: Post-stroke disability is a prevalent complication in patients who have experienced a stroke. It is imperative that patients suffering from associated disability be hospitalised in rehabilitation wards, with a view to minimising their disability. The primary objective of the present study is to analyse the direct medical costs associated with the rehabilitation of patients with post-stroke disability who are admitted to a rehabilitation clinic for the first time. Methods: This retrospective study was conducted in a public hospital in Romania between January 2021 and December 2024. Patient information was retrieved from the hospital database and included the following: socio-demographic and clinical characteristics; disability score assessed using the modified Rankin scale (mRS); number of days of hospitalisation; and direct medical costs related to hospitalisation. Results: A total of 584 patients were included in this study. The average age was 68.04 years, 82% had suffered an ischaemic stroke, and 18% had suffered a haemorrhagic stroke. The mRS disability scores for ischaemic stroke were 2 (28.54%); 3 (24.79%); 4 (30.41%); and 5 (16.25%). The mRS scores for haemorrhagic stroke were 4 (33.65%); 5 (29.80%); 3 (20.19%); and 2 (16.34%). Hypertension was present in 80% of patients. The average length of hospital stay was 12.44 days. The total cost of hospitalisation per patient averaged RON 5295.33 thousand (approximately EUR 1031). Pearson’s correlation indicates a statistically significant positive association between higher mRS disability scores and higher hospitalisation costs (p < 0.001). Conclusions: The financial burden imposed on healthcare systems in Romania by medical expenses related to the rehabilitation of patients with post-stroke disability is significant. It is imperative to implement measures that will reduce the financial burden associated with hospitalising these patients and minimise the duration of their hospital stay.

Acromegaly is associated with a higher risk of certain malignancies, but not hematological neoplasia, although multiple myeloma (MM) was found in very limited cases. We aim to present such a case, adding a particular presentation with co-occurrence of a plasmocytoma. A 52-year-old male with acromegaly confirmed at 46 (MRI: pituitary macroadenoma of 12 × 11 × 10 mm) underwent hypophysectomy followed by 3 years of octreotide LAR then lanreotide depot. After another 6 months, he experienced a rapidly growing, painful lump in the right lateral thoracic area confirmed by CT as a 9-cm osteolytic lesion at the third rib. Core biopsy revealed plasmocytoma of the bone and medullary biopsy confirmed MM. Plasmacytoma was managed with 10 radiotherapy sessions, with favorable outcome and mass resorption; MM was managed with a VRD regimen, followed by autologous hematopoietic stem-cell transplantation. Six months after sFLC normalization and plasmacytoma resorption, complete remission was reported. In the meantime, lanreotide was continued, with complete acromegaly control. To conclude, what started as a rather typical scenario for an otherwise rare condition, as is acromegaly in the general population (but not so rare for endocrinologists), turned into an unexpected and more severe outcome. Noting this exceptional association, we pinpoint that further research is needed for understanding the dual acromegaly–MM relationship.

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

This study investigates employment rates and their determinants among individuals with spinal cord injury (SCI) in Romania using data from the Romanian National Spinal Cord Injury Survey (RO-InSCI), part of the International Spinal Cord Injury (InSCI) Community Survey. The cross-sectional study included 215 adults with traumatic or non-traumatic SCI living in the community. Participants were recruited through rehabilitation hospitals and patient organizations. Employment status, demographic characteristics, and injury-related factors were assessed. The observed employment rate was 25.35%, with a 39.45% employment gap compared to the general population. Barriers to employment included health status, disability, inadequate transport, and insufficient access to infrastructure, particularly for those with traumatic SCI. Vocational rehabilitation participation was low (18.7%), despite a strong desire to return to work (82% for traumatic SCI, 61.1% for non-traumatic SCI). Before injury, participants were primarily employed in elementary occupations, with higher rates among those with paraplegia. The findings highlight the need for targeted interventions, inclusive labor market policies, and improved accessibility to vocational rehabilitation to support workforce reintegration and address the specific needs of individuals with SCI in Romania.

Background: Teriparatide (TPT) acts against severe primary (postmenopausal) osteoporosis (MOP), and it requires continuation with another anti-resorptive drug to conserve or enhance the effects on fracture risk reduction. Objective: To analyse the sequential pharmacotherapy in MOP who were treated upon a 24-month daily 20 µg TPT protocol (24-mo-TPT) followed by another 12 months of anti-resorptive drugs (12-mo-AR) amid real-life settings. Hypotheses: 1. TPT candidates had a more severe fracture risk profile versus those who did not fulfil the TPT criteria according to the national protocol of TPT initiation; 2. Patients treated with TPT improved their DXA profile after 24 mo; 3. After 1 year of therapy since the last TPT injection, the improved bone profile and fracture risk at the end of the TPT protocol were conserved; 4. The mineral metabolism assays and fracture risk status were similar at TPT initiation between those who finished the 24 mo protocol and those who prematurely stopped it. Methods: This was a longitudinal, retrospective, multicentre study in MOP. The entire cohort (group A) included the TPT group (B) versus the non-TPT group (non-B). Group B included subjects who finished 24-mo-TPT (group P) and early droppers (ED), and then both continued 12-mo-AR. Results: Group B (40.5%) from cohort A (N = 79) vs. non-B had lower T-scores, increased age and years since menopause. A similar profile of demographic features, BTM, and prevalent fractures (73%, respectively, 57%) was found in group P (72%) vs. ED (21.8%). Group P: osteocalcin was statistically significantly higher at 12 mo (+308.39%), respectively, at 24 mo (+171.65%) vs. baseline (p < 0.001 for each), while at 12-mo-AR became similar to baseline (p = 0.615). The cumulative probability of transient hypercalcemia-free follow-up of protocol had the highest value of 0.97 at 6 mo. An incidental fracture (1/32) was confirmed under 24-mo-TPT. BMD had a mean percent increase at the lumbar spine of +8.21% (p < 0.001), of +12.22% (p < 0.001), respectively, of +11.39% (p < 0.001). The pharmacologic sequence for 12-mo-AR included bisphosphonates (24.24% were oral BP) or denosumab (13%). BTM showed a suppression at 12-mo-AR (p < 0.05), while all BMD/T-scores were stationary. No incidental fracture was registered during 12-mo-AR. Conclusions: All research hypotheses were confirmed. This study in high-risk MOP highlighted an effective sequential pharmacotherapy in reducing the fracture risk as pinpointed by BMD/T-score measurements and analysing the incidental fractures profile.