Vol 23, No 5 (2024)

Introduction. Metabolic syndrome is defined as a pathological condition characterized by abdominal obesity, hypertension, dyslipidemia, and impaired glucose tolerance. Insulin resistance is hypothesized to underlie metabolic syndrome. Modern studies, including Mendelian randomization, have demonstrated that muscle strength and muscle mass may play an important role in the mechanisms of insulin resistance.

Aim. To establish the relationship between relative upper limb muscle strength and triglyceride/glucose index, and to evaluate the effects of different resistance exercise regimens on alternative measures of insulin resistance in men with metabolic syndrome.

Materials and methods. At the first stage of the study, 216 men aged from 25 to 50 years were examined. The relative muscle strength of the upper limbs in the bench press exercise and the triglyceride/glucose index were assessed. At the second stage, a randomized controlled trial was conducted, for which 60 men who met the criteria for metabolic syndrome. Men with metabolic syndrome were divided into three groups: low-intensity strength training with blood flow restriction (n = 20), high-intensity strength training (n = 20), low-intensity strength training without blood flow restriction (n = 20). Training was carried out 2 times a week for 12 weeks. Before and after the study, the triglycerides/glucose index, the ratio of triglycerides to high-density lipoproteins, and the combination of the triglycerides/glucose index with body mass index were assessed.

Results and discussion. It was found that the relative muscle strength of the upper limbs was inversely proportional to the triglycerides/glucose index (r = –0.52; p < 0.05) in the examined men. After 12 weeks of resistance training, statistically significant reductions in triglyceride/glucose index, triglyceride/high-density lipoprotein ratio, and triglyceride/glucose index/body mass index combination were found for the low-intensity resistance training with blood flow restriction and high-intensity resistance training groups (both, p < 0,01). Changes in body composition, an increase in the proportion of muscle fibers I and IIa and a decrease in the proportion of muscle fibers IIx, an increase in the activity of glucose transporters, and a decrease in systemic inflammation are the main potential mechanisms for the beneficial effects of resistance training, including in combination with blood flow restriction, on insulin resistance in men with metabolic syndrome.

Conclusion. There is an inverse relationship between muscle strength and triglycerides/glucose index; resistance training is an effective and safe tool for reducing alternative indicators of insulin resistance and can be included in comprehensive correction programs for men with metabolic syndrome.

Introduction. The validated Hospital Anxiety and Depression Scale HADS is recommended for screening symptoms of anxiety and depression in the routine practice of somatic doctors; it is also recommended by experts for use in rehabilitation medicine and frequently used in scientific research to assess the emotional state of stroke patients. At the same time, the literature provides various contradictory data on the sensitivity of this scale for stroke patients.

Aim. To evaluate the detectability of emotional disorders in stroke patients using the HADS scale in comparison with the author’s computer program for studying the actual emotional state of the patient.

Materials and methods. 60 stroke patients underwent inpatient rehabilitation in the National Medical Research Center for Rehabilitation and Balneology were randomly divided into 2 groups. 30 patients of Group 1 received a basic rehabilitation complex (aimed at correcting motor disorders); 30 patients of Group 2 received a basic rehabilitation complex in combination with a course of cognitive behavioral psychotherapy (CBT). To assess the emotional state at the beginning and at the end of rehabilitation, the HADS scale and the author’s computer program were used to study the actual emotional state of the patient. Statistical analysis was carried out using the Statistica-10 program.

Results. The study groups were comparable in gender, age and clinical parameters. Initially, in patients of both groups, the median values of anxiety and depression on the HADS Scale corresponded to the norm, while the median values of the author’s methodology corresponded to a low level of comfort, the presence of fatigue, high levels of anxiety and depression. At the end of rehabilitation, according to the HADS Scale, significant positive dynamics was revealed in both groups, both for depression and anxiety (p < 0.05), without significant intergroup differences. Whereas with the help of the author’s methodology, significant intergroup differences (p < 0.05) were revealed, indicating a better positive dynamics of the emotional state in group 2, additionally receiving CBT.

Conclusion. In comparison with the author’s program in stroke patients, the HADS scale is significantly less sensitive in the diagnosis of anxiety and depression, and does not reflect the established intergroup difference in the dynamics of emotional state after the use of the basic complex and its combination with CBT.

Introduction. Surgical treatment of vulvar cancer (VC) entails mental and somatic disturbances due to pain, body image changes, and sexual dysfunction, which are closely associated with impaired social functioning and reduced overall quality of life. However, the results evaluating the impact of rehabilitation programmes on various components of quality of life in these patients remain limited.

Aim. to evaluate the effectiveness of rehabilitation programs in relation to the psycho-emotional sphere during 36 months following surgical treatment of early-stage VC.

Materials and methods. The randomized controlled study included female patients with VC, divided into two parallel groups of those who received a personalized program of comprehensive rehabilitation (VC-1) and rehabilitation according to the general principles regulated in the national clinical guidelines (VC-2). 36 patients each were randomly assigned to VC-1 and VC-2 groups. The control group included 80 women without female cancer. The VC-2 group was recommended physical activity, psychological support, and anti-edema therapy for lymphostasis. The personalized rehabilitation program in the VC-1 group additionally included lifestyle modification, cognitive-behavioral therapy, intimate hygiene training, magnesium, vitamin B6 and folic acid supplementation, correction of sexual disorders, phytotherapy and physiotherapy from the 3rd month, and climatotherapy and landscape therapy from the 6^th month. The “Well-being, Activity, Mood” (WAM) questionnaire was administered at the preoperative visit, 1 week, 1, 3, 6, 12, 24 and 36 months after surgery. Scores were presented as Me [Q₂₅; Q₇₅], differences were considered significant at p < 0.05.

Results. In the control group, scores on all WAM domains were within normal values throughout the study. In the 1st week after the surgery, well-being and activity decreased to unfavorable values in both VC-1 and VC-2 groups. Mood, however, showed significant positive dynamics compared to baseline. Subsequently, the improvement in the WAM domains was significantly faster and more pronounced in the VC-1 group than in the VC-2 group, reaching the range of favorable values by the 12th month, but not reaching the control group.

Conclusion. The personalized comprehensive rehabilitation program showed efficacy on well-being, activity and mood on the WAM questionnaire compared to basic rehabilitation. However, rehabilitation measures should be continued one year after surgery.

Introduction. Possession of a wheelchair allows disabled people with paraplegia to compensate for mobility limitations. In order to build the rehabilitation process, it is important to know what factors hinder and what factors facilitate the development of a wheelchair.

Aim. To determine functional independence, quality of life and secondary health conditions in persons with lower paraplegia and to assess their relationships with the degree of difficulty when moving around in a wheelchair.

Materials and methods. We examined 396 patients with spinal cord injury (SCI) and lower paraplegia who used a wheelchair. The level of independence of the patients was determined using Functional Independence Measure (FIM) and Spinal Cord Independence Measure (SCIM III), quality of life was assessed using the SF-36 questionnaire, secondary health conditions were determined using the SCI SCS scale and the presence of problems moving around in the wheelchair was assessed using category d465 «moving around using equipment» of the International Classification of Functioning, Disability and Health.

Results. Half of the examined patients with SCI had a sufficiently high level of independence when performing daily activities. 43.5 % of the patients showed either moderate, severe or absolute problems moving around in the wheelchair and 65.4 % demonstrated the presence of more than three secondary health conditions. We found negative correlations between the degree of difficulty experienced by the patients when moving around in the wheelchair and the levels of independence in daily life and the indicators of quality of life such as vitality, social functioning and mental health. In binary logistic regression it was ascertained that the significant independent factors associated with difficulty when using the wheelchair were spasticity, contractures of the muscles of the lower limb and circulatory disorders.

Conclusion. The success in using the wheelchair is limited by spasticity, contractures of the muscles of the lower limb and circulatory disorders.

Introduction. Myelodysplasia (MD) in children is accompanied by disorders of the musculoskeletal system and pelvic functions, causing a decrease in activity and restriction of participation in society, leading to disability and contributing to social isolation. The rehabilitation potential, determined by the International Classification of Functioning, Disability and Health (ICF), is realized when the child is active and participates in the processes of life. The improvement of methods and technologies for the rehabilitation of children with MD remains relevant.

Aim. To study the effect of medical rehabilitation in children with MD on the development of motor skills in all children and self-care in children over the age of 1 year.

Materials and methods. The study included 117 children diagnosed with male and female MD between the ages of 6 months and 13 years, 11 months and 30 days (average age 6 years and 9 ± 6 months). The diagnosis of the functioning of the body was performed in the categorical profile of the ICF using a ranking system for the degree of disorders / limitations of functioning. The subjects are divided into three groups. Patients of group I received physical rehabilitation, ergotherapy, magnetic stimulation of the spinal cord (MS) and electromyostimulation (EMS); group II — physical rehabilitation, ergotherapy and MS; group III — standard physical therapy techniques, massage, ergotherapy, therapy with sinusoidal modulated currents (SMT-therapy) on the muscles of the lower extremities.

Results and discussion. The effectiveness of consistent use of MS, EMS during physical exercises for the development of motor skills, classes with an occupational therapist on self-service skills has been demonstrated in children with MD, which is confirmed by positive dynamics in mobility and self-service skills assessed using functional scales and questionnaires. Medical rehabilitation increases muscle strength in children with MMD, and the combined use of MS with EMS during targeted exercises contributes to the effective development of motor functions. The development of motor skills and classes with an occupational therapist increase the level of independence in children with MD.

Conclusion. Medical rehabilitation with the inclusion of MS and EMS during the performance of targeted exercises contributes to the better development of motor skills and improves self-care in children with MD.

The symptoms and syndromes associated with visual impairment that occur in acute cerebrovascular accident (OMNA) of various parts of the brain are quite characteristic, can develop with circulatory disorders in various arteries of the brain and depend on the severity of damage to brain tissues. Disorders of vision and oculomotor functions, including decreased central vision, impaired peripheral vision, limited eye mobility and impaired visual perception, are widespread among patients who have suffered a cerebral stroke. This article is the first part of a two-part review devoted to the problem of visual impairment in patients with acute cerebral circulatory disorders. In the first part, we examined the prevalence and diversity of such violations. The second part will provide an overview of the methods of rehabilitation of patients in this category.

Main content of the rewiew. The data of the analysis of the prevalence of various types of visual impairments in patients who have undergone ONMC are presented, based on publications in international and domestic databases OpenAlex, Scilit, Lens, PubMed, Cyberleninka and eLibrary.ru available for analysis by August 15, 2024, with a search depth of mostly 15 years. As a result of the search, 52 articles on a given topic were reviewed. In addition, 5 sources dated from an earlier period (1989–2000) were used, as they contain the necessary information within the framework of this review.

Conclusion. Visual impairment entails a significant decrease in the quality of life of such a category of patients. To obtain a complete picture of the patient’s condition after a cerebral stroke, it is necessary to conduct a thorough targeted screening of visual impairment.

This will allow you to take timely measures to restore visual functions, which may have a beneficial effect on further rehabilitation.

Introduction. Currently, modern high-tech methods of small incision cataract surgery are not always immune to the development of iatrogenic «dry eye» syndrome. Currently, one of the common complications of the anterior segment of the eye after small incision cataract surgery is the development of iatrogenic dry eye syndrome, which leads to a decrease in the quality of medical and social rehabilitation of operated patients.

Aim. Development and evaluation of the effectiveness of the complex use of preformed physical factors in the correction of «dry eye» syndrome in patients after phacoemulsification of cataract.

Materials and methods. The open randomized controlled clinical trial involved 90 patients (90 eyes) aged from 58 to 75 years, who were diagnosed with «dry eye» syndrome (DES) on the 1st day after phacoemulsification (PE) of cataract. Patients, depending on the treatment, were divided into three groups of 30 people (30 eyes).In the control group, patients received standard tear replacement therapy (RT) with Stillavit 4 times a day for 7 days,in the comparison group — in addition to ST 7 procedures of low-frequency magnetic therapy in the orbital area and in the main group — TRT was expanded by the complex application of low-frequency magnetic therapy to the orbital area and medicinal electrophoresis (EP) of the Taufon using the orbital-occipital technique for 7 daily procedures performed daily. Evaluation of parameters of ocular xerosis included: tear film rupture time, total tear production, and ocular surface disease index according to the OSDI questionnaire. The duration of the study was 6 months.

Results and discussion. Complete regression of the xerotic process was observed immediately after treatment in 76,7 % (23) of patients in the main group, in 40 % (12) patients in the comparison group and 20 % (6) of patients in the control group. After 6 months after surgery — in 96.7 % (29) of patients in the main group, in 83,3 % (25) of patients in the comparison group and 70 % (21) of patients in the control group.

Conclusion. The developed comprehensive program for the treatment of postoperative «dry eye» syndrome, which includes low-frequency magnetic therapy and medicinal electrophoresis Taufon against the background of tear replacement therapy, helps to significantly improve the clinical outcome of treatment, reduce the recovery time of the ocular surface and improve the quality of life of patients.