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

Objective: To determine the characteristics of sanatorium-resort therapy impact on children with post-COVID-19 syndrome of various severity, as well as to reveal association of its severity with family history data and genetic polymorphisms of alpha-1-antitrypsin-serpin-1 complex.

Material and methods: This 2-week retrospective cohort study involved 42 adolescents after new coronavirus infection (COVID-19). The first group included 28 (67%) patients (mean age 13.1±0.8 years) after mild COVID-19 (without confirmed coronavirus pneumonia), the second group - 14 (33%) patients (mean age 14.5±0.1.2 years) after moderate or severe disease (with confirmed coronavirus pneumonia). A complex of procedures, according to the approved standard, was prescribed for all patients admitted after outpatient and hospital treatment to the pulmonology department of the state children's sanatorium in order to aftercare. The certain follow-up parameters were evaluated: symptoms severity, life quality, respiratory function and respiratory gases, as well as family medical history and alpha-1-antitrypsin-serpin-1 complex.

Results: Patients after moderate and severe COVID-19 had initially lower and less dynamic growth of integral life quality index, more torpid follow-up rates of spirometry, pulse oximetry and exhaled gases. Additionally, the higher incidence degree of adverse family medical history associated with respiratory illnesses was established in the group after new coronavirus infection. Moreover, relatively more deficient alpha-1-antitrypsin and more frequent heterozygous polymorphism type of serpin-1 were found in the group after severe new coronavirus infection.

Conclusion: The revealed complex of epigenetic and genetic factors may indicate various risk and development phenotypes of both acute and chronic respiratory diseases.

Static motor disorders are the main cause of falls and decrease of daily activity in patients after previous ischemic stroke.

Objective: To study impact of robotic mechanotherapy with functional electrostimulation (FES) on rebalancing in patients in acute and early recovery periods of ischemic stroke.

Material and methods: The number of patients equal 60, divided into 2 groups, were examined. Study group included 30 patients, who were treated in an exoskeleton with FES; control group consisted of 30 patients, whose walking and balance recovering was carried out with exercise therapy.

Results: The study group showed a more pronounced improvement of balance indicators by Tinetti scale compared to the control group (11 [8; 13] against 8 [6; 12]; p=0.0281) at the end of treatment. Patients of study group demonstrated significantly better results both by Tinetti scale and stabilometrical parameters in acute period of stroke compared to the control group.

Conclusion: Application of exoskeleton with FES in patients in acute and early periods of ischemic stroke contributes (to a better balance recovery), which may be achieved by long-lasting verticalization and large repetition of the correct walking pattern during rehabilitative trainings.

Previous research experience on cardiac rehabilitation programs as a part of general health care system has shown that they are an important part of the management of cardiovascular patients. Improving quality of life, reducing the severity of risk factors, increasing physical performance, slowing disease progression, decrease in morbidity and mortality indicate the clinical efficacy of cardiac rehabilitation and make it an integral part of therapeutic interventions. Heart rehabilitation is a 1st class recommendation in the majority of modern cardiovascular guidelines around the world.

Despite the development and implementation of preventive measures, new coronavirus infection (COVID-19) cases are still being registered among the population.

Objective: To describe the methods of recovery treatment, used at different rehabilitation stages of patients suffered from COVID-19.

Material and methods: An analytical review of rehabilitation methods of patients after COVID-19 was conducted. The literature reviews and original researches from Scopus, Web of Science, PubMed, CyberLeninka and eLibrary electronic databases were studied.

Results and conclusion: Lungs, heart and vessels, gastrointestinal tract and central nervous system are most commonly affected by COVID-19. Due to this, the article considers key aspect of rehabilitation of patients with revealed disorders. Multidisciplinary approach is the main treatment type of patient with COVID-19. The effective result of comprehensive and multidisciplinary approach can be achieved only by the work of a team of specialists from different disciplines. The early onset, consistency and continuity of rehabilitation activities are important factors in the recovery of patients with post-COVID syndrome.

Introduction: As a prevention of falls in elderly people with chronic cerebral ischemia, it is necessary to carry out rehabilitation measures with the inclusion of training aimed at improving statolocomotor and cognitive functions, improving proprioceptive sensitivity and reaction speed to external stimuli.

Aims: To compare the effectiveness of inclusion of hardware balance training on Huber («LPG-Systems», France) and C-mill («Physiomed Elektromedizin AG», Germany) simulators in complex postural control rehabilitation programs for elderly patients with chronic cerebral ischemia (CCI).

Material and methods: The study included 48 patients (19 men, 29 women), 81% of whom had moderate cognitive impairment. The median age was 76.2±8.5 years. The median Morse scale score before rehabilitation was 50.2 (CI 74-80). The patients were divided into three groups by randomization method: the patients of the 1st comparison group (n=16) were assigned to the Huber stabilizer; the patients of the 2nd comparison group (n=16) underwent training on the track with BOS-video reconstruction of walking «C-mill»; the patients of the control group (n=16) underwent the course of therapeutic gymnastics according to the developed method. The duration of the course in each group amounted to 8 therapeutic procedures. In the dynamics of the conducted trainings we evaluated: the risk of falls, parameters of postural disorders in statics and dynamics, as well as criteria determining cognitive dysfunction and quality of life of patients.

Results: A pronounced improvement of static and dynamic postural indices was observed in the first comparison group, where there was a significant improvement of stabilometric indices: «SL» (p=0.001), amplitude of saggital sway (p=0.014), walking speed (p=0.001) and percentage of hitting the marks (p=0.001). The second comparison group showed significant improvement in dynamic balance parameters: walking speed (p=0.001), stride width (p=0.006), percentage of hitting the marks (p=0.001).

Conclusion: Training on rehabilitation simulators according to the applied methods contributed to the improvement of fall risk related indicators as well as the effectiveness of improving motor performance in older adults with HIM compared to the control group. However, training on the stable-platform induced more significant clinical effects on both static and dynamic balance.

Introduction: The phenomenon of therapeutic and prophylactic effect of natural mineral waters (MW) used to restore tissue tolerance to glucose and normalize basal insulin secretion in metabolic syndrome is well known. At the same time, the use of selenium-enriched MW is promising due to its multitarget action including participation in the regulation of the protein-synthesizing function of cells.

Aim: To study the effect of internal course intake of selenium-modified mineral waters of different composition on bone mineral density after long-term diet-induced metabolic disorders in the experiment.

Material and methods: The study was carried out on outbred male white rats that were distributed into 3 control groups (CG) and 4 main groups (MG). In CG1 14 animals received laboratory food and drinking water; in CG2 14 animals were modeled for diet-induced metabolic disorders, and they were withdrawn from the experiment the day after the cancellation of the hypercaloric diet (180 days); after the cancellation of the hypercaloric diet 180 days later 14 animals with diet-induced metabolic disorders in CG3 had a standard diet (laboratory food and drinking water) for 30 days. In the experimental groups (EG), the animals similarly to CG3 were modeled diet-induced metabolic disorders, after the cancellation of the diet they had a standard diet and watering with MW. In MG1 18 animals were given MW1 (Essentuki-4); in MG2 19 animals had a course of MW1Se (Essentuki-4 enriched with selenium); in MG3 14 animals had a course of MW2 (Slavyanovskaya); in MG4 18 animals had a course of MB2Se (Slavyanovskaya enriched with selenium). The weight (body weight) of the animals was monitored monthly. Biochemical studies, densitometry and computed microtomography were used to determine the effectiveness of MW.

Results: The characteristics of spongy bone tissue of femoral metaphysis of the rats of the control groups revealed disorders of varying degrees, but, despite this, the bone tissue structure of the examined vertebral bodies in animals without a hyper caloric diet (CG1) was preserved. The analysis of the study results demonstrated a significant effectiveness of selenium-enriched MW in regulating metabolic processes (p<0.05-p<0.01), bone mineral density (p<0.05), reduced bone resorption (p<0.05), that is, the characteristics of spongy bone tissue of femoral metaphysis and vertebral bodies of animals showed a clear tendency to restore bone structure.

Conclusion: The results of this study make it possible to predict an increase in the effectiveness of medical rehabilitation of patients with somatic diseases when selenium-enriched MW is included in the programmes.

Drinking water is one of the most important factors influencing the formation of the health and quality of life of the population. In recent years, there has been a steady trend towards an increase in the consumption of packaged drinking water, including mineral water, by the population. Identification and elimination of counterfeit products are necessary to improve product quality, protect consumers from substandard products and protect the rights of honest producers.

Objective: Conduct an assortment identification of packaged mineral water of a well-known brand according to the information indicated on the label to confirm its compliance with the declared name.

Material and methods: The work was carried out at VNIIPBiVP, a branch of the Federal State Budgetary Scientific Institution "Federal Scientific Center for Food Systems named after V.I. V.M. Gorbatov» RAS (Moscow). As objects of study, industrially bottled mineral natural medicinal table waters «Essentuki No. 4» from different manufacturers, packaged in consumer packaging made of polyethylene terephthalate and glass, were chosen. Water quality and compliance with the labeling were assessed by organoleptic indicators (transparency, color, taste and smell), basic composition and mineralization. The indicators were determined according to approved methods registered in the prescribed manner.

Results: Examination of the labeling of the studied samples showed the compliance of the name and purpose of mineral water with the requirements of the technical regulations. A physicochemical and organoleptic analysis of the studied mineral water was carried out according to the identification indicators indicated in the labeling.

Conclusion: Identifiable packaged mineral water according to the indicators indicated in the labeling meets the requirements for mineral natural drinking water «Essentuki No. 4».

The search for ways to assess the rehabilitation potential (RP) in patients with acute myocardial infarction (AMI) who have undergone stenting remains relevant, which will allow personalizing approaches to prescribing treatment complexes necessary for a particular patient, increasing their effectiveness and reducing the likelihood of complications.

Objective: To develop a method for assessing RP in patients in the acute period of myocardial infarction and to evaluate its role in predicting the effectiveness of therapeutic measures in the early recovery period.

Material and methods: The study consisted of two parts. In the first part, a method for assessing the RP of patients with AMI was created using mathematical modeling methods. For this purpose, the analysis of discharge epicrisis of 137 patients (training sample) with AMI aged from 34 to 85 years (average age 59.4±2.1 years) was carried out. In the second part of the study, the results of rehabilitation measures were analyzed in these patients who, after the intensive care unit and intensive care unit, were transferred to the cardiology department of Angara Clinical Resort JSC. At the end of the II stage of rehabilitation, a multidisciplinary team evaluated the effectiveness of treatment of patients using integral indicators characterizing the clinical condition of a patient who has undergone acute coronary syndrome and stenting.

Results: In the first part of the study, devoted to the development of a mathematical model for assessing the RP of patients with AMI, an algorithm of methodology was created: a formalized patient map was formed, the evidence base was represented by 109 indicators; certain indicators were assigned the values of coefficients of linear classification functions, depending on which the patient fell into one of three groups: group 1 - high RP; group 2 - medium RP; group 3 - low RP. The second part of the study was devoted to determining the value of RP for predicting the effectiveness of therapeutic measures in the early recovery period (stage II of medical rehabilitation). When testing patients at the end of treatment at the resort, it was found that the greatest effect was observed in group 1 patients with high RP. A lesser effect was observed in patients of group 2 and, especially, group 3.

Conclusion: The use of a method for assessing RP based on mathematical modeling in AMI patients who have undergone stenting allows predicting the results of medical rehabilitation of patients at stage II in the conditions of the resort.

The concept of the personalized rehabilitation is based on the principle of applying physical and rehabilitative medicine techniques depending on the factors that mostly influence on rehabilitation efficacy in a particular patient - determinant of effectiveness. Current achievements in the diagnosis and treatment of breast cancer (BC) significantly increased overall patients' life expectancy, updating rehabilitative treatment stage, which is often unmet.

Objective: To perform the comprehensive analysis of the efficacy of personalized rehabilitation programs in patients with BC.

Material and methods: The combined comparative multi-centre randomised trial of rehabilitation program efficacy in patients with breast cancer was done. The study included 219 patients aged from 30 to 45 years (median 39.4 year), who were divided into 2 groups. The rehabilitation by programs, that included current personalized rehabilitative techniques (RT) with proved efficiency, based on scientometrical analysis of evidential research was performed in the first group patients. In the second group aftercare was done according to the standard programs. The comprehensive evaluation of treatment efficacy was conducted in several stages: 1) performance analysis of rehabilitative programs; 2) verification of the effectiveness' determinant of rehabilitation; 3) factor analysis to assess the mechanisms of therapeutic effects in experimental groups; 4) comparative analysis of alternative strategies for selecting rehabilitation programs.

Results: The use of rehabilitative programs, based on recommended RT, changes the rehabilitation structure, significantly increasing its efficacy by 17%. Furthermore, the percentage of high-efficiency usage of this type programs increases by 17% compared with standard programs. The main determinants, affecting the efficacy of rehabilitation programs, based on selected RT, are anamnestic data, parameters of exercise tolerance and physical activity and ultrasound parameters of upper limb blood flow. The therapeutic effects of personalized rehabilitation programs are realized by correction of clinical rates, increasing exercise tolerance and physical activity, as well as psychophysiological parameters.

Conclusion: The use of the evaluation system of anamnestic, clinical, functional and psychophysiological features of patient (the effectiveness' determinant) in realization of personalized rehabilitation programs for women with BC, allows to predict and manage the efficacy of RT applying.