Vol 14, No 5 (2015)

The aim of the study was to assess the capabilities of remote application of eleсtro-veсtorсardiographiс methods in the diagnosis of myocardial infarction in comparison with the results of echocardiography on the basis of the central district hospital. The study was conducted in two rural hospitals and outpatient hospital at Uryupinsk central district hospital. Registration and remote transmission of digital ECG was carried out using a computer system «Easy ECG». In automatic mode, the conclusion of “myocardial infarction” was issued in 127 cases out of 5911 (2.15%). 22 of the 127 patients had a history of myocardial infarction. In 8 cases acute coronary syndrome was diagnosed. In 97 cases myocardial infarction of uncertain age was suspected for the first time. Expert analysis confirmed automated conclusion “inferior myocardial infarction” in 20 cases and “anterior myocardial infarction” in 27 cases. Echocardiographic study was conducted of 20 patients. Zones of hypo - or akinesia were identified in 9 patients. In 11 cases of ECG and echocardiography mismatch ECG revealed small scars or combination of myocardial infarction with ventricular hypertrophy or intraventricular blocks. Development and implementation of modern diagnostic and treatment technologies, including remote recording and analysis of ECG, will bring a new level of domestic practical cardiology, including rural areas.

The article presents the results of treatment of 200 patients with atherosclerotic vascular changes in the lower limbs under the influence to develop a comprehensive drug - free programs. It is proved that the use of programs developed in patients with peripheral arterial disease of the lower extremities, causing a normalization of enzyme, metabolic and electrolyte balance and pronounced analgesic, vegetokorrigiruyuschy lipolytic effects, which leads to an increase in their quality of life. The authors found that the use of a comprehensive program of rehabilitation treatment in patients with peripheral arterial disease of the lower extremities improves autonomic regulation of the functioning of the cardiovascular system, as evidenced by the elimination hypersympathicotonia to values Ayton according cardiointervalography, as evidenced by the values of the integral index of autonomic regulation - stress index, primarily by magnetic influences. Results of the study demonstrated a pronounced effect of application the comprehensive programs of rehabilitation treatment for one of the most important pathogenetic mechanisms of atherosclerosis - the correction of lipid imbalances, manifested in the elimination of atherogenic lipid fractions and improve the anti - atherogenic lipid fractions - HDL cholesterol, mainly through the use of laser therapy. In addition, it stated the elimination of metabolic and electrolyte abnormalities that are known to contribute to improve the stability of cell membranes of tissues to hypoxia. A comprehensive program of rehabilitation treatment of patients with peripheral arterial disease of the lower extremities reduces the activity of lipid peroxidation, increased antioxidant protection, non - specific adaptive responses and adaptation system as a whole due to the participation of all components of the complex, to a greater degree of laser and magnetic influences.

Presents the results of the examination and medical rehabilitation of patients with chronic obstructive lung disease with underlying ischaemic heart disease in a rehabilitation center. The study describes the features of the clinical picture in these patients, are characterized by a "syndrome of mutual aggravation". Describes the impact and effectiveness of rehabilitation program with the use of ultrasonic antibacterial humidifier and microwave therapy low - intensity device «Aster». It is proved that the application of the above techniques leads to a decrease in the rate of exacerbations, respiratory (dyspnea, paroxysmal cough, improving expectoration) and cardiac (decrease the frequency of angina attacks, shortness of breath, increase of tolerance to physical load) insufficiency, to improve the psychological condition of patients. In laboratory and advanced methods of study, there was a statistically significant reduction of inflammatory signs (decreased level of leukocytes in the blood and in the sputum, ESR), have improved cardiorespiratory system according to respiratory function (VC increased from % 71,4±5,6 до 87,6±5,3 % and MVV with 65,4±4,6 до 81,9±4,2 l/m, FEV1 from 75,9±4,5% до 88,1±3,9%), echocardiography (ejection fraction increased 51,9±1,4 to 55,4±1,2 % and the mean pulmonary artery pressure decreased from с 22,1±1,7 до 17,1±1,6 mm.Hg.calendar), veloergometry (tolerance to physical load increased from 76,8 ± 3,6 до 90,1±3,7 W). Patients have improved their psychological state. Reduce the appearance asthenovegetative syndrome is present in almost all patients with this comorbidity, which was confirmed by the improvement of the background of mood, sleep, the emergence of a sense of cheerfulness. Increased indicators of well - being from 3,2±0,5 to 5,0±0,6 activity from 3,4±0,6 to 5,6±0,7), sentiment from 3,8±0,7 to 6,3±0,9. Indicator of reactive anxiety decreased from 47,3±4,2 V to 33,4±3,1. When sanitary and bacteriological studies on microbial contamination of air in the chambers was revealed lower content of microorganisms in 1m 3, which was installed germicidal ultrasonic humidifier «Aquacom», more than 2 times. In addition, it is proved by the significant reduction of dust levels in these wards 2,7 times.

Long - term monitoring studies, including the practice of medical maintenance in sports activities and rehabilitation of athletes in intervals between competitions should take into account the seasonal variability of the monitored parameters. In this investigation, a comparative study of common functional indices of the cardiovascular system and the performance of their autonomous regulation in summer (April - June) and winter (November - February) periods was done. The study involved 65 young women between the ages of 18 to 25 years: students of Moscow colleges and universities involved in sports clubs and physical education teachers of Moscow schools. This work method spiroarteriokardioritmograf allowing in addition to assessing the main functional parameters of the cardiovascular system (heart rate, blood pressure), to carry out a simultaneous analysis of variability of heart rate and blood pressure, as well as to assess the sensitivity of spontaneous arterial baroreflex. In parallel with the registration parameters of the cardiovascular system evaluated the psychological condition of the subjects using a questionnaire Being - Activity - Mood. It is shown that in the winter records were obtained higher values of heart rate, higher values of the absolute and relative power of the LF band in systolic blood pressure spectrum, and decrease of the absolute power of VLF band in the heart rate variability spectrum. The lack of seasonal changes in the value of the spontaneous arterial baroreflex sensitivity suggests a leading role in the variability of heart rate neuro-autonomic regulation systems. Seasonal changes in the autonomic regulation of the cardiovascular system of young women were accompanied by a decrease in their well - being in winter.

Studies of endothelium and microbial cell derived gaseous products (NO, CO, H2S, H2) formed in mammalian organisms have shown their participation in the various fundamental physiological and pathophysiological reactions and conditions of the host. Many of these gaseous molecules are pleiotropic mediators having different effects in many tissues and organs, especially in the cardiovascular system. Current data have determined that molecular cross talk occurs between NO, CO, H2S and other intestinal gases. The introduction in medical practice simple, reliable methods for detection as well as quantity measurement of synthesis of gaseous mediators and transmitters in the cells and tissues, selective inhibitors of enzymes that participate in their endogenous synthesis, safe chemical and microbial donors of mentioned specific and pleiotropic gaseous mediators permits to introduce them as novel therapeutics for number of important indications in restorative medicine and rehabilitation. Targeting the intestinal microbiota might offer novel perspective for restoration of gasotransitters homeostasis.

The importance of the issue staged rehabilitation treatment, would ensure the continuity of rehabilitation patients who no doubt. Aspects of the implementation stages, therapeutic and economic efficiency of today are under active development, analysis and implementation in the practical activities of institutions. Sharp enough, in our opinion, to date, it is the issue of the second phase of rehabilitation after discharge from the surgical or therapeutic beds. It is relevant to the second stage of the patients two main areas - are patients with neurological deficits and patients after injuries and operations on the skeleton. To date, the existing specialized centers and medical rehabilitation department can not fully cover the increasing number of patients in need of rehabilitation treatment after discharge from hospital. The article provides an analysis of studies on the therapeutic and cost - effectiveness of remote rehabilitation using the Internet - technologies in patients after replacement hip and knee joints. The analysis of foreign works on the therapeutic effect (results of the dynamics of rating scales and objective patient data) held telereabilitation compared with carrying out the procedures in ambulatory form or specialist at home in patients after knee replacement, as well as in the comparative aspects of the question of economic benefits of a particular form rehabilitation. In addition, it presented their own experience in remote patient rehabilitation program after hip and knee joints in the therapeutic aspect. The use of modern technologies for the realization of remote - controlled rehabilitation as the second stage of medical rehabilitation on the example of the rehabilitation of patients after joint replacement surgery, is in our opinion a perfect solution to the problem of continuous rehabilitation of patients.

Objective assessment of treatment results in cosmetology is an important task. The aim of the study was the quantitative assessment of the effectiveness of physiotherapeutic correction of age facial skin using high frequency ultrasonography. Under our supervision there were 43 women aged 42 to 63 years, with age-related changes of the facial skin. For correction of age changes we applied low - frequency pulse currents and cathode galvanization. For quantitative monitoring of morphological and functional parameters of the skin with high - frequency ultrasound we used DUB SkinScanner (tpm GmbH) with linear probe 22 MHz. The depth of wrinkles, thickness of epidermis, dermis and acoustic density was measured. Quantitative analysis of the skin structure using high frequency ultrasonography showed a significant increase in the thickness of the dermis and reducing the depth of fine and deep wrinkles. In this study, using high frequency ultrasonography, for the first time we determined the efficiency of combined application of galvanic and low frequency pulse currents for correction of age changes of skin.

In the modern conditions, in order to achieve the desired clinical and economical effectiveness, the 3rd stage of cardiac rehabilitation must be organized by a multidisciplinary teams and at the medical establishments that follow the Order of rehabilitation and are able to ensure a multi-faceted, safe approach to the recuperation of patients who suffered a myocardial infarction. It is advised that the prophylactic and polyclinic departments of the specialized Cardiac Rehabilitation Centers or Multidisciplinary Medical Rehabilitation Centers are used for such purposes. This article highlights the operational principles of the cardiac rehabilitation department of the “Health Academy” Innovative Clinic (the Clinic) located in Chita, Transbaikal territory, Russia. The Clinic is a private medical rehabilitation center created in cooperation with the government which allows it to operate under the obligatory medical insurance policy. The center has a range of rehabilitation programs including the cardiovascular disease patients’ rehabilitation program. Currently, the Clinic has a multidisciplinary work team that includes the following specialists: cardiologists, medical fitness professionals, a physiotherapist, a psychotherapist, a nutritionist, an andrology urologist, a endocrinologist, a neurologist, functional diagnostics specialists, kinesiotherapists, anesthesiologists, rheumatologists etc. The center has a set of high-level individualized and controlled training programs performed in a facility equipped with a series of computerized exercise machines. There are also a number of psychological guidance and support programs for the patients suffering from the cardiovascular diseases. Considering that the modern three - level cardiac rehabilitation model has only recently begun to function in the Russian Federation, there are a number of organizational issues that require a further discussion as well as some managerial decision-making. All in all, the “Heath Academy” Innovative Clinic has created all the necessary conditions for a successful implementation of the third stage of cardiac rehabilitation. The conditions which the Clinic currently possesses are in accordance with the all the requirements stipulated in the respective legal acts which are now in effect, and allow the team to perform secondary prevention activities of the unfavorable cardiovascular events by forming the correct behavioral stereotype among the patients.