Vol 23, No 6 (2024)
- Year: 2024
- Published: 03.12.2024
- Articles: 13
- URL: https://journals.eco-vector.com/2078-1962/issue/view/10246
Full Issue
Articles
Geriatric Rehabilitation in Patients with Frailty: Interim Results of the POSTSCRIPTUM. An Open Prospective Study
Abstract
INTRODUCTION. Introduction of additional stage of rehabilitation in elderly patients with varying degrees of frailty into practice helps to restore functional independence in patients, reduce the frequency of rehospitalizations and mortality in this population. Additional studies are needed in the Russian Federation for a wider integration of geriatric care models into clinical practice.
AIM. To assess the impact of geriatric rehabilitation on the level of functional activity in patients with frailty.
MATERIALS AND METHODS. A multicenter prospective study of the effectiveness of individual 21-day geriatric rehabilitation programs based on the results of a comprehensive geriatric assessment for patients aged 60 years and older with frailty syndrome.
RESULTS AND DISCUSSION. The analysis population included 483 patients, of which 84.2 % (n = 390) were women, the average age of patients was 78.6 ± 7.7 years. The patients were divided into three groups: frailty (n = 171; 36 %), pre-frailty (n = 291; 60 %) and "robust" patients (n = 21; 4 %). Improvement of geriatric status was registered in all groups. The most pronounced changes were found in patients with frailty: the sum of points of the SPPB, the Barthel index, the sum of points on the MOCA scale increased; the sum of points on the GDS-15 scale and the insomnia severity index decreased, self-assessment of pain on the VAS and dynamometry indicators improved.
CONCLUSION. A multicomponent intervention based on the results of a comprehensive geriatric assessment is associated with an improvement in the functional, physical and cognitive status of elderly patients already 3 weeks after the start of the intervention.
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Effect of Ultrasound Combined with Dry Needling on Myofascial Pain in the Upper Trapezius : a Controlled Randomised Study
Abstract
INTRODUCTION. Myofacscial Pain Syndrome (MPS) Upper trapezius is a condition of tightness in the upper trapezius characterized by the appearance of myofascial trigger points in the upper trapezius muscle fibers. This causes pain and decreased elastitrapezius muscle fibers, resulting in cervical motion limitations.
AIM. To determine the effect of the addition of ultrasound to Dry needling intervention on reducing pain and increasing cervical range in the condition of upper trapezius MPS.
MATERIALS AND METHODS. This type of research is a quasi-experiment with a randomized pre-test-post-test control group design that uses 2 sample groups, where the treatment group is given Ultrasound Therapy and Dry needling intervention, and the control group is given Dry needling intervention only. The sample obtained was 30 people according to the inclusion criteria, then randomized into 2 groups, namely 15 people in the treatment group and 15 people in the control group. Data collection was obtained through measurement of tenderness using Visual Analog Scale (VAS) and measurement of Range of Motion (ROM) using a goniometer.
RESULTS AND DISCUSSION. Based on the independent sample t-test for the VAS scale, the value of p = 0.619 (mean difference of 3.767 control > 3.553 treatment), and based on the Mann-Whitney test, the value of p = 0.074 for flexion ROM (mean difference of 17.00 control > 12.33 treatment), p = 0.311 for lateral flexion ROM (mean difference of 9.33 treatment > 8.00 control), and p = 0.494 for rotation ROM (mean difference of 13.33 treatment > 11.67 control), which means that there is no significant difference in effect between the treatment and control groups.
CONCLUSION. The addition of ultrasound to the dry needling intervention resulted in an increase of 9.33 in lateral flexion and 13.33 in rotation which means this number is greater when compared to dry needling alone with an increase of 8.00 in lateral flexion and 11.67 in rotation. However, the addition of ultrasound did not result in a decrease in tenderness and a greater improvement in cervical flexion where the value of 3.767 in dry needling alone > compared to the value of 3.553 in the addition of ultrasound and 17.00 > 12.33.
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Approbation of the Methodology "Scale for Cognitive Status Assessment of the After-Stroke Patients with Speech Disorders"
Abstract
INTRODUCTION. The development of a screening tool for diagnosing cognitive status in stroke patients with speech disorders is an urgent problem of rehabilitation.
AIM. To develop and validate a screening diagnostic technique for the cognitive status of patients after ischemic stroke with speech disorders.
MATERIALS AND METHODS. The methodology "Scale for cognitive status assessment of the after-stroke patients with speech disorders" (ShKSPIR) was evaluated by a retrospective clinical and statistical analysis of 7814 patient medical histories, 1916 of which were patients with speech disorders due to ischemic stroke in the period up to 1 year: average age 66.5 ± 11.3 years, 843 (44.0 %) women, 1073 (56.0 %) men. Psychometric characteristics were studied in 147 patients (age — 63.0 ± 8.0 years, 26 (57.8 %) women, 19 (42.2 %) men), 40 patients of them (27.2 %) had speech disorders. The prognostic assessment, practical significance and competitive validity of the methodology were studied by comparing the results obtained with the data of the methodology with known psychometric characteristics ("Brief neuropsychological examination of the cognitive sphere").
RESULTS. Satisfactory psychometric characteristics of the technique have been proven: substantive and constructive validity, synchronous reliability, discriminativeness. The non-orthogonality of the three-factor structure explaining 55 % of the variance of the original data matrix is discussed. The practical significance is investigated and the high competitive validity of the tested methodology is shown. The standardization of indicators was carried out in accordance with the quantitative determinant of the ICF.
CONCLUSION. In the process of testing the ShKSPIR methodology, test standards have been developed and standardized. The technique can be used for screening assessment of the cognitive status of stroke patients with speech disorders, while planning individual rehabilitation programs.
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The Effect of Natural Mineral Water on Regulators of Gastroduodenal Motility in Young Adults: a Comparative Controlled Study
Abstract
INTRODUCTION. Drinking balneotherapy has long been successfully used for pathologies of the digestive system. However, the sanogenetic mechanisms of normalization of gastrointestinal motility when using drinking mineral waters have not been sufficiently studied.
AIM. To assess the dynamics of the level of hormones that regulate gastric motility with a single dose of moderately mineralized sulfate-sodium-calcium mineral water in a young adults to reveal their sanogenetic role in functional dyspepsia.
MATERIALS AND METHODS. 3 groups were formed: the first — 57 people with postprandial distress syndrome (PDS), the second — 57 with epigastric pain syndrome (EPS), the third — 56 healthy people. All subjects were assessed for gastroenterological symptoms using a specific validated Gastrointestinal Symptom Rating Scale (GSRS) questionnaire, and the levels of motilin and cholecystokinin in the blood were determined before and after taking 200 ml of mineral water.
RESULTS. The level of motilinemia in patients with PDS initially (9811.67 ± 48.34 pg/ml) did not have significant differences from the level of healthy people (9665.64 ± 106.94 pg/ml) (p = 0.379), with EPS it was lower (8780.67 ± 102.94 pg/ml) (p = 0.000). In healthy people, the concentration of motilin in the blood after taking mineral water did not undergo statistically significant changes (p = 0.59), in patients with PDS it led to a decrease in its level by 13.8 % (p = 0.000), in patients with EPS it increased by 9.3 % (p = 0.000). The value of cholecystokininemia in EPS (180.6 ± 5.83 pg/ml) turned out to be statistically significantly higher (p = 0.008), and in PDS (116.67 ± 3.32 pg/ml) lower (p = 0.000) than in healthy group (146.64 ± 6.24 pg/ml). After drinking mineral water, healthy people experienced an increase in cholecystokininemia by 21.5 % (p = 0.003), in the group of patients with PDS — by 43.6 % (p = 0.000), with EPS — without significant dynamics (p = 0.491).
CONCLUSION. Features of the dynamics of the level of motilin and cholecystokinin in the blood of healthy people and with functional dyspepsia in response to a single dose of mineral water were revealed, which play an important role in the sanogenetic effect of drinking balneotherapy for gastric motility disorders.
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Comparative Evaluation of the Biocompatibility of Sponges Based on Different Chitosan Salts in vitro
Abstract
INTRODUCTION. The relevance of the study is due to the increase in the number of human skin lesions as a result of natural and man-made emergencies. Among the natural polymers widely used for the manufacture of wound dressings is chitosan, but its poor solubility is a technological and biological limitation for its effective inclusion and use as a component of wound dressings. One way to solve the problem is to modify chitosan with glycolic, lactic or ascorbic acids. For eff ective and adequate use of chemical modifications of chitosan as a material for wound dressings, it is necessary to evaluate their biocompatibility.
AIM. In vitro assessment of the cytotoxicity and hemostatic properties of sponges based on chitosan modified with glycolic, lactic and ascorbic acids.
MATERIALS AND METHODS. Sponges based on water-soluble chitosan salts were provided by Chemical Company “Orion” LTD. The biocompatibility of the obtained products was assessed on the culture of mesenchymal stem cells, using light and fluorescent microscopy. The metabolic activity of the cells (MTT-test) and the sorption properties of the biomaterials were assessed by spectrophotometry.
RESULTS AND DISCUSSION. Chitosan glycolate or chitosan lactate sponges ensure the survival of most adherent cells, while chitosan ascorbate sponges inhibit cell viability and growth. It was found that chitosan glycolate sponges have the highest blood sorption capacity and are capable of absorbing over 700 μl of blood/cm3. Chitosan lactate and chitosan ascorbate sponges demonstrate a sorption capacity of 250 μl of blood/cm3. However, the ascorbate-based material inhibits the metabolic activity of cells.
CONCLUSION. Based on the research results, sponges made of chitosan glycolate or lactate, which have good biocompatibility in vitro, can be used for further development of wound-healing coatings. In addition, sponges made of chitosan glycolate can be used as highly effective hemostatic materials. Sponges made of chitosan ascorbate require further development and separate study.
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Resumption of Employment after Cervical Cancer Surgery: a 3-Year Follow-Up Study of Long-term Outcomes
Abstract
INTRODUCTION. Despite advancements in cervical cancer (CC) diagnosis and treatment, surgical intervention remains the cornerstone of radical treatment. However, surgical procedures can result in complications such as lymphedema, sexual dysfunction, and other physical and psychosocial disorders, significantly affecting patients' quality of life (QoL) and ability to return to work. This emphasizes the need for effective strategies to support patients in resuming their occupational activities post-treatment.
AIM. To investigate the relationship between different rehabilitation programmes following cervical cancer surgery and return to work
MATERIALS AND METHODS. The study included patients aged 18 and older with stage 1A–1B cervical cancer. Patients were randomized into two groups: those receiving an active comprehensive rehabilitation program (СС-1, 51 patients) and those receiving passive rehabilitation (СС-2, 52 patients). The active rehabilitation program included a personalized, year-long regimen encompassing physical therapy, psychotherapeutic support, and lifestyle modifications, among other interventions. In contrast, the passive rehabilitation group received standard post-operative care information and general recommendations based on local clinical guidelines. The primary outcome was the proportion of patients who returned to work at various time points up to 36 months post-surgery.
RESULTS. Patients in the СС-1 group demonstrated significantly higher rates of return to work compared to the CC-2 group from the third month post-surgery onwards. At 36 months, all patients in the CC-1 group had returned to work, whereas only 66.7 % of patients in the CC-2 group had resumed their professional activities. In the CC-1 group the chance of returning to work within 3 years after surgery was 2.14 times higher compared to those in the CC-2 group (OR = 0.467, 95 % CI 0.309–0.706, p < 0.001).
CONCLUSION. The study highlights the significant impact of personalized comprehensive active rehabilitation programs on improving the likelihood of return to work following surgical treatment for early-stage cervical cancer. These findings suggest that such rehabilitation approaches may be crucial in enhancing the long-term recovery and social reintegration of cervical cancer patients, ultimately contributing to better overall outcomes. Further research is needed to identify the most effective components of these rehabilitation programs and optimize their implementation.
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Gender-related Differences in Rat Sciatic Nerve Regeneration after Autoplasty and Intraoperative Electroneurostimulation
Abstract
INTRODUCTION. According to the literature, intraoperative electrical neurostimulation (IES) after autoneuroplasty (AN) accelerates the regenerative growth of axons. It is unknown whether sexual dimorphism occurs in peripheral nerve regeneration after AN and with single-dose IES.
AIM. To identify possible gender-related differences in the regeneration of the sciatic nerve (SN) after AN resection of the defect of its tibial portion and a single IES in mature rats.
MATERIALS AND METHODS. 72 male (n = 39) and female (n = 33) rats underwent resection and AN of the tibial portion of the SN. Series 1 — non-stimulated control, series 2 — IES session 40 minutes. The tibial functional index (TFI) was calculated from the paw prints; Histomorphometric parameters of myelinated nerve fibers (MF) of the tibial nerve (TN) were determined.
RESULTS AND DISCUSSION. In series 1, 2 months after surgery, males were found to have higher values of the numerical density of MVs of the WBN and axon diameters (DA) than in females. After 4 months, YES and MV diameters are larger in females. After 6 months, females have greater myelin sheath (MS) thickness. TFI in series 1 decreases towards the end of the experiment, especially in males. In series 2, 2 and 4 months after surgery, in females the DA, MS, and MF diameters were greater than the values in series 1; after 6 months, only MS and MF diameters were greater. In series 2 males, 2 and 4 months after surgery, the MS and MF diameter are greater than in series 1, and after 6 months, all dimensional parameters in series 2 males are higher than in series 1 males. TFI in series 2 is greater than the values in series 1 and increases towards the end of the experiment, especially in males.
CONCLUSION. 2 months after AN, the growth and differentiation of nerve fibers in males is faster than in females, then the differences are inverted. Despite the increase in histomorphometric indicators of regeneration, in unstimulated animals, by the end of the experiment, TFI decreases, especially in males. In stimulated rats, compared to unstimulated ones, the morpho-functional indicators of regeneration at all periods of the experiment are better, to a greater extent in males.
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Monitoring of Electrodermal Activity in the Diagnosis of Stress in Stroke Patients (3 Clinical Case Reports)
Abstract
BACKGROUND. Common consequences of stroke are disabling neurological deficits, pain, cognitive and affective disorders that cause distress in patients, but generally accepted diagnostic methods are not always successful in detecting it. Currently, there is an increasing accumulation of data that the assessment of the level of sympathetic activation according to the parameters of electrodermalic activity (EDA) is effective for the diagnosis of stressful conditions.
AIM. To evaluate the possibility of objectification of stress by EDA parameters in stroke patients using examples of clinical observations.
CASES DESCRIPTION. In addition to clinical and metric assessment, EDA was registered in 3m stroke patients (I69.3) at the beginning and at the end of rehabilitation. In the 1st observation, the stress level of EDA indicators initially coincided with high levels of anxiety and depression, the reduction of which at the end of rehabilitation to optimal values led to normalization of EDA. In the 2nd case, at the beginning and at the end of rehabilitation, despite minimal neurological deficit, absence of pain and affective disorders and any complaints, stress indicators of EDA were recorded, due to previously undiagnosed alexithymia and persistent psychosomatic disorder. In the 3rd observation, a patient with a pronounced neurological deficit, who made increased demands on herself, initially normal EDA indicators, at the end of rehabilitation, in the absence of any complaints, changed to stressful ones due to overtraining.
CONCLUSION. The presented clinical observations can be useful for neurologists, psychologists, psychiatrists and psychotherapists, they demonstrate that taking into account ED indicators in a comprehensive assessment of the condition of stroke patients can increase the detection of stress and optimize rehabilitation measures.
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Rehabilitation of a Patient with Knee Arthrofibrosis after Tibial Spine Fracture: a Case Report in Paediatrics
Abstract
INTRODUCTION. Tibial spine fracture (TSF) is a rare injury, the incidence is higher among children. The common complication of treatment is arthrofibrosis. Early rehabilitation is important for its prevention. Guidelines haven’t been worked out.
CASE REPORT. Patient A., 11 years old, was operated for TSF. When she had hospitalized in medical rehabilitation center after 4 months, knee arthrofibrosis was diagnosed. Examination: range of knee motion is 180–155°. Edema of periarticular tissues. The gait pattern is impaired. She couldn’t maintained balance in Trendelenburg test on affected leg. Psychological diagnostics: fear of knee flexion, decreased motivation. Rehabilitation aims: A. will begin to bend knee while walking after 10–14 procedures d450.3.2–d450.2.1, b7100.2–b7100.1. A. is not afraid to bend knee during exercises by the end of the rehabilitation d240.2.0–d240.1.0. Rehabilitation program: physical exercises, mechanotherapy (treadmill, ladder with ramp, continuous passive motion), electrical myostimulation, aquajet therapy, vibrotherapy, kinesiotaping, hardware massage, sessions with psychologist, magnetic laser.
RESULTS AND DISCUSSION. Range of knee motion is 180–135°. Edema of tibia and hip has decreased. A. minimally bends knee when walking, hip flexion has appeared. A. can maintain balance in Trendelenburg test. The fear of bending knee has decreased according to self-assessment, but it is difficult for A. to cope with the situation of physical discomfort on her own. The aims have been partially achieved. Rehabilitation potential is low because of long period after surgery and personal characteristics. Life quality didn’t decrease, it made difficult setting rehabilitation aims. The team decided to focus on psychological work and improving motion.
CONCLUSION. Teamwork and guidelines are important for rehabilitation due to variety and complexity the pathology.
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A Comparative Review of Traditional and Prospective Methods for Vitiligo Treatment
Abstract
INTRODUCTION. Vitiligo is an acquired skin disease characterized by loss of pigmentation with the destruction of epidermal melanocytes. The etiology and pathogenesis of this disease are still poorly understood. The course of vitiligo affects the patient's quality of life, his psychological state and self-esteem. In this regard, there is a need to develop new and promising methods aimed at stimulating and modulating the reparative processes of damaged tissues.
AIM. To review the scientific literature on traditional therapy and new approaches to the treatment of vitiligo.
MATERIALS AND METHODS. The literature review was conducted using the RINTS, PubMed and ScienceDirect databases. Query dates — March–July 2024, query depth — 1964–2024.
MAIN CONTENT OF THE REVIEW. Conservative treatment methods are aimed at inhibiting the pathological process, preventing the appearance of new spots and reducing the cosmetic defect. Thus, patients are prescribed topical and systemic glucocorticosteroids, calcineurin inhibitors, immunosuppressants, phototherapy both in monotherapy and in combination. In recent years, technologies based on transplantation of autologous suspension of regenerative skin cells have been considered the most promising.
CONCLUSION. Innovative methods of regenerative medicine are a good alternative to traditional treatments for patients with stable vitiligo, especially for those who do not respond to standard drug therapy.
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Visual Impairment in Stroke Patients: a Two-Part Review. Part II — Rehabilitation Methods
Abstract
INTRODUCTION. The search and development of optimal rehabilitation programs for patients who have suffered acute cerebrovascular accident (OMNA) is an urgent problem of modern medicine. The development of scientific and technical capabilities leads to the active introduction of the latest technologies at different stages of medical rehabilitation of cerebral stroke. This article is the second part of a two-part review devoted to the problem of visual impairment in patients with acute cerebrovascular accident, which provides an overview of the methods of rehabilitation of patients in this category.
MAIN CONTENT OF THE REWIEW. This overview of rehabilitation methods for patients with impaired visual functions who have undergone OMNA is based on publications in international and domestic databases OpenAlex, Scilit, Lens, PubMed, Cyberleninka and eLibrary available for analysis by 15.08.2024, with a search depth of mainly 15 years. As a result of the search, 66 articles on a given topic were reviewed. In addition, 6 sources dated from an earlier period (1989–2005) were used, as they contain the necessary information within the framework of this review. The rehabilitation methods considered in the review correspond to the accepted basic strategies for restoring impaired visual functions, including those caused by cerebral stroke. Two main strategies include the use of optical devices to adapt to the environment and training of intact structures of the visual analyzer aimed at compensating for lost functions. The third strategy is aimed at increasing the processing of visual information in areas of residual vision.
CONCLUSION. The variety of types of visual disorders, the degree of influence on the quality of life of stroke patients, necessitates the search and development of optimal rehabilitation programs. This will significantly expand the choice of recovery options after a cerebral stroke in this category of patients.
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Key Milestones and Events in the History of Kazakh Balneology
Abstract
INTRODUCTION. The profound socio-political and economic changes of the 1990s had a negative impact on people's quality of life and overall health. The constant stress inherent in urbanized society leads to a decline in the functional capabilities of the human body. Developing the health resort complex is a key solution to maintain the population's essential life-support systems and address the challenges associated with urbanization. To better understand the current state of the resort industry in Kazakhstan, it is important to explore its history and development. This will help us understand its characteristics and challenges.
AIM. To examine and evaluate the historically significant events in the development of balneology in Kazakhstan, as well as to identify current trends and outlooks for the modernization of the country's resort industry.
MATERIALS AND METHODS. In order to conduct a comprehensive literature review, a range of international electronic databases were consulted, including Medline, PubMed, Google Scholar and eLibrary. The period under review extended from 2014 to 2024, with earlier works of seminal importance also included in the analysis. Literature searches were conducted using comprehensive search strategies that were relevant to the development of Kazakhstani balneology during certain historical periods.
RESULTS AND DISCUSSION. The history of health resort treatment in Kazakhstan goes back well beyond the thirty years since the country's independence. This traditional form of therapy is used in various fields of medicine for disease prevention. Sanatoriums and resorts offer a wide range of natural resources, including a unique climate, clean mountain air, mineral waters and therapeutic muds. These elements create exceptional conditions for recovery and improved health. This approach combines traditional medical practices with modern technologies, as well as natural and climatic factors. Although Kazakhstan has a significant recreational potential, the demand for these services is still low. This may be due to the fact that the focus is still on the Soviet-style recreation, which emphasizes social interaction and the state engagement. In the past, the government had to cover significant expenses for running sanatoriums, resorts, and providing recreational services, ensuring restorative care for people.
CONCLUSION. The development of resorts in Kazakhstan has undergone significant transformations, starting in the pre-socialist period and continuing into the post-Soviet era of modernization. Thanks to its rich natural resources and government support, as well as private investment, Kazakhstan was able to partially maintain its resort industry. However, the modernization of Kazakhstan's resorts and sanatoriums requires government regulation, followed by optimization and digitalization of the health resort network in order to provide high-quality treatment and recreational services that are accessible to all segments of the population.
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Modern View on the Etiology and Methods of Treatment of Bruxism: а Review
Abstract
INTRODUCTION. Currently, the prevalence of bruxism ranges from 9 % to 32 % of the total population, of which 6 % to 20 % are adults, while the question of the etiology of bruxism remains open, due to the presence of various theories of the development of this disease.
MATERIALS AND METHODS. The search was conducted for the period from 2002 to 2024 in the Medline database using the keyword "bruxism" and in the Elibrary database of the scientific electronic library using the keyword "bruxism". Articles that included a systematic review and meta-analysis (17 articles) and randomized clinical trials (26 articles) were analyzed.
MAIN CONTENT OF THE REWIEW. The possible causes of bruxism are considered to be the presence of stress factors, occlusal disharmony, dysfunction of the TMJ, parafunctional activity of the masticatory muscles, genetic factors, the presence of a number of concomitant diseases, taking medications, smoking, which requires an interdisciplinary approach both in the study of the etiology and in the treatment of such a multifarious disease as bruxism. The methods of treatment used in patients with bruxism can be divided into the following groups: intraoral: occlusal correction, occlusal caps, devices for advancing the lower jaw, etc.); intramuscular injections of botulinum toxin A; drug therapy; physiotherapy; biofeedback technologies (BFB); behavioral: relaxation techniques, cognitive therapy, psychological counseling; other: alternative or supportive treatments. The main effects of the treatment include: a decrease in muscle activity confirmed by various types of electromyography, a decrease in muscle symptoms such as the level of pain, soreness, discomfort, fatigue, both according to subjective questionnaires and according to clinical examination, as well as a decrease or cessation of tooth attrition or grinding. When choosing one of the intervention options to suppress or reduce the activity of bruxism, it is necessary to take into account the corresponding indications, contraindications and side effects of each treatment option, as well as the individual characteristics of the patient. However, to date, indications for the appointment of various differentiated methods of treating bruxism remain contradictory and, in some cases, insufficiently substantiated, there are no highly effective individualized methods of therapy and prevention of bruxism, while irrational treatment of this pathology can lead to serious health consequences.
CONCLUSION. Timely diagnosis and treatment of bruxism is an urgent problem of modern medicine, which is associated with the multifactorial nature of this disease, which determines the use of a differentiated approach to the treatment of bruxism, in order to normalize the functions of the dental system and the psychoemotional state of patients.
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