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

Urinary tract infections, in particular acute gestational pyelonephritis (AGP) determine a high risk of developing various complications of pregnancy and childbirth. The development of new medical technologies for the treatment of AGP remains relevant. It has not only high direct effectiveness, but also shows a distinct impact of secondary prevention of pyelonephritis exacerbations and a fetoprotective effect. An objective evidence for these effects is the study of long-term treatment outcomes.

Objective: To evaluate the general condition of pregnant women in a randomized controlled study of the long-term observation period who underwent acute gestational pyelonephritis, birth results, quality of life of the patients and vitality of the newborns.

Material and methods: The study included 93 women at the age of 16 to 40 years old who underwent AGP. They were divided into two groups by simple randomization: the main/MG (46 people) and the control/CG (47 people). The control group of the patients was prescribed the drug standard; the main one had intravenous ozone therapy (OT) in addition to it.

Results: In the MG the patients had significant differences (p<0.05-0.001) with women of the CG in such indicators as: repeated relapses of gestational pyelonephritis (4.5 times), late gestational toxicosis (2.6 times), the number of newborns with normal growth and weight parameters (1.9 times), bacteriuria (3.0 times), leukocytouria (4.0 times), medical care for the main disease (5.0 times), outpatient treatment (8.0 times) and quality of life indicators - physical and social activity as well as general health.

Conclusion: An additional prescription in the standard of care for patients with AGP based on intravenous administration of an ozone-oxygen mixture significantly improves the long-term results of the therapy and the quality of life of patients who have undergone AGP, and also has a distinct fetoprotective effect. The absence of adverse reactions with all the patients including in the long-term follow-up period indicates the safety of a new complex of restorative treatment for AGP.

Dystrophinopathies - a group of hereditary X-linked neuromuscular diseases characterized by worsening fibrofatty degeneration of skeletal muscles, muscular weakness, low exercise tolerance, as well as orthopedic, cardiovascular and respiratory complications. Study of the effectiveness of physical medical rehabilitation in patients with neuromuscular diseases, evaluation of the influence of external and internal factors on functional capabilities and effectiveness of the conducted rehabilitation are highly relevant.

Objective: To evaluate the effectiveness of physical medical rehabilitation of patients with dystrophinopathies at the outpatient stages of the disease's course and the influence of anthropometric characteristics and functional status of patients' motor capabilities.

Material and methods: The study included 47 patients with genetically confirmed Duchenne muscular dystrophy (DMD) (the 1st group - 32 patients at an early outpatient stage, mean age 7.0±0.2 years; the 2nd group - 15 patients at a late outpatient stage, mean age 9.0±0.2 years) and 17 patients with Becker muscular dystrophy (BMD) (the 3rd group, mean age 12.0±1.2 years). All patients performed aerobic exercises 3 times a week, the duration of rehabilitation course was 4 months. The distance of 6-minute walk test (6MWT) with fatigue assessment on the visual analogue scale, the speed of rising from the floor with assessment of the functional class on a 6-point scale, the functional capacities on the Motor Function Measure (MFM) scale, dimension D1 (standing and transfers) were evaluated at baseline and after 2 and 4 months.

Results: Positive dynamics has been revealed in the form of elongating 6MWT distance, increasing speed of tests for time performance with increase of test's functional class, improvement of motor functions on the MFM scale at the end of case follow-up in the 1st and 3rd groups (p<0.01). A high correlation of the patients' motor capabilities with reduction of strength and speed indicators, moderate relationship with age and anthropometric indicators have been found (p<0.01).

Conclusions: Performance of aerobic exercises without weight combined with exercises on an ergocycle allows to improve motor capabilities in patients with DMD at the early stages and in patients with BMD. Exercising at the late stages of DMD can slow down the disease's progression. The dynamics of motor capabilities' indicators in regular performance of dynamic aerobic exercises are more influenced by the initial functional status, less - by age and concomitant overweight and high body mass index.

Stanislav Iosofatovich Zalesky - the first head of the Department of General Medical Chemistry of the Imperial Tomsk University (currently the Department of Chemistry of the Siberian State Medical University), a versatile scientist and public figure, acknowledged expert in medical, chemical, hydrogeological and balneological sciences. Professor S.I. Zalesky participated in the creation of health resorts of international importance In Russia and performed a great research and practice aimed at making the richest natural therapeutic factors of Siberia available for treatment. Investigation of the waters and muds of the Siberian region for a purpose of creating resorts for the health improvement of people is one of the most important aspects of his scientific activity. S.I. Zalesky developed a scientific approach to sampling and determination of the chemical composition of natural objects, the therapeutic effect of which he associated with the iron compounds contained in them. Professor S.I. Zalesky successfully combined the hard work in expeditions with teaching activities primarily in the Imperial Tomsk University, then in the Saint-Petersburg Women's Medical Institute as a professor in the Department of General, Analytical and Physiological Chemistry. Stanislav Iosofatovich was deeply involved in educational activities. He founded the «Samoobrazovanie» popular science magazine in 1901 and edited the «Recept» pharmaceutical journal since 1902. Russian translations of textbooks were published under his editorship. He compiled a number of popular books and brochures in the sphere of balneotherapy and hygiene in addition to «Samoobrazovanie», «Narodnoe zdorov'e», «Sputnik zdorov'ya» and separately. Tireless research, educational and public activities of the scientist, his scientific foresight have initiated the development of balneological health resorts in Siberia, Altai, Caucasus and Ukraine. The search and study of archival materials on the multi-faceted activity of professor S.I. Zalesky allowed to establish an invaluable contribution of the scientist in the development of health resorts of Russia.

Postmastectomy syndrome (PMS) is a complex neurovascular set of symptoms that develops in most patients after breast cancer (BC) treatment and significantly reduces the quality of life. One of the potential mechanisms of its occurrence is considered to be an endothelial dysfunction. The possible method of reducing manifestation of endothelial dysfunction is systematic aerobic dynamic training.

Objective: To evaluate the influence of 12-week aerobic dynamic training program of moderate intensity on the endothelial dysfunction laboratory markers and life quality in patients with PMS.

Material and methods: Single-center prospective randomized trial included 40 patients with PMS divided into study (20 patients) and comparative (20 patients) groups, as well as 20 healthy female volunteers. The expression level of soluble intercellular adhesion molecule-1 (ICAM-1) and platelet endothelial cell adhesion molecule-1 (PECAM-1) were evaluated in all participants at baseline by enzyme-linked immunosorbent assay method, and additionally psychological and physical component of health by SF-36 questionnaire were assessed in patients with PMS.

Patients of study group received a course of 12-week partially controlled aerobic dynamic training of moderate intensity lasting 45 minutes with frequency equal 5 times per week. Patients with PMS were re-evaluated for ICAM-1 and PECAM-1, as well as for life quality.

Results: The group of patients with PMS after BC treatment had increased level of ICAM-1 in long-term period, that may indicate endothelial dysfunction. Statistically significant decrease of endothelial dysfunction laboratory markers was revealed in patients with PMS, who underwent the course of cardiorespiratory training. In the same time, the dynamics of changes in ICAM-1 was higher in the study group than in comparative group. Further, improvement of physical and psychological components of health by SF-36 questionnaire was found.

Conclusions: The program of cardiorespiratory trainings of moderate intensity in patients, who had BC treatment a year ago, decreases intercellular adhesion molecules level that may show an improvement of endothelial dysfunction.

One of the methods of non-drug treatment of essential arterial hypertension, is manual, osteopathic effects on the spine, primarily the cervical spine. Despite the absence of these methods in clinical guidelines for essential arterial hypertension, they continue to develop and improve. One of the promising areas is manual-physical correction with an effect on the cervical spine and subsequent strengthening of the muscle corset with the help of physical exercises (method of A.Yu. Shishonin). One of the supposed mechanisms for reducing blood pressure (BP) in this case is the effect on the autonomic nervous system (ANS). In the course of the study, which was based on the study of heart rate variability (HRV), the presence of pronounced signs of a decrease in sympathetic influences and activation of the parasympathetic nervous system was shown. The parameters of statistical linear analysis (standard deviation of NN intervals; stress index, etc.) and the wave spectrum shifted towards sympathicotonia during therapy using the method of A.Yu. Shishonin. The HRV data were obtained against the background of a decrease in blood pressure and a decrease in heart rate (HR), which suggests the impact of manual physical correction on the ANS as one of the key mechanisms mediating its effect.

There is a long-observed relationship between the pathology of the spine and arterial hypertension. There are a number of explanations for this, including one based on reflex effects and obstruction of blood flow to the cerebral vasodilatory centre localized in the rhomboid fossa projection. Obstruction can be absolute and relative, preventing the increase of blood flow during stress, when the brain turns on additional energy demand (phenomenon of «selfish brain»). In conditions of insufficient blood supply anaerobic metabolism is included, requiring in the future, the addition of anaerobic glycolysis products. This leads to the persistence of an elevated level of AD and is part of the theory of centralized compensation of aerobic-anaerobic balance (theoretical aerobic-anaerobic energy concept, TAAEBC). The existing methods of manual manipulation and physical action on the spine, mainly the atlantoacral section of the cervical spine, have, according to existing publications, varying degrees of effectiveness. The modern approach to treatment of arterial hypertension and correction of metabolic disorders by A. Shishonin is promising. It is based on the TAAEBC concept and assumes a system approach and long-term effect through a consistent three-step manual and physical interventions aimed at restoring, retaining and long-term support of the vertebral blood flow.

Archive documents and sources in scientific electronic databases were analyzed in order to study the historical origins of the health resort business in terms of children's health resort medicine in the Samara government. It has been established that the period of origin and intensive development of balneology for children in the Samara region occurred at the beginning of the 20th century and the first children's sanatoriums began to function thanks to the initiative of the Society of Governmental Physicians for charitable funds of the Samara nobility and merchantry in territories with natural and climatic therapeutic factors, namely Sernovodsky resort, Barboshina glade and Postnikov ravine. A comparative analysis of the dynamics of morbidity structure of children admitted for sanatorium treatment, as well as general education institutions, from which information on the health of school pupils is received, has been conducted over a period of 120 years. Despite the change of years and generations, there is a general concept of sanatorium health improvement of school pupils as a future social and economic pillar of society, with the formation of a healthy generation for both the region and the country in general.

Peripheral magnetic stimulation (pMS) has shown its effectiveness in the treatment of lower urinary tract symptoms, such as symptoms of an overactive bladder (OAB). The perineal region (pelvic floor) and the sacral roots area (projection S3 of the root) are used as the locus of stimulation. The published literature presents protocols with different parameters of stimulation, while each of them reliably demonstrates clinical efficacy, however, no comparative studies have been found to select priority stimulation modes when analyzing available sources.

Objective: To compare the efficacy and safety of different frequency - 1 and 5 Hz - modes of sacral MS in patients with symptoms of OAB.

Material and methods: A single blind prospective randomized comparative clinical study included 59 patients with OAB symptoms. The patients were divided by simple randomization into the group 1 (n=30), which received MS 3 times a week for 5 weeks with a frequency of 1 Hz per sacral root area (S2-S4), and the group 2 (n=29), in which stimulation was performed at a frequency of 5 Hz, while the remaining parameters and duration of therapy were identical to group 1.

Results: Sacral pMS with different frequency modes (1 and 5 Hz) is reliably equally effective against the clinical symptoms of OAB, which is confirmed by the absence of significant intergroup differences. In patients receiving MS with a frequency of 5 Hz, there was a more pronounced increase in maximum cystometric capacity, normalization of the maximum and average urine flow velocity and regression of the residual urine volume (p<0.001, p=0.007, p=0.011 and p=0.012 compared with group 1). The greatest difference in indicators was observed in the increase in the maximum cystometric capacity - +31±25 ml at MS with a frequency of 1 Hz and +109±96 ml at MS with a frequency of 5 Hz (p<0.001). MS is a safe procedure and is well tolerated by patients.

Conclusion: pMS when exposed to the area of S2-S4 roots for 20 minutes 3 times a week with a course for 5 weeks is reliably effective against the clinical symptoms of OAB at different frequency modes (1 and 5 Hz). At the same time, MS with a frequency of 5 Hz may have an advantage over stimulation of 1 Hz in terms of its effect on urodynamic parameters (maximum cystometric capacity, peak and average urine flow velocity and residual urine volume), which may be associated with a large inhibitory effect on detrusor.