Background: Joint arthroplasty is one of the most common modern operations in orthopedics and traumatology. Physiotherapy and rehabilitation are the final phase of the endoprosthesis and are of great importance both for the rate and for the extent of functional recovery. DEEP OSCILLATION® is a patented therapeutic procedure using resonant vibrations of tissues with minimal external mechanical effect and proven analgesic, antifibrotic, anti-inflammatory and anti-inflammatory effect. Aim of the study: To investigate the effect of deep oscillations and kinesitherapy on the reduction of edema, reduction of pain syndromes and restoration of the range of motion in patients after knee joint arthroplasty. Materials and methods: The study was conducted on 106 patients -38 men and 66 women randomly assigned to 2 groups - experimental group (EG) with 56 patients and control group (CG) with 50 patients, all after knee joint arthroplasty. Results: Our preliminary results indicate that there are significant differences in the recovery of patients in EG and CG. Patients who have a deep oscillation procedure are recovering faster and better, both in terms of subjective complaints and in terms of the monitored functional parameters (p<0.001). Conclusions: The results obtained have shown that deep oscillations are an effective method for reducing swelling, suppressing pain and inflammation, and increasing the range of motion (ROM) in early rehabilitation of patients after knee joint arthroplasty.

Halotherapy – an alternative method for the treatment of respiratory diseases

Diabetes is one of the leading causes of health losses among the Bulgarian population. Diabetic neuropathy (DN) occurs in at least 34 % of people with type 1 diabetes after 25 years of disease duration and 20 % - 30 % of newly diagnosed patients with type 2 diabetes, increasing to 50 % after 10 years of disease duration. The treatment of DN is challenging. There is growing interest in non-pharmacological forms of treatment. High-power lasers have increasingly been used in the practice of physical and rehabilitation medicine. However, clinical trials testing their effectiveness in DN are scarce. Purpose: The aim of this single blinded, placebo-controlled field trial is to investigate the effect of a multiwave locked system (MLS laser) on sensory perception and electroneurographic parameters of sensory and motor nerves in patients with diabetic sensorimotor neuropathy of lower limbs. Material/Methods: A total of 69 patients were randomly assigned laser treatment (n=41) or placebo treatment (n-28) for three weeks, totaling 9 procedural sessions. Vibration sense was measured three times per session. Neurophysiological evaluations were conducted at baseline and on day 90. Results: On day 21, vibration sense increased bilaterally at all sites in the laser group, with statistically significant differences (p < 0.05 for all sites) compared to the placebo group, persisting through day 90. Nerve conduction velocity and amplitude of the sural, peroneal, and tibial nerves improved by day 90 from baseline, with superior results in the sural nerve. Conclusions: Deep tissue laser therapy can be considered a safe, non-pharmacological adjunct to the standard for managing diabetic neuropathy.

Peripheral nerve injuries can lead to significant functional impairments, and treatment options remain limited. Galantamine, widely used for cognitive disorders, has shown potential effects on the peripheral nervous system, making it a candidate for new therapeutic approaches. The narrative review explores the use of galantamine for peripheral nerve injuries, with a focus on transdermal and iontophoretic delivery methods. Searches in scientific databases revealed no peer-reviewed publications addressing this specific application. As a result, the review expanded to include printed and offline sources and a broader timeframe to capture earlier reports. Available evidence from Bulgaria suggests that galantamine ampules have been applied via iontophoresis for peripheral neuropathy. However, this approach is not documented in established scientific databases, and information on its safety and effectiveness is limited. Overall, research on transdermal galantamine for peripheral nerve injuries is still scarce. More studies are needed to better understand its potential benefits and to optimize safe delivery methods.

Galantamine, a reversible inhibitor of acetylcholinesterase, exhibits both acetylcholinesterase-inhibiting and neuroprotective properties. The FDA (Food and Drug Administration) and EMA ( European Medicines Agency) have approved it for use in the treatment of Alzheimer's disease dementia (AD). The side effects associated with oral administration include gastrointestinal irritation, first-pass hepatic metabolism leading to reduced bioavailability and systemic adverse reactions such as nausea or liver enzyme elevation. These issues have led to the exploration of alternative delivery routes, such as transdermal, intranasal, or buccal. Such routes can bypass the gastrointestinal tract and liver, thereby reducing the risk of digestive discomfort and hepatic strain. The FDA has approved acetylcholinesterase inhibitors, such as rivastigmine, for transdermal administration in the form of patches. Studies on the transdermal administration of galantamine are ongoing. In addition to its use for AD, galantamine is increasingly being investigated for its effects on various conditions, including its potential in treating peripheral nervous system damage. In Bulgaria, a method for depositing galantamine through iontophoresis has been developed and widely used in clinical practice for many years. However, there is a lack of scientific evidence to support its effectiveness according to modern scientific approaches, necessitating further research in this direction.