Introduction. Infectious and autoimmune rheumatic diseases (ARDs) are closely linked. Apart from the challenging, sometimes differential, diagnosis between these conditions, it is recognized that microbes play an important role in the pathogenesis of the latter. Material and method. We present the case of a 45-year-old female patient from our rehabilitation department, with complex pathology (infectious, neurological, rheumatological and orthopedic pathology) that began more than 15 years ago. The patient’s pathological history began insidiously at theage of 30 when she was diagnosed with neurotoxoplasmosis. She received anticoagulant, antiepileptic, steroidal, antibiotic and antihelmintic treatment. After four years, the patient shows insidious onset of inflammatory pain in the large joints and in 2010 is diagnosed with seropositive rheumatoid arthritis, according to American College of Rheumatism/European League against rheumatism (ACR/EULAR) criteria with symmetric impairment of the large joints (shoulder, elbow, hip, knee, ankle). Despite the treatment with disease-modifying anti-rheumatic drugs (DMARDs) received, in the following years she needed 4 arthroplasties in the large joints due to osteonecrosis. Conclusions. On clinical grounds, infections, especially chronic infections, can cause a plethora of autoimmune phenomena, thus mimicking ARDs. Therefore, the differential diagnosis between ARDs and infectious diseases is sometimes challenging as they often display similar clinical manifestations. It is highlighted that the immune system can be our friend or our foe considering that its function and dysregulation are the common denominators in autoimmune and infectious diseases. In the era of new drugs and new therapeutic strategies, safety of the patients should always be our first concern.

Degenerative low back pain is one of the most important causes of disability worldwide, and it also has a negative impact on the economy, due to the high cost of medical care required for this pathology. It has an increased prevalence among the population, between 80-85%, it affects population between 45 and 65 years old, and the most frequent cause is the mechanical one, with degenerative syndromes on the first place. Balneal treatment is a complex treatment with multiple benefits for patients with degenerative low back pain syndromes, and in the recent years this topic is intensely studied due to its benefits, as well as the increased addressability of the patients for this type of treatment. Our study evaluated 99 patients with low back pain divided into 2 groups of patients admitted for 2 weeks to Balneal and Rehabilitation Sanatorium of Techirghiol, who performed balneal treatment with hot mud baths and cold mud baths, but also classic rehabilitation treatment (electrotherapy, masotherapy, kinetotherapy, thermotherapy). The aim of the study was to evaluate the characteristics of degenerative low back pain syndromes on patients under balneal treatment, and for the patients from our study the most frequent pathology was Spondilosis, female patients was predominantly affected than male patients, with high education level and from urban residence.

Introduction. Stroke is one of the main reasons for acquired disability, and the past 2 years have demonstrated that COVID-19 is a major cause of thromboembolic accidents, which usually determine cardio-pulmonary infraction, as it has a higher incidence on larger blood vessels, but there are also numerous cases reported of stroke in patients after or, more rarely, during COVID-19 active infection. Material and Methods. We present the case of a 52 year old man diagnosed with stroke during hospitalisation for a moderate type of COVID-19(Coronavirus 2019), which after several days from admittance, was found with left hemiplegia in his chamber. A comprehensive sensitive-motor rehabilitation program has been established after two and a half months after discharge, as the deficit did not regress. Results and discussion. The evolution of the patient was favorable, with an improvement of the symptoms after treatment, especially the pain syndrome, but also on improved muscle tonus and slight muscle strength increase and improved disability scores The patient rehabilitation should continue for a longer period of time, as new cerebral pathways take time to be established. Conclusions. In patients with stroke, independent of the mechanism of occurring, complex sensitive-motor rehabilitation should be started as soon as possible, in good condition, so that the benefits outbalance the risks. Extra precautions should be taken in regards to patients with COVID-19 related stroke, as they are more inclined to have a thrombotic related development, even after fully medically recovering from the disease.

Stroke is an important health problem generating a set of musculoskeletal and cognitive consequences that significantly affect the patient’s clinical-functional status and quality of life, as well as the effectiveness of the recovery treatment. Hydro-/ thermo-/ kinesio-therapy with water from Lake Techirghiol, known for its special properties, is also used for patients with neurological disorders and consists in immersing the patient in the therapeutic pool with specific exercises under the strict supervision of specialized medical staff. The aim of this study is to analyze the effects of Lake Techirghiol water on the functional deficit in patients with post-stroke sequelae. In this sense, 200 patients who were hospitalized in the Balneal Rehabilitation Sanatorium of Techirghiol, Constanta County, Romania during 2018-2020 were included in the study and they were divided into two groups: patients from group 1 performed on a daily basis, for 12 days, hydro-/ thermo-/ kinesiotherapy and other physical-kinetic procedures, and the patients from group 2 performed on a daily basis, for 12 days, only physical-kinetic procedures, without hydro-/ thermo-/ kinesio-therapy. Patients’ assessment was made based on the Functional Independence Measure scale and a better evolution was observed in the patients who performed hydro-/ thermo-/ kinesio-therapy as compared to those who did not perform this procedure, in the sense of a diminution of the functional deficit by making self-service activities easier and by improving gait disorders and transfers. We consider appropriate that we extend the period of patients’ treatment and follow-up in our next research so as to highlight, if relevant, any notable changes in terms of increasing functional independence also in the case of patients undergoing land-based kinesiotherapy.