Voprosy kurortologii, fizioterapii, i lechebnoi fizicheskoi kultury最新文献

The rehabilitation of patients after upper limb injuries is becoming increasingly relevant in current medical practice considering that this pathology is often occurred in professional athletes, elderly people, people with active lifestyle.

Objective: To study the effectiveness of isolated therapeutic exercises (TE) with eccentric muscle loads when using rubber cable compared to traditional TE to restore functional capabilities of patients after upper limb injuries.

Material and methods: The study included 38 patients with upper limb injuries diagnosed by orthopedic surgeon. Patients were randomly enrolled into group of isolated TE with eccentric muscle loads (group A, 20 patients, mean age 40.2±10.8 years) and group of traditional exercises (group B, 18 patients, mean age 38.6±12.3 years). The study consisted of anamnesis taking, clinical examination, functional tests applying (isometric dynamometry, joint mobility tests, functional scales and questionnaires). The rehabilitation effectiveness was assessed by comparing the indicators before and after treatment course.

Results: There has been a significant improvement in muscle strength, movement amplitude and decrease of pain syndrome in patients rehabilitated by eccentric muscle loads. A comparison with a control group using traditional TE methods confirmed the superiority of eccentric exercises in reducing recovery time and improving functional performance.

Conclusion: The study confirmed the high effectiveness of eccentric muscular loads in the rehabilitation of patients after upper limb injuries. The method has shown significant improvement in clinical and functional indices, which allows to recommend it for inclusion in standard rehabilitation protocols. Further researches may extend application of this approach and reveal the TE effectiveness in other types of traumas and orthopedic injuries.

The problem of patients' rehabilitation after spinal surgery remains relevant. The use of therapeutic physical factors, both preformed and natural, including pelotherapy, is very important. The application of the latter requires to develop new techniques in this pathology, one of which is low temperature exposure.

Objective: To study the possibility and to assess the effectiveness of resource-saving nonthermal pelotherapy techniques in patients' rehabilitation, who underwent surgeries for intervertebral discs' herniation.

Material and methods: The number of patients equal 88, including 39 males and 49 females, after lumbar microdiscectomy, was examined in this study. The patients were divided into 3 groups. Control group (28 patients) received a basic rehabilitation complex (therapeutic gymnastics, massage, low-frequency magnetotherapy); the 1st study group (30 patients) - basic complex and procedures of thin layer applications with peat muds preparation (Tomed-applikat) at 20-24 °C; the 2nd study group (30 patients) - basic complex and procedures of fluctuoresis of 2% solution of peat mud Tomed-aqua preparation.

Results: There was a significant reduction of pain syndrome, recovery of sensitivity and motor activity, decrease of Oswestry index, characterizing the degree of vital activity disturbance, in patients of the study group compared to the control group after treatment.

Conclusion: The inclusion of nonthermal resource-saving techniques of pelotherapy in rehabilitation complex of patients who underwent spinal surgery is effective and pathogenetically justified.

There are some non-communicable diseases (NCD) associated with arterial hypertension (AHT) that are cured after recovery from AHT. Recently confirmed the theory of centralized aerobic-anaerobic energy balance compensation (TCAAEBC) originated some NCDs with the obstructions of arterial blood flow access to the rhomboid fossa. For some sergeants, this has already been demonstrated. Since neurological NCDs are similarly considered by TCAAEBC, it is logical to analyze dynamics of such musculoskeletal neurological problem as isolated musculoskeletal chest pain (IMCP) in connection with the therapy based on TCAAEBC. We retrospectively evaluated the medical records of adult patients with AHT, simultaneously suffering from IMCP. All these patients underwent complex treatment including manual techniques that restore arterial blood flow to the rhomboid fossa, followed by therapy that strengthens the muscular corset primarily of the cervical region. This, in addition to the normalization of AHT, led to a decrease in the musculoskeletal pain syndrome. The dynamic of pain was recorded according to four questionaries - Oswestry Disability Index (ODI) Hospital Anxiety and Depression Scale (HADS), Numerical Rating Scale (NRS), and the Quality-of-life assessment questionnaire (SF-12). The collected data were analyzed with the Wilcoxon signed-rank test, which confirms the recovery of the patients from both AHT and IMCP.

The search for methods to assess the rehabilitation potential (RP) of patients with ischemic heart disease (IHD) who underwent coronary artery bypass surgery (CABS), which will allow to personalize approaches to the administration of necessary for the certain patient treatment complexes, increasing their effectiveness and reducing the probability of complications, remains relevant.

Objective: To develop a method for RP evaluation in patients with IHD who underwent CABS and to assess its role in predicting the effectiveness of therapeutic activities in the early rehabilitation period.

Material and methods: The study consisted of two parts. A method for RP assessment in 118 patients with IHD aged 36-85 years (mean age 62.3±2.0 years) who underwent CABS was developed in the 1^st part based on the analysis of hospital discharge reports using mathematical modeling methods. The results of rehabilitation activities were analyzed in the 2^nd part of the study in patients who were transferred to the cardiovascular department of the Angara Clinical Resort after the cardiovascular surgery department for the second stage of rehabilitation. The multidisciplinary team evaluated the effectiveness of patients' treatment after the rehabilitation completion using integral indicators characterizing clinical condition of the patient who underwent CABS.

Results: A methodological algorithm was created in the 1^st part of the study, namely a formalized patient chart was formed, the evidence base was represented by 99 indicators. The values of linear classification functions' coefficients were assigned to certain indicators, according to which the patient was classified into one of four groups: the 1^st group - without RP; the 2^nd group - with medium RP; the 3^rd group - with high RP and the 4^th group - with low RP. The values of RP were determined in the second part of the study for predicting the effectiveness of therapeutic measures in the early rehabilitation period (the second stage of medical rehabilitation). It has been found that the greatest effect was observed in subjects of the 3^rd group with high RP in the patients' testing after treatment at the health resort. The lesser effect has been noted in patients of the 2^nd group and especially of the 4^th group.

Conclusions: The use of RP assessment method based on mathematical modeling in patients who underwent CABS allows to predict the results of patients' medical rehabilitation at the second stage in the health resort conditions.

The COVID-19 epidemic has made significant changes in the organization of treatment process both at the inpatient and outpatient stages.

Objective: To analyze the work results of the rehabilitation units dealing with patients who have suffered from COVID-19, in order to summarize the used approaches to medical rehabilitation and improve the effectiveness of care delivery in the recovery phase.

Results and conclusion: Currently, the rehabilitation system has been effectively rebuilt to meet new challenges of the COVID-19 pandemic. Recovery of patients with pronounced neurotic disorders has become a showing good results direction in rehabilitation. It is necessary to implement a tight integration of physical exercises and telerehabilitation facilities in order to effectively settle the main issues directly related to the treatment and recovery of patients with COVID-19 and other pathologies. The control, prevention, treatment and rehabilitation of other infectious diseases will have great prospects regarding the possibility of remote follow-up of patients and correction of their functional state of the body in the nearest future.

Hepatic encephalopathy is an early and severe complication of obstructive jaundice and is characterized by occurrence of non-focal and focal neurological manifestations. Different methods of therapy are applied for disorder correction. Low-intensity laser blood irradiation has a pronounced antioxidant and vasoactive effect.

Objective: To analyze the results of pharmaceutical treatment and low-intensity laser therapy use in encephalopathy correction in obstructive jaundice of non-neoplastic origin.

Material and methods: The study was performed at the surgery department in the S.V. Katkov Republican Clinical Hospital (Saransk). The trial included 54 patients with moderate obstructive jaundice of non-neoplastic origin with latent encephalopathy, who were divided into 2 groups: the 1st group (control) consisted of 27 patients receiving standard pharmaceutical treatment; the 2^nd group (study) - 27 patients receiving standard treatment and laser therapy (low-intensity laser irradiation in red emission at the cubital vein projection for 15 minutes). A comparative group (norm) included 20 healthy volunteers. All patients underwent biochemical studies (alanine aminotransferase and total bilirubin levels in the blood were assessed) after treatment. Registration of microcirculatory disorders and psychometric testing were conducted to reveal latent hepatic encephalopathy along with the evaluation of liver functional condition.

Results: Correlation analysis showed the association of psychoneurological status improvement with liver functional condition (indicators of microcirculation and biochemical blood analysis were considered) in patients receiving a comprehensive therapy with laser irradiation. Correlation coefficient amounted to 0.87-0.96 (p<0.05).

Conclusion: The use of above vascular laser blood irradiation in a comprehensive treatment of moderate obstructive jaundice leads to improvement of liver functional condition (the first barrier organ on the toxin pathway) and to a significant reduction of latent encephalopathy's manifestations. The conducted treatment resulted in a reduction of initially elevated levels of alanine aminotransferase and total bilirubin. Laser therapy has an ability to restore microcirculation that leads to the improvement of psychoneurological status in patients with moderate obstructive jaundice.

Cardiovascular diseases and diabetes mellitus, debuting as arterial hypertension (AH) syndrome and prediabetes, are common types of chronic non-communicable processes, that are the leading cause of death in the world. The main treatment method for above mentioned disorders, according to the current guidelines, is pharmacotherapy. However, it is possible to effectively apply non-pharmacological correction methods, aimed at the probable etiological factor and inversive mechanism involved in AH maintenance, in the early stages when no permanent changes are maintaining a high level of blood hypertension (BH) and glycemia. Frequently, this mechanism is hypoxia in the vertebral arteries system due to cervical spine osteochondrosis.

Objective: To evaluate the therapeutic effect of non-pharmacological methods of restoring brainstem blood supply in patients with AH and prediabetes.

Material and methods: The number of patients equal 125 (57 men and 68 women, mean age 63.3±11.5 and 65.4±11.8 y.o., respectively) with prediabetes and 1st degree of AH without target organs damage, among whom 102 patients with prehypertension or 1st degree of hypertension and 24 ones with 2nd degree of hypertension, were examined. The original method of manually restoring brainstem blood supply developed in the Shishonin's Clinic was applied to all patients. The control group included patients with the same disorder, who did not receive manipulations. Blood pressure (BP) measurement, ultrasound and triplex ultrasonography of vertebral arteries, biochemical blood test, and estimation of glycemia and glycated hemoglobin were performed.

Results: All patients of the study group had decreased levels of systolic BP (by 23.8±10.7 mm Hg for men and 32.8±11.9 mm Hg for women), an increase of flow velocity in vertebral arteries (by 20.6±7.5 and 21.5±7.2 cm/s, respectively), a decrease of glycated hemoglobin concentration (by 0.32±0.51 and 0.34±0.41%, respectively). In the comparison group, there were no patients with improvement in these indicators.

Conclusion: The effectiveness of the author's manual method of cervical spine osteochondrosis correction in the reduction of BP and glycemia levels in the early stages of the disease is shown.

Search of new rational ways to increase the effectiveness of treatment and rehabilitation measures for patients with psoriasis vulgaris continues to be one of the urgent problems in modern clinical dermatology.

Objective: To carry out a comparative analysis of the impact of different variants of sanatorium-resort treatment (SRT) - pelotherapy and pelotherapy in combination with intravenous laser blood irradiation (ILBI) - on the level of IL-17 and TNF-a, dermatological status, psychoemotional state and quality of life (QL) assessment of patients with psoriasis vulgaris.

Material and methods: A naturalistic comparative study included 120 patients with psoriasis vulgaris, who were undergoing SRT: 57 patients in the pelotherapy group and 63 in the group of pelotherapy in combination with ILBI. The SRT effectiveness was assessed using the PASI index, the HARS and HDRS scales and the DLQI questionnaire. The dynamics of IL-17 and TNF-a plasma levels in blood plasma was studied. The study duration was 6 months 14 days.

Results: After 14 days of SRT, a decrease in IL-17 and TNF-a levels in blood plasma was statistically significant both in the pelotherapy group and in the group of pelotherapy in combination with ILBI, no statistically significant differences between the groups were found. Furthermore, the comprehensive use of pelotherapy in combination with ILBI has contributed to a more pronounced statistically significant decrease in the PASI index, the HARS and HDRS scales' total scores and an increase in the level of QL. The number of patients with clinical remission was statistically higher in the group of pelotherapy combined with ILBI compared to the pelotherapy group (87.3% versus 42.1%) six months after SRT.

Conclusion: The advantage of comprehensive application of pelotherapy and ILBI in comparison with pelotherapy in patients with psoriasis vulgaris in SRT has been shown. The comprehensive application of pelotherapy and ILBI reduces the level of inflammatory biomarkers, improves dermatological and psychoemotional status, improves QL and is well tolerated by patients.

Objective: To identify features of development of adaptive protective reactions when applying drinking sulfate mineral water (MW) and low-intensity electromagnetic radiation of extremely high frequency (EMR EHF) against the background of a high-calorie diet and after its elimination at an early stage of development of experimental metabolic syndrome.

Material and methods: Experiments were conducted on 40 non-linear male rats with 200-220 g. weight. The model of metabolic syndrome was reproduced for 60 days. All animals were divided into 5 groups: 2 study groups, 2 control groups and 1 intact one. Rats of the 1st study group were given sulfate MW in combination with EMR EHF against the background of a high-calorie diet, controlled by rats receiving only a high-energy diet. Rats of the 2nd study group also received sulfate MW in combination with EMR EHF but when the metabolic syndrome simulation was finished and the high-calorie diet was eliminated, control was done by rats that were given standard food after eliminating the high-energy diet. Liver, testes and blood were objects of the study. Light-optical, morphometric methods of examination and electron microscopy were used.

Results and discussion: The use of sulfate MW in combination with EMR EHF against the background of the high-calorie diet was the most cause of increased activity of the antioxidant system and the plastic processes were weaker; the activation of natural adaptive reactions was noted after the elimination of the diet that in combination with actions of MW and EMR EHF led to the further intensification of protein synthesis (RNA, DNA, total protein), intensification of cellular and intracellular regeneration processes. The identified adaptive shifts during the action of the studied factors were caused by their antioxidant, membrane stabilizing and detoxifying actions.

Conclusion: The results of the study can be used to develop the problem of regulating adaptive reactions with the application of therapeutic physical factors and to create new highly effective methods of preventing and treating metabolic syndrome.

The purpose of the article is to attract the attention of specialists in the resort business in the document being developed - the Decree of the Government of the Russian Federation «On Approval of the Regulations on the Districts of Sanitary (Mining and Sanitary) Protection of Natural Medicinal Resources», the draft of which is proposed for discussion. The article presents all the comments on the discussed draft Regulation and proposals for making appropriate changes with their reasoned justification. The proposals put forward to change the wording of specific paragraphs of the Regulation are aimed at protecting and preserving the wealth of our country - natural healing factors that form the basis of sanatorium treatment. The proposals made to edit the paragraphs of the Regulation will undoubtedly guarantee the preservation of Russia's natural healing resources in order to use them for the prevention, treatment and rehabilitation of the population of our country and the successful development of the resort industry.