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Balneo and PRM Research Journal - Vol 12 No. 3, September 2021 - issue cover / full issue pdf link

 (438) Hydrogen sulfide (H2S) - therapeutic relevance in rehabilitation and balneotherapy Systematic literature review and meta-analysis based on the PRISMA paradigm

- MUNTEANU Constantin, MUNTEANU Diana, ONOSE Gelu

Balneo and PRM Research Journal. 2021;12(3):176-195  


An active molecule in sulfurous mineral - medicinal waters and also in sapropelic mud is H2S, a hormetic gaseous molecule that can actively penetrate the skin. While high levels of H2S are extremely toxic, low levels are tolerated and have potential cytoprotective effects, with anti-inflammatory and antioxidant applicationsObjective. This systematic review aims to rigorously select related articles and identify within their content the main possible uses of hydrogen sulfide from balneary sources and to explain its physiological mechanisms and therapeutic properties. Methods. To elaborate our systematic review, we have searched for relevant open access articles in 6 international databases: Cochrane, Elsevier, NCBI/PubMed,  NCBI/PMC, PEDro, and ISI Web of Knowledge/Science, published from January 2016 until July 2021. The contextually quested keywords combinations/ syntaxes used are specified on this page. The eligible articles were analyzed in detail regarding pathologies addressed by hydrogen sulfide. All articles with any design (reviews, randomized controlled trials, non-randomized controlled trials, case-control studies, cross-sectional studies), if eligible according to the above-mentioned selection methodology, containing in the title the selected combinations, were included in the analysis. Articles were excluded in the second phase if they did not reach the relevance criterion. Results. Our search identified, first, 291 articles. After eliminating the duplicates and non-ISI articles, remained 121 papers. In the second phase, we applied a PEDro selection filter, resulting in 108 articles that passed the relevance criterion and were included in this systematic review. Conclusions. H2S biology and medical relevance are not fully understood and used adequately for sanogenic or medical purposes. More research is needed to fully understand the mechanisms and importance of this therapeutic gase. The link between balneotherapy and medical rehabilitation regarding the usage of hydrogen sulfide emphasises the unity for this medical speciality.

Keywords: Hydrogen sulfide / H2S AND balneotherapy / inhalations / mud / Rheumatoid arthritis / neuroprotection / neurodegenerative disorders / Stroke / Parkinson / Alzheimer / Huntington / vascular dementia / Immune system / Diabetes / Cancer / Cardioprotection / Asthma / Alergic Rhinitis / COPD / COVID-19 / Burns / Analgesic effect / Clinical trials


 (439)   Water intake meets the Water from inside the human body – physiological, cultural, and health perspectives - Synthetic and Systematic literature review

-       MUNTEANU Constantin, TEOIBAS-SERBAN Droteea, IORDACHE Liviu,  BALAUREA Mariana, BLENDEA Corneliu-Dan

Balneo and PRM Research Journal. 2021;12(3):196–209

Background. The average adult human body of 70 kilograms consists in about 67.85% water distributed evenly to an average of 70 % in all major organs of the body: skin, muscles, brain, spinal cord, liver, heart, lungs, spleen, kidneys, pancreas and gastro-intestinal tract. A smaller percentage is found in the bones (30%), teeth (5%) and fat tissue (50%). Objective. This review article attempts to present different perspectives on the physiological properties of water in the human body. We describe from the ancient Chinese medicine theory about water being one of the 5 elements of nature and its harmonious interrelation with the other elements in order to balance the human body, to the successful experiments of researchers which demonstrated waters’ capability to change its molecular structure based on feelings, intentions and energy it was exposed to. We briefly describe the role of water for the human body and what effects can the lack of it have, especially dehydration with all the phases of severity. Also, we present the health benefits of drinking water and which type of water is best to consume. We shorty review the different types of natural mineral waters in Romania and the importance of the Romanian researches for balneology and how the waters cand be administrated in crenotherapy for different types of pathologies. Methods. To elaborate our systematic review, we have searched for relevant open access articles and review articles in ISI Web of Science, published from January 2017 until August 2021. The terms used were water AND health in the title. Articles were excluded in the second phase if they did not reach the relevance citation criterion. The eligible articles were analyzed in detail regarding water importance for human health. Results. Our search identified, first, 548 articles. After applying a PEDro like selection filter and, we selected 93 articles with a minimum of 8 points on our PEDro like filtering scale (good, very good, and excellent articles with a minimum of 5 citations per year). Detailed analysis of the 93 selected articles has conducted us to the elimination of 33 of them as being on a different subject than that of our article. To the 60 full articles retained for this systematic and synthetic article, we have added 10 articles found through a separate Google search, as being considered of high relevance for our subject and necessary to be included. Conclusions. Water is essential for the entire planet and also indispensable for the survival of the human body. 

Keywords: water intake, water balance, body water, water molecular structure, dehydration, crenotherapy


 (440) The outcomes of ultrasonic and laser therapy in case of temporomandibular disorders – an evidence based update 

NEGUCIOIU Marius, KUI Andreea, MITARIU Mihai, MANZIUC Manuela, CONDOR Daniela, MITARIU Loredana, BUDURU Smaranda

Balneo and PRM Research Journal. 2021;12(3):210-217

Introduction. Temporomandibular disorders (TMDs) are considered multifactorial conditions, thereby with different therapy options, from occlusal equilibration, splint therapy, pharmacotherapy or physical therapy. Among the physical therapies, over the last years, laser therapy and ultrasound therapy have gained attention, as different experimental or clinical studies suggest their efficacy in case of TMDs. The aim of our literature review is to evaluate the available evidence on the effectiveness of laser and ultrasound therapy in the treatment of temporomandibular disorders. Material and method. A research of literature has been performed - articles published over the last 5 years (January 2016 until June 2021) were searched by introducing a combination of different terms, using the Pubmed, Scopus and Google Scholar databases. Results and discussions. A total number of 332 articles was found. For multiple publications regarding the same group of patients, the most recent studies were included. Initial analysis of titles and abstracts eliminated 232 articles, leaving 35 articles whose full text was examined. 20 articles met the inclusion criteria Conclusions. According to the findings of this literature update we can conclude that low level laser therapy, ultrasound therapy, and photobiomodulation may effectively reduce pain for patients suffering of muscular and joint TMDs. However, their effects appear to be only shortly maintained, and only for less complex cases. In addition, it was difficult to compare the studies included, as they do not offer an optimal usage (program, duration of sessions, or number of sessions) of each technique. In this context, we consider that further randomized clinical studies are necessarily to compare each physical technique as well as their synergic effect on the symptoms in case of temporomandibular disorders.

Keywords: temporomandibular disorders, low level laser therapy, ultrasound therapy, photobiomodulation, TMD, LLLT


 (441)  Osteoarthritis is not a disease, but rather an accumulation of predisposing factors. A systematic review 

Robert Gherghel, Daniel-Andrei Iordan, Mircea-Dan Mocanu, Ana Onu, Ilie Onu

Balneo and PRM Research Journal. 2021;12(3):218-226

Introduction: Although they do not endanger the life of the individual, the major symptoms of osteoarthritis (OA), such as pain, inflammation and dysfunction, it will slowly decrease quality of life and performance, leading finally to disabilities. Due to the fact that this disease has no cure, strategies are still being sought to slow its evolution. The lack of understanding of the predisposing and triggering factors of OA, has led to different approaches to this pathology so discussed, but with modest results. This systematic review aims to debate the main phenomena underlying joint destruction in OA, and etiopathogenic theories. Materials and Methods: In this study were included 58 bibliographic sources, of which title 39 refers to OA, 6 with inflammation, 28 with cartilage, 3 with chondrocytes, and 5 with synovitis. In this study were discussed the etiopathogenic theories of OA which include: age, alteration of the cartilaginous matrix, alteration of chondrocyte metabolism, microtrauma and major trauma, inflammation of the joints - synovitis and obesity. Results: Increasing the level of understanding of predisposing factors, the occurrence of acute inflammatory phenomenon and the perpetuation of mechanisms that latently maintain chronic inflammation that over time develops a destructive effect on articular cartilage, would limit the negative effects of OA, delay the evolution and optimally combat that maintain the vicious circle: inflammation → production of enzymes → chondrolysis → inflammation. Conclusions: These studies contribute significantly to the understanding of destructive phenomena in OA. More studies are needed on the risk factors of OA and its production mechanisms, to find increasingly effective therapies that limiting its progression.   

Keywords: Osteoarthritis, etiopathogenic theories, chronic inflammation, age, obesity, cartilaginous matrixm, chondrocyte metabolism


 (442)  A multidisciplinary approach for the physic-chemical characterization of peloids to new perspectives in the development for “hydrothermal Developing Countries” using partecipatory methodology 

 ROSSI Davide, URUCI Renata

Balneo and PRM Research Journal. 2021;12(3):227–232
The Osservatorio Termale Permanente (OTP) operated from 1996 to 2014 in the field of italian and international therapeutic thermalism. The main aim of OTP was the development of a multidisciplinary approach for the characterization of the quality of peloids for cutaneous application and their maturation process using different quali-quantitative analytic techniques opening at the Integrated Analitical Approach in the field of therapeutic thermalism. The main innovation introduced by OTP was represented by rheology and surface tensiometry. In particular, the introduction of surface tensiometry allowed to include the skin as a fundamental element for the development of mudtherapy protocols based on the bioadhesive properties of peloids. The interfacial investigations between peloids and skin led to the characterization of the exchange activity occurring during pelotherapy on cutaneous surface in non invasive and rapid way. On these basis, in this work we linked eachother the multidisciplinarity approach to the study of hydrothermal resources performed by OTP with the concept of the participative methodology common applied to the development of projects in the field of development cooperation. This combined approach led us to develop a scientific proposal for the development of therapeutic thermalism in countries not yet developed in this field and characterizated by the presence of hydrothermal resources

Keywords: peloid, surface tensiometry, Rossi factor, rheology, Rheological Termal Mud, skin, integrated analytical approach, participative methodology, therapeutical thermal proposal, hydrothermal development countries,



George-Dănuț Mocanu, Daniel-Andrei Iordan

Balneo and PRM Research Journal. 2021;12(3):233–247

    The study aims to investigate the ways of spending free time for a group of 180 students of the Faculty of Physical Education and Sports in Galati (years 1, 2 and 3 of cycle 1 / bachelor’s degree studies, with an average age of 22.34 ± 5.79 years.), by using a questionnaire-based survey, structured on 4 distinct factors: leisure time budget, causes limiting leisure time, favorite leisure activities and leisure sports activities. The purpose of the research is to determine the perception of students of the Faculty of Physical Education and Sports on how to spend free time and determine differences of opinion, depending on BMI / body mass index, by dividing them into 3 groups (underweight, normal weight or overweight). Results: The analysis of variance (ANOVA) indicates significant influences of the independent variable on the response values for the following items (F <.05): inaccessibility of going out with friends, stress generated by shopping, limiting free time to help others, spending free time with entourage and life partner, spending holidays in the country, etc. Socializing on the internet, physical sports activities, TV, internet and computer games, going out with friends are the preferred options for students, and reading gets low scores. The differences between groups (in most cases insignificant) however, signal that normal weight students watch TV and the Internet the least, but waste more time with commuting and household activities and have high scores when involved in most sports. Overweight people have low scores for time spent on favorite activities, are most dissatisfied with time management, work more overtime, spend less time with those around them, but prefer to spend time with their life partner or alone, have slightly better scores for reading and music auditions, get the lowest scores for involvement in most sports activities, but have high satisfaction generated by physical effort. Underweight students perceive the inaccessibility of going out with friends more strongly, are more affected by difficult homework, have a higher level of stress for reading, but perceive most other activities as less stressful, socialize more on the internet, prefer jogging and cycling / rollerblading as sports activities. Swimming is selected by all groups as indicated for optimizing health and ensuring body harmony, even if its practice is deficient, and contact / combat sports are indicated as the most risky for physical integrity.


 (444)  The importance of stratifying ischemic risk by using the Duke score in women with ischemic heart disease and hypothyroidism before inclusion in cardiovascular rehabilitation programs 

GURZĂU Diana Andrada, CALOIAN Bogdan, COMŞA Horaţiu, SITAR-TĂUT Adela, ZDRENGHEA Dumitru, POP Dana

Balneo and PRM Research Journal. 2021;12(3):248–254 

    Introduction: The relationship between abnormal thyroid function and coronary heart disease has been known for a long time, and particularly, hypothyroidism is associated with an increased risk of cardiovascular disease. The aim of this study was to evaluate the ischemic risk by using the Duke score in women with ischemic heart disease and associated hypothyroidism before inclusion in cardiovascular rehabilitation program. Materials and methods: We included in the study 150 female patients admitted to the Cardiology Department of the Clinical Rehabilitation Hospital Cluj-Napoca. All the patients included had ischemic heart disease and performed an exercise stress testing to evaluate the effort capacity and also to stratify the ischemic risk by calculating the Duke Score. After dosing the thyroid stimulating hormone (TSH) we divided the patients in two groups: with hypothyroidism and a control group. Results: Patients with hypothyroidism were more frequently hypertensive, (98% vs 87%, p-0.035), and they had diabetes mellitus in a higher proportion (51% vs 22%, p-0.005). HDL cholesterol was significantly decreased in the group of patients with hypothyroidism: 40.36±10.39mg/dl vs 44.85±10.29mg/dl (p-0.01). Regarding the ischemic risk assessed by the Duke score, the statistically significant differences between the two groups were registered only for the category of high-risk patients, 5.55% vs 18% (p-0.048). Also, the TSH value was higher in the group with high-risk Duke score, 4.21±3.73µIU/ml, compared to the moderate-risk score group, 1.95±1.12µIU/ml(p-0.05). Conclusion: In women with ischemic heart disease, assessing thyroid function can be useful to identify patients at high risk of ischemia. Patients with hypothyroidism tend to have a higher prevalence of cardiovascular risk factors, a higher ischemic risk objectified by the Duke score and more commonly multivascular coronary lesions. For these patients, the inclusion in cardiovascular rehabilitation programs is essential, but it is very important that the programs to be customized for each patient.

Keywords: coronary heart disease in women, exercise ECG, Duke score, ischemic risk, hypothyroidism, cardiovascular rehabilitation programs


 (445)  Can inflammatory biomarkers play a role in the inclusion of patients with acute myocardial infarction in cardiac rehabilitation programs? 

DĂDÂRLAT-POP Alexandra, ROȘIANU Horea, POPTILE Renaldo, TOMOAIA Raluca, BEYER Ruxandra, ȘERBAN Adela

Balneo and PRM Research Journal. 2021;12(3):255–260

    Introduction: In spite of the enormous progress made over the last decades, acute coronary syndromes remain the leading cause of death globally. Inflammation plays an important role in coronary artery disease development. Although the role of inflammatory biomarkers in acute obstructive myocardial infarction is well established, there is no data regarding the potential differences between acute myocardial infarction (AMI) with ST segment elevation, AMI without ST segment elevation (NON-STEMI) and non-obstructive acute myocardial infarction (MINOCA), respectively. Also, it is well known that cardiac rehabilitation of acute myocardial infarction survivors significantly improves their long-term prognosis. Aim of the study: To asses the possible existing differences between patients with STEMI, NON-STEMI and MINOCA in terms of clinical and paraclinical parameters, especially inflammatory biomarkers. A second objective of our study was to describe the relationship between inflammatory, cardiac necrosis enzymes and left ventricle systolic function. Material and methods: The study included 35 adult patients admitted in the Cardiology service of the Niculae Stăncioiu Heart Institute, Cluj-Napoca with acute myocardial infarction. Demographic, clinical, echocardiographic and laboratory data were analyzed. Patients were divided into 3 groups, 19 patients (54.2%) were diagnosed with STEMI- group 1, 9 patients (25.7%) with NON-STEMI- group 2 and 7 patients (20%) with MINOCA- group 3, respectively. Dosage of serum inflammatory markers was performed on the day of admission. Results and conclusion: The most common associated cardiovascular risk factor was arterial hypertension (65.7% of patients). Markers of myocardial necrosis (CK, CK-MB, hs Troponin) were significantly higher in patients with STEMI (p <0.05) in comparison with NON-STEMI and MINOCA patients. Congestive heart failure was most frequently encountered in STEMI patients. hsCRP value was higher among patients with STEMI. The value of ESR was significantly higher among patients with NON-STEMI. Serial dosage of inflammation biomarkers in patients with recent acute myocardial infarction may serve as valuable risk stratification instruments and also for functional capacity and recovery status assessment in patients included in cardiac rehabilitation programs.

Keywords: acute coronary syndrome; inflammatory biomarkers; non-obstructive acute myocardial infarction,



Waheed Nida, Amir Muhammad, Noureen Rabia, Nawaz Sumaira, Zaidi Syeda Wajeeha Raza

Balneo and PRM Research Journal. 2021;12(3):261–264

   Introduction. A huge literature is available regarding the efficacy of various physiotherapy techniques for neck pain (NP), however, comparative study is still in scarcity. Therefore, this study aimed to compare effectiveness of stretching exercises versus manual mobilization techniques in the management of NP. Material and method. A randomized controlled trial parallel-group design study was conducted on the patients suffering from NP. Participants with the history of NP, aged between 19 to 60 years, NP without radiculopathy, and no history of trauma were included in the study. Two outcome measures were used i.e., Numeric pain rating scale (NPRS) and neck pain disability index (NDI) questionnaire. Two groups were equally divided had twenty-five patients each. Group A received cervical stretching with strengthening exercises as home-treatment program and group B received manual mobilization with strengthening exercises as home-treatment program. Six sessions were given on alternate basis and assessed pre- and post-treatment information of all patients. Results and discussions. Independent sample t-test was run to compare the post difference between stretching exercises and manual mobilization at 95% confidence interval (p<0.05). The Post NPRS difference between the groups shows no significant improvement (p=0.32). Similarly no significant difference was found in post NDI Disability (p=0.57). Therefore, both the treatment strategies are equally effective in improving NP and disability. Conclusions. This clinical trial concluded that stretching or manual mobilization is equally effective to reduce pain and disability. Hence, improve the quality of life in neck pain survivors.
Keywords: Manual Mobilization Technique, Neck Pain, , Neck Pain Disability Index Questionnaire, Numeric Pain Rating Scale, Range of Motion, Stretching Exercises,


 (447)  A comparative approach on the impact of diet and physical activity on young people between 19 and 26 years 


Balneo and PRM Research Journal. 2021;12(3):265–269

 Introduction. In the literature, nutrition is considered to be the basis for the energy supply in all the forms of physical activity. Energy needs depend on gender, age, body weight and possibly the type of the physical activity. Inadequate energy intake can lead to weight loss, fatigue, lack of concentration and no athletic performance. The constant physical activity involves the consumption of carbohydrates, useful for the formation and storage of muscle glycogen. The development of healthy eating and physical activity behaviors in childhood and adolescence are very important for adult life. That is why an early intervention can lead to healthy behaviors and it can prevent the occurrence of overweight and obesity. Objectives. The purpose of this study was to demonstrate how important a controlled diet is correlated with regular physical activity, in the normal development of young people aged between 19 and 26 years. Conclusions. The attitude is the one that should lead to a food program with a balanced diet that ensures good health, without increasing the percentage of fat, and to cause a weight loss for the young people who want to lose weight.

Keywords: impact, diet, physical activity, young people,


 (448)  Foramen Magnum Meningioma – A common histological tumor in a rare location 

Vitalie Văcăraș, Tiberiu Maior, Aurora Munțiu, Aurora Taloș, Dafin-Fior Mureșanu

Balneo and PRM Research Journal. 2021;12(3):270–273

Meningiomas located in the foramen magnum area are uncommon. We report the case of a patient with a mass lesion compressing the medulla, who was admitted to the Neurology Department for cervical pain and tetraparesis. On the MRI (Magnetic Resonance Imaging) examination, specific features for a meningioma were described, confirmed later by the histopathological examination. The patient presented a favorable evolution, at only one month after surgery.

Keywords: Meningioma, Tetraparesis, Foramen Magnum, Neurosurgery


 (449)  Rehabilitation in a case of severe osteoporosis with prevalent fractures in a patient known with multiple sclerosis and prolonged glucocorticoid therapy 

POPA Florina-Ligia, ILIESCU Madalina Gabriela, STANCIU Mihaela

Balneo and PRM Research Journal. 2021;12(3):274–278

    Introduction. Osteoporosis has a major influence on the quality of life because of its impact on bone strength. Osteoporosis and fractures are frequent in patients with multiple sclerosis, decreased mobility being an important risk factor in these patients. This paper presents a case of severe osteoporosis in a patient with multiple sclerosis, to emphasize a correlation between this two pathologies. Material and Methods. We present the case of a female Caucasian patient, aged 65 years, known with progressive multiple sclerosis, on long-term use of glucocorticoids, and severe osteoporosis, who is investigated for mechanical pain and functional deficiency in the lumbar spine and the right hip, motor deficit, predominantly on right limbs and walking disorders. The patient was diagnosed with severe osteoporosis treated with raloxifene and bisphosphonates, with multiple vertebral fractures and vitamin D deficiency. During hospitalization the patient followed myorelaxant therapy and an individualized rehabilitation program. Results and discussion. During follow-up, there was a significant increase followed by a recent decrease in bone mass density in the lumbar spine and hip. The patient was recommended a loading dose of cholecalciferol for three months and initiation of teriparatide therapy after restoring 25-hydroxy vitamin D levels. Conclusion. In patients with multiple sclerosis,screening and early management of osteoporosis and osteopenia are essential.

Keywords: Keywords: multiple sclerosis, glucocorticoid therapy, osteoporosis,