Vol 33, No 9 (2022)

Hemorrhagic stroke is a polyethologlcal disease that includes all forms of non-traumatic intracranial hemorrhage. The article evaluates the rehabilitation potential in the acute period of hemorrhagic stroke based on the analysis of significant factors: gender, age, social, topographic characteristics of hematomas, concomitant diseases, focal symptoms. Rehabilitation potential was classified using the Rankin and Rlvermead scales into three degrees: low, medium and high. Unfavorable and favorable predictors of rehabilitation potential have been identified.

The paper substantiates the necessity of Introducing the concept of situational disability In somatic medicine and psychiatry into the clinical and organizational-and-legal reality (using obnubilation of consciousness [mild torpor] and/or asthenic confusion as an example). The Introduction of this concept will be able to protect the rights and freedom of a patient and his attending physician. The paper presents the main clinical symptoms of obnubilation (disorientation In time and situations, their sense association) as a decompensation in a somatic disease throughout the time course of changes In the painful process. It analyzes the clinical manifestations and legal categories of the concept (definition) of situational disability. Practical recommendations are given.

Objective. To Investigate the Impact of therapy with the combination drug Equapress on cardiac remodeling and silent myocardial Ischemia (SMI) In premenopausal women with hypertension and estradiol deficiency. Subjects and methods. The Investigation Involved 47 premenopausal patients (mean age 47.80+2.37years) with Stage II essential hypertension and estradiol deficiency, who were prescribed the combination drug Equapress (lisinopril, amlodipine, and Indapamlde long) as an antihypertensive agent. Before the start of the Investigation and at 6 months after therapy, the patients underwent echocardiography, an analysis of the structural and geometric parameters of the left heart chambers, and an assessment of the systolic and diastolic functions ofthe left ventricle (LV). Hotter monitoring was done with a Kardiotekhnika cardlomonltor complex to detect SMI. Results. Triple antihypertensive therapy (lisinopril, amlodipine, and Indapamlde long) in premenopausal patients with hypertension and estrogen deficiency can slow down the development of LV hypertrophy and left heart chamber dilatation, also has a positive impact on LV remodeling, and lowers the Incidence of SMI.

Depression among children and adolescents Is relatively common but frequently undiagnosed. Early detection of depression In young patients contributes to the efficiency of therapy and to a substantial improvement in quality of life. Combination treatment with psychotherapy and the herbal remedy Hypericum P (Hypericum perforatum) is the safest method for treating children. Hypericum P is designed using Russians unique cryopreservation technology. The paper considers the pharmacotherapeutlc mechanisms of human exposure to the medicinal plant Hypericum P that is a natural antidepressant and has great potential to treat adolescent mental illness. In addition, the administration of the drug does not cause unwanted reactions.

Objective. To evaluate postinfarction remodeling (PR) according to О myocardial Infarction (О-Mi) location within 1 year in able-bodied men during combination therapy including thrombolysis and maximum doses of statins. Subjects and methods. A follow-up was performed in 106 men under 60 years of age with primary Q-Mi, who were randomized Into 2 groups: 1)55 patients who took rosuvastatin 40 mg/day as part of drug therapy: 2)51 patients received atorvastatln 80 mg/day as part of drug therapy. According to age, the patients were divided Into subgroups: A) 49 (46.23%) young patients aged 30-44 years; B) 57 (53.77%) patients aged 45 to 60years. A control group consisted of 30 apparently healthy people without cardiovascular diseases. Results. The patients with Q-MI who took rosuvastatin for 1 year achieved more pronounced reductions In low-density lipoprotein (LDL) and C-reactive protein (CRP) levels compared to those who received atorvastatln. In the subgroup of young patients, the anterior location of Ml prevailed In 79.6%; In the subgroup of patients aged 45-60years, the lo wer location of Ml was In 64.9%. In both subgroups, the patients with anterior Q-MI showed an Increase In the left ventricle (LV) end-systollc diameter (ESD) during both early and late PR; In those with lower Q-MI, the Increased LV ESD was observed In persons aged 30-44 years during late PR. Conclusion. It is preferable to prescribe rosuvastatin 40 mg/day as part of combination therapy for able-bodied patients with the anterior location of Q-MI, by taking into account the characteristics of PR, as it contributes to a faster achievement of the target level of both LDL and CRP, which is one of the criteria for predicting the severity of Q-MI. One-year administration of the maximum doses of statins has been shown to be safe.

Objective. To evaluate diastolic disturbances in patients with unstable angina (UA) in the presence of an increase in epicardial adipose tissue (EAT). Subjects and methods. The investigation involved 64 men and 38 women (mean age, 612+7.6 years) with UA treated in the emergency cardiology unit. The patients were examined; standard laboratory parameters were determined, coronary angiography (CAG) and stenting of one or more coronary arteries were performed on days 1-3 of hospitalization. Echocardiography (EchoCG) with measurement of EAT thickness (EATT) was done at 2-4 days after CAG. EAT was measured from the parasternal position along the long and short axes of the left ventricle (LV) at the end of systole during 3 cardiac cycles; the average of three successive values was taken as the EATT value. According to EATT, the patients were divided Into 2 groups: 1)46 patients who had an EATT of <7.6 mm; 2) 56 patients who had an EATT of >7.6 mm. Results.Analysis of anamnestic and anthropometric data showed no significant differences between the groups, with the exception of waist-to-hip ratio (higher in Group 1; p=0.0026). EchoCG revealed heart failure with preserved LV e/ection fraction (EF); however, LV EF had lower values In Group 2 than In Group 1 (55 [51-59]% versus 58 [53-60]%; p=0.031). There was a significant decrease In the following indicators of diastolic function (DF) in Group 2 compared to Group 1: lateral Em was 6.5 (4.2-8.1) versus 9.3 (6.5-11.1) cm/s (p<0.001); median Em was 5.7 (4.6-6.6) versus 7 (5.6-8.5) cm/s (p=0.001), a significant increase In DT was 228 [207-273] versus 178 [150-211] ms (p<0.001),as well as the E/Em ratio was 11.4 (8.3-14.9) relative units versus 8.7 (5.1-14.2) relative units (p=0.017). There was a positive correlation between EATT and DT (r=0.498; p=0.001) and a moderate negative correlation between EAT and lateral Em (r= -0.374; p = 0.001) and between EATT and median Em (r=-0.331; p=0.001). In Group 2, grade 2 DF disturbances were detected significantly more often (60.8% versus 30.5%; p=0.013). Thus, the individuals with UA were observed to have more pronounced DF disturbances with an increase in EATT. To evaluate diastolic disturbances in patients with acute coronary syndrome without ST segment elevation in the presence of an increase in EAT, it is advisable to use myocardial tissue Doppler EchoCG. The increased EATT In patients with UA should be considered as a possible adverse factor for myocardial dysfunction.

Objective. To investigate mast cell populations in patients of different ages with Stage li-ill bladder cancer (BC), by using innovative immunohistochemical approaches (to study chymase and thymase of positive structures). Subjects and methods. Immunohistochemical approaches were used to examine material from 25 patients: a study group of 20 patients with histologically verified Stage ll-lll bladder cancer; a control group of 5 men aged 36-50years without cancer who died in traffic accidents. Results. The investigation ofthe protease profile of a mast cell population in the bladder showed that during the process of cancer development, the time course of changes In the content of protease-posltive mast cells was different: the number of tryptase-positlve mast cells Increased, while that of chymase-positive mast cells significantly decreased. An analysis ofthe protease profile indicated that with the process of cancer development, mast cell chymase expression noticeably decreased; the size of mast cells in the connective tissue subpopulation reduced. However, they could form local intraorganlc accumulations, secreting both tryptase and chymase in fairly immense areas.

Changes in the locomotion system are mediated by the interplay between bone, muscle, and adipose tissues and accordingly the signaling molecules that they produce, such as adlpoklnes, myokines, and osteoklnes. Sarcopenia in the elderly has now become a major focus of research and debate in healthcare due to Its Impact on morbidity, mortality, quality of life (QoL), and health care seeking. Hypertension and sarcopenia as a geriatric syndrome are often associated In the elderly. At the same time, the primary component in the pathophysiological gerontological continuum Is hypertension, In which prerequisites are created for the development of dynapenic, and later sarcopenlc processes, while osteopenic processes are observed In parallel. This pathophysiological gerontological continuum Is embodied In the assessment of QoL in these patients.

The consequences of experienced COVID-associated pneumonia show it necessary to develop a phased set of rehabilitation measures to restore lung function, which can be implemented by patients, including those at home, after discharge from a healthcare facility. Objective. To evaluate the effectiveness of designed multi-stage breathing exercises In patients who have experienced COVID-associated pneumonia. Subjects and methods. The Investigation Involved 30 patients (14 (46.66%) women and 16 (53.33%) men) aged 41 to 80years. The patients received a cycle of Individual therapeutic exercises according to the developed multistage breathing exercises In terms of the Initial physical capability level. The rehabilitation program was compiled after an objective assessment of a patlenfs current physical status. Allowance was made for the following Indicators: blood oxygen saturation (SpOJ level, heart rate (HR), respiratory rate (RR), and subjective health assessment by a patient. The program provided for several successive load levels: transition to the next cycle step was made only If the Indicators SpO? HR, and RR were adequate for the current level, as well as In the absence of complaints associated with the Intensity of a set of gymnastic exercises. Results. After a rehabilitation cycle, the patients showed cardiovascular adaptations to Increasing physical activity: a significant decrease In HR from 87.0 (75.50; 97.75) to 80.50 (70.00; 84.75) per minute (p<0.0001); significant positive changes in Sp02 from 93.0 (90.25; 95.00) to 98.00 (96.25; 98.75)% (p<0.0001); formation of the correct pattern of respiration, i.e. a reduction In RR from 20.50 (19.00; 23.00) to 18.00 (17.00; 18.00) per minute (p<0.0001); and an Improvement In the Indicators of subjective assessment of exercise tolerance according to the Borg Rating of Perceived Exertion Scale. Conclusion. The effectiveness of the developed multi-stage breathing exercises has a positive impact on the cardiovascular and respiratory systems of patients who have experienced COVID-assodated pneumonia, which is shown during a follow-up of Sp02, HR, and RR, and functional tests.

The model for cancer rehabilitation begins with the pre-rehabilitation stage, next is the first rehabilitation stage. It is imperative to strictly justify the choice of rehabilitation technologies. There is evidence that nutritional and physical pre-rehabilitation has a positive effect on patient survival. However, there are no researches on the possible complex use of nutritional support and physiotherapy In the medical rehabilitation of patients with malignant neoplasms (MNs) of the breast in the early postoperative period, by substantiating the role of each factor. Objective. To investigate the efficiency of specialized dietary therapeutic and preventive nutrition and fluctuorlzation in the complex medical rehabilitation of patients with breast cancer (BC) In the early postoperative period. Subjects and methods. A prospective simple randomized study was conducted, which Involved 202 patients with BC in the early postoperative period (on 24 days after surgery). All the patients underwent medical rehabilitation: Individual physiotherapy exercises, balance therapy, and sessions with a medical psychologist. A study group included 68 patients receiving nutritional support In the medical rehabilitation cycle using the specialized LEOVIT ONCO dietary therapeutic food products, as well as fluctuorlzation. The rehabilitation cycle involved physiotherapy without therapeutic nutrition In a comparison group of 67 patients. A control group of 67 patients received a medical rehabilitation cycle without physiotherapy and therapeutic nutrition. The patients underwent clinical, functional, laboratory, and instrumental studies. Results and conclusion. The use of the specialized LEOVIT ONCO dietary products and fluctuorlzation In the preoperative and early postoperative periods was established to be an effective method of rehabilitation. The advantage of fluctuorlzation is the rapid relief of postoperative pain syndrome and the acceleration of regeneration. The use of the specialized LEOVIT ONCO dietary health food products assists in reducing postoperative intoxication, improves the antitoxic function of the liver, and reduces inflammatory processes and a negative impact of oxidative stress in the patients with BC. As a result, faster recovery of damaged tissues occurs and quality of life improves In the patients.

The early detection of diseases, especially In elderly patients, Is an urgent public health problem. The functional abilities of patients of older age groups (over 65 years) were screened using the WHO ICOPE Handbook App and a comprehensive geriatric assessment. The efficiency of digital technologies used In the primary health care system was also evaluated In Identifying various functional disorders (cognitive, motor, hearing, and visual Impairments, malnutrition, decreased muscular strength, probable depression, etc.) in elderly patients.