Osteopathic status in patients with new coronavirus infection COVID-19

Introduction. The appearance of COVID-19 has set tasks for healthcare professionals related to the rapid diagnosis and provision of medical care to patients. Currently, intensive study of the clinical and epidemiological features of the disease continues, and of the development of new means of its prevention and treatment. At the same time, it is necessary not only to provide medical care in the acute period of the disease, but also to carry out rehabilitation measures for the consequences of a coronavirus infection. In accordance with the approved clinical recommendations, osteopathic correction in the acute period of an infectious disease is contraindicated. However, there is a potential interest of the possibility of osteopathic correction methods use during the period of convalescence, as well as within the framework of rehabilitation measures after a new coronavirus infection.At the same time, for objective reasons, there is no data on the structure of somatic dysfunctions in this group of patients in the literature. All of the above has predetermined the purpose of the research.The aim of the study is to draw up a map of the most common somatic dysfunctions and analyze their relationship with other subjective and objective manifestations of the disease based on the data of the osteopathic status assessing of patients who have undergone a new coronavirus infection COVID-19.Materials and methods. A cross-sectional study was conducted on the basis of Samara medical and sanitary unit № 2 and on the basis of the Saint-Petersburg «City Mariinsky Hospital» in the period from May 2020 to March 2021. There were 70 patients under observation in the rehabilitation department who had undergone a new coronavirus infection COVID-19. There were assessed the osteopathic status of all patients (by an osteopathic doctor with using personal protective equipment) and the level of anxiety; the data was copied from medical documentation.Results. Somatic dysfunctions of all three levels of manifestation are revealed in patients with the new coronavirus infections during the convalescence period. The global and regional somatic dysfunctions were distributed almost equally (45,7 and 54,3 %, respectively) in the structure of dominant somatic dysfunctions in patients with new coronavirus infections during the convalescence period. Patients with new coronavirus infections during the convalescence period are characterized by medium and high levels of both situational and personal anxiety. In the course of the work, a moderate positive relationship was established between a global rhythmogenic disorder (violation of the production of a thoracic rhythmic pulse) and a large volume of lung tissue damage (CT-2) according to the multispiral computed tomography of the thoracic cavity, as well as between a global psychoviscerosomatic disorder and a high level of situational anxiety.Conclusion. Somatic dysfunctions of all three levels of manifestation are revealed in patients with new coronavirus infections during the convalescence period. In addition, this group of patients is characterized by an average and high level of both situational and personal anxiety.The revealed correlations suggest that the inclusion of osteopathic correction in comprehensive rehabilitation programs for this group of patients may be pathogenetically reasonable.

STATE OF IMMUNITY IN PRESCHOOLERS WITH ACUTE RESPIRATORY VIRAL INFECTIONS ASSOCIATED WITH ADENOID VEGETATIONS

Introduction. Acute respiratory infections are the most common infectious diseases worldwide among children of different age groups. Materials and methods. 59 children between the ages of 3 and 7 participated in the study. The first group included 22 patients with an acute respiratory viral infection, the second one consisted of 23 patients with acute respiratory viral infections associated with adenoid vegetation, and 14 apparently healthy children were included in the control group. Immunology research was conducted during the acute period of the disease. Statistical processing of received data was done with the standard statistical software EZR 1.41. Results. After the research, most of the patients with acute respiratory viral infections were identified an actual increase in CD3+, CD4+, CD8+, CD22+- cells and IgA, IgM in the blood serum. Simultaneously, in patients with acute respiratory viral infections associated with adenoid vegetation during the acute period, the increase in total lymphocytes was identified due to CD4+, CD8+, CD22+ cells and IgG. A comparative analysis of the study results of both groups of patients showed that children from the second group had a significantly higher level of CD3+- cells, while the CD22+- lymphocytes, IgA, IgM and IgG were significantly lower from the similar indicators of the first group. Conclusions. The acute period of the disease in children with acute respiratory viral infections, associated with adenoid vegetation, had an imbalance in both the cell and the immune system's humoral component

On the Question of the Reflexotherapy Action Mechanisms in the Ischemic Stroke Acute Period (Literature Review)

A high degree of disability in stroke patients, along with severe social and economic losses, determine the enduring urgency of the problem of early rehabilitation for post-stroke patients. Despite the proven effectiveness of the various reflexotherapy techniques in rehabilitation of patients with ischemic stroke, the underlying mechanisms remain unclear. The aim of the review was to analyze the mechanisms of the acupuncture intervention effect on the main links of the ischemic stroke pathogenesis, on neurological deficit and the volume of cerebral infarction (based on publications in international databases). The use of acupuncture in the acute period of ischemic stroke can improve the ability to cerebrovascular reserve, reduce the severity of arterial stiffness and endothelial dysfunction, induce neuroprotection, inhibit cell apoptosis and stimulate neuroplasticity, alleviate the inflammatory response in acute cerebral ischemia, regulate mediators of inflammation and oxidative stress etc., thus improving cerebral blood flow. The analysis of literature data has shown that acupuncture induces multilevel regulation through complex mechanisms, and one factor may not be enough to explain the positive effect against cerebral ischemia.

Change in hippocampal volume in children with febrile seizure at different periods

Background This study aimed to investigate the change of hippocampal volume in children at different periods after febrile seizure. Methods MRI of the brain was performed in 60 children with febrile seizure (30 patients with simple febrile seizure and 30 patients with prolonged febrile seizure) and in 30 healthy children. The volume of the hippocampus was tested and compared at different periods after febrile seizure. Results The volumes of hippocampus in the two febrile seizure groups increased compared with that of the control group in acute period after seizure. There was no obvious difference in hippocampal volume between the simple febrile seizure group and the prolonged febrile seizure group in the acute or chronic period after seizure. The average annual growth of hippocampal volume in the simple febrile seizure group was greater than that in the prolonged febrile seizure group. Conclusions Febrile seizure can affect hippocampus volume in the acute stage of convulsion. Prolonged febrile seizure affects hippocampus development with aging.

Role of neuron-specific enolase, glial fibrillar acidic protein and NR2-antibodies in early diagnostic of ischemic stroke

Background. Application of a biomarker panel during the acute period of the ischemic stroke (IS) can contribute to a more accurate and prompter diagnostics and verification of the optimal approach to a patients’ management.Objective. We aimed to clarify values of neuron-specific enolase (NSE), glial fibrillar acidic protein (GFAP) and antibodies for NMDA receptor’s NR2-subunit (NR2-antibodies) in the acute period of IS, to compare with such values in patients without IS, to assess their relationship with severity of neurological deficit and short-term outcome and also to establish sensitivity and specificity of the biomarker panel.Design and methods. 63 patients with IS and 31 people (11 with chronic brain ischemia and 20 healthy individuals) as controls were included. Results. NSE and GFAP values in IS group exceeded reference values at the onset of disease, lowering significally by 10-14 day, while NR2-antibodies’ values were lower at the onset of the disease compared with controls, rising by 10-14 day. In patients with unfavourable short-term outcome higher levels of NSE, GFAP and NR2-antibodies were found. A panel of such biomarkers has higher sensitivity and specificity than each of them individually.Conclusion. Researched substances can be used in a biomarker panel for IS diagnostics, brain damage monitoring, patient’s condition evaluation and short outcome prognosing.

ROLE AND PARTICIPATION OF THE MULTIDISCIPLINARY TEAM IN PROVIDING MEDICAL CARE TO PATIENTS WITH ACUTE CEREBRAL BLOOD CIRCULATION DISORDERS AT THE LEVEL OF A MULTIDISCIPLINARY HOSPITAL

Нами изучены и проанализированы годовые отчеты инсультных центров многопрофильных стационаров города Алматы с 2018 года по 2019 год включительно. За данный период было пролечено всего 8783 пациентов. Поступившие и пролеченные случаи инсульта были распределены по возрастному признаку в 2018 году (средний возраст составил 60,5±1,17 лет %) и половому признаку (мужчины - 46,6±6,4%, женщины - 53,3±6,4%). В 2019 году по возрасту было 61,30±5,8% пациентов, а по полу - 58,4±6,1% составляли женщины, а 41,5±6,1% - мужчины, следовательно, тенденция преобладание инсульта у женщин. Мультидисциплинарная бригада на уровне стационара в полном объеме выполняет свои функциональные обязанности, своевременно диагностируя вид инсульта, определяя тяжесть пациентов, перенесенные инсульт в остром периоде. Роль и место невролога при в мультидисциплинарной бригаде огромная и неоценима. We have studied and analyzed the annual reports of stroke centers of multidisciplinary hospitals in the city of Almaty from 2018 to 2019 inclusive. During this period, a total of 8783 patients were treated. Stroke cases received and treated were distributed by age in 2018 (average age was 60.5 ± 1.17 years%) and gender (men - 46.6 ± 6.4%, women - 53.3 ± 6, 4%). In 2019, by age there were 61.30 ± 5.8% of patients, and by gender - 58.4 ± 6.1% were women, and 41.5 ± 6.1% were men, therefore, the trend is the prevalence of stroke in women. The multidisciplinary team at the hospital level fully fulfills its functional duties, diagnosing the type of stroke in a timely manner, determining the severity of patients suffering from a stroke in the acute period. The role and place of a neurologist in a multidisciplinary team is enormous and invaluable.

The effect of percutaneous electrical stimulation of the spinal cord on autonomic reactions in the acute period of rehabilitation after ischemic stroke

The effect of percutaneous electrical stimulation of the spinal cord on the reactions of the autonomic nervous system in patients after acute cerebral circulatory disorders was evaluated. Patients in the acute period of rehabilitation treatment underwent a course of percutaneous electrical stimulation for 10 days. Before and after rehabilitation, vegetative reactions were assessed using an orthoclinostatic test, an A.M.Wein questionnaire, and neurological disorders on the Scandinavian scale. The inclusion of the course of percutaneous electrical stimulation in the program of physical rehabilitation of patients who have suffered an ischemic stroke indicates an improvement in the motor status of patients and a decrease in the imbalance of sympathetic and parasympathetic influences Keywords: ischemic stroke, percutaneous electrical stimulation of the spinal cord, vegetative reactions

Physical methods of motor function correction in the acute period of rehabilitation after ischemic stroke

The paper presents the data on the use of percutaneous electrical spinal cord stimulation in patients in the acute period of rehabilitation treatment after ischemic stroke. It was revealed that inclusion of percutaneous electrostimulation of the spinal cord into the rehabilitation program improves the quality of motor skills recovery and can be used in the correction of locomotor functions during rehabilitation after ischemic stroke. Key words: ischemic stroke, percutaneous electrical spinal cord stimulation.

Тhe contribution of computed tomography to the diagnosis of multiple aneurysm in the acute period of aneurysmal intracranial hemorrhage

Introduction. Multiple aneurysms are detected in patients with non-traumatic subarachnoid hemorrhage (nSAH) in 14–45% of cases. The diagnostic algorithm for this pathology can be shortened by performing the non-enhanced CT of head, CT-angiography, and if the localization of hemorrhage according to non-enhanced CT data matches, there is enough evidence to perform direct surgery without obtaining preoperative DCA.Objective. Determination of the diagnostic efficiency of CT and CTA of brachiocephalic arteries (CTA BCA) for planning the surgical treatment in the case of multiple aneurysms of intracranial arteries in the acute period of non-traumatic ICH in an emergency room.Material and methods. Retrospective analysis of the records of radiological examinations in the preoperative period in patients in an acute period of non-traumatic subarachnoid hemorrhage in the acute period performed in an emergency room of the Research Institute — Ochapovsky Regional Hospital no. 1. in the period from September 2017 to July 2018 (cerebral angiography, non-enhanced CT of the brain, CTA BCA).Results. According to the CTA BCA, 60 aneurysms were found: 21 patients had 2 aneurysms each one, 2 patients had 3 aneurysms, one patient had 8 aneurysms, and 4 patients had one aneurysm each. In comparison with DCA, which was performed in 10 patients, additionally there were found 3 miliary aneurysms, one aneurysm was excluded. For patients who did not obtain DCA, CTA scans were compared with intraoperative data on the side of surgical intervention (n=18). According to the CTA BCA, 18 aneurysms were found, according to the intraoperative record were found 17 aneurysms, while in one case a large bilobulated aneurysm was defined by a radiologist as two oppositely directed. The rest of the data was consistent.Conclusion. The presence of nICH on the non-contrast CT of the brain, and the correspondence of the localization of hemorrhage according to the results of CT-angiography, is sufficient for direct surgery without obtaining preoperative DCA, which is especially important in difficult patients. The use of DCA in patients with multiple aneurysms is recommended only in controversial and difficult cases.