Aid Methods of Treatment in the Recovery Period of Patients Underwent Surgical Treatment of Cervical Hip Fractures (Literature Review)

The literature review summarizes the scientific information devoted to the study of auxiliary methods used in restorative treatment after surgery for fractures of the femoral neck. The restoration of motor functions in patients with cervical hip fractures is a priority task of the comprehensive restorative treatment program. Despite the achievements in the field of osteosynthesis and endoprosthetics, many patients receive an unfavorable outcome of surgery and a group of disabilities. As a result of an improperly selected program of complex rehabilitation treatment or neglect of auxiliary methods, in most cases, patients gradually develop secondary complications from the damaged segment: the formation of articular contractures, muscle hypo- and atrophy, violation of the walking stereotype, ineffective consolidation, fracture and migration of metal structures with excessive load on the limb, etc., as well as the general somatic condition of the patient worsens: secondary hypostatic complications join and chronic diseases a exacerbated. The purpose of the literature review is to systematize data on the use of auxiliary treatment methods in the recovery period of patients who have undergone surgical treatment of hip fractures and their effectiveness. The article discusses the general characteristics of the applied auxiliary methods of restorative treatment, the timing and scope of their implementation, and also presents the results of individual randomized controlled trials on their effectiveness.

First-Time Psychotic Symptoms in a Patient After COVID-19 Infection—A Case Report

A 39-year-old, previously healthy, white male with no personal or family history of mental illness presented with new, first-time psychotic symptoms. The new psychotic symptoms appeared on patient admission to the hospital, occurring during a diagnosis of symptomatic SARS-CoV-2 infection. On the first day of hospitalization for worsening psychotic symptoms and the appearance of aggression toward the staff, the patient was transferred to the psychiatric hospital. After the initial treatment with antipsychotics and benzodiazepines, his mental condition improved. The patient was then transferred for further treatment of his somatic condition in the internal medicine ward, with a recommendation to continue treatment in the psychiatric ward once his somatic condition was stabilized. This is one of the few reported cases of COVID-19-related psychosis in a patient without a personal or family history; moreover, this description contains important data regarding elevated IL-6, which may prove to be a key factor in the induction of new psychotic symptoms. It indicates the important need for careful monitoring of neuropsychiatric symptoms among COVID-19 patients.

The results of using endovascular methods for stopping ulcerative gastroduodenal bleeding

This article presents the results of treatment of patients with ulcerative gastroduodenal bleeding who were treated in the 2nd clinic (surgery for the improvement of doctors) Military Medical Academy at the I.I. Dzhanelidze Research Institute of Emergency Medicine. A retrospective analysis was conducted of the frequency of rebleeding, surgical activity and mortality in groups with the use of transcatheter arterial embolization with and without it. The criteria for inclusion in the study were: the presence of ulcerative gastroduodenal bleeding, confirmed by laboratory and instrumental methods of examination, severe general somatic condition of patients. The comparison was carried out in the main and control groups. The main group consisted of 20 patients who underwent endovascular hemostasis. The control group included 46 patients without the use of X-ray surgical methods. The average age of patients in the main and control groups was 65.5 3.7 and 60.7 3.9 years. In both groups, most patients were admitted later than 24 hours after the onset of the disease and with severe blood loss. The severity of the somatic state of the intervention was assessed according to the APACHE II multiple organ failure assessment scale, according to which, patients in the main group were somatically more severe than in the control group. In the groups, bleeding from stomach ulcers prevailed (up to 75%). Most often, endovascular hemostasis is performed at a high risk of recurrent bleeding, and adhesive compositions and spirals were used as an embolizing agent. Angiography revealed direct or indirect signs of bleeding (extravasation, hypervascularization, aneurysmal dilatation) in 12 cases, and preventive embolization was performed in 8 cases. In 70% of cases, the source of bleeding was the left gastric artery. In the control group, recurrent bleeding and surgical activity accounted for 26%. In the main group, 20% and 15%, respectively. In the main group, recurrent bleeding occurred in 4 cases, 1 patient underwent repeated endoscopic hemostasis, 3 patients underwent open surgical interventions. All 4 patients had a fatal outcome, against the background of massive blood loss and aggravated somatic pathology. The overall mortality rate in the control group was 44%, in the main group 35%. Transcatheter arterial embolization did not significantly improve the results of treatment of ulcerative gastroduodenal bleeding due to the severity of the general somatic condition of the patients included in the study.

Methylphenidate-induced psychosis in a young antipsychotic-naïve female patient

Methylphenidate (MPD) is commonly prescribed for patients with Attention Deficit/Hyperactivity Disorder (ADHD). Although used off-label, MPD forms part of complex and multifactorial treatment regimen for narcolepsy and hypersomnia, together with including behavioural interventions. The drug is sometimes also prescribed off-label to subjects with other mental illness or somatic condition to improve intellectual outcome, ease fatigue or enhance the ability to concentrate. Common side effects include headache, insomnia, decreased appetite and hypertension. Concurrently, clinicians should be aware of relatively rare but potentially threatening adverse effects including agitation and psychotic symptoms. Several case reports regarding MPD-induced psychosis have been published, but most of them regard children or teenagers (1) and much less is known about drug-induced psychosis in adults (2). In this article, we present a case report of MPD-induced psychosis in a 31-year-old, antipsychotic-naïve patient. Careful evaluation including clinical examination, medical and family history and possible early signs of psychosis is recommended each time before MPD treatment will be initiated.

SOCIO-DEMOGRAPHIC AND MEDICO-BIOLOGICAL FACTORS AS PROGNOSTIC INDICATORS OF QUALITY OF LIFE IN EARLY CHILDHOOD

Patient’s quality of life (QL) measures are endowed with independent predictive value and these factors are considered to be more distinct than patient’s general somatic condition for predicting patient’s health condition. However, the number of researches devoted to QL prediction in the field of medical science is low. The aim of research is evaluation of predictive measure of QL of early aged children. Prospective observational study was carried out. The objects of the research were 2362 early age children (3months-3years old) from pediatric polyclinics of Yerevan. QL of children was evaluated with the international questionnaire “QUALIN”. Wald’s analytical method has been applied for predictive evaluation of QL criteria and formation of risk group. For the analysis and evaluation of the statistical material used SPSS Statistics software package. In social-hygienic factors more important were: family type, conflicts in family, disabled child and frequent morbidity families, presence of artificial nutrition since birthday. Among medico-biological factors the presence of two or more diseases in neonatal period, low and high levels of physical development, weight deficit and obesity, child’s health group and respiratory, nervous and digestive system diseases were more significant. In terms of predictive evaluation of QL, it can be stated that a number of medico-biological and socio-hygienic factors affect the overall formation of QL. By means of predictive evaluation of QL one can originally set apart targeted risk groups and if the score of predictive evaluation is +13 and higher, implement health measures, which may provide with improvements of QL criteria.

Variability in Population Traits of a Sentinel Iberian Fish in a Highly Modified Mediterranean-Type River

Human pressures on water resources have been suggested as a driver of biological traits that induce changes in native fish populations. This study highlighted the interplay between environmental stress factors, mostly related to flow regulation, and the longitudinal river gradient in biological traits such as the growth, size structure and somatic condition of a sentinel fish, Luciobarbus sclateri. We found an increase in size-related metrics and somatic condition at population levels associated with downstream reaches, although fragmentation and habitat alteration, flow regime alteration and the abundance of non-native fish were also significantly involved in their variability. Age-related parameters and growth were only explained by flow regime alterations and the abundance of non-native fish species. The high plasticity observed in L. sclateri population traits suggests that this is a key factor in the species adaptability to resist in a strongly altered Mediterranean river basin. However, the interplay of multiple stressors plays an important role in fish population dynamics and could induce complex responses that may be essential for long-term monitoring in sentinel species.

Stigmatization as a psychological resource for rehabilitation of cardiology clinic patients

Aim. Identify the adaptive level of stigma and describe its characteristics. Methods. Adapted for the cardiology clinic questionnaire of N. Sartorius, symptomatic questionnaire SCL-90-R (Simptom Check List-90-Revised), Schutzs Interpersonal relations questionnaire (1958), Tobol test method of the type of attitude to disease and treatment, and the Personal differential questionnaire. The data obtained were processed using the statistical program SPPS 20. Results. The study determined the optimal degree of stigmatization, which performed a positive role in relation to the state of health, helping patients to adequately assess the severity of the pathology, identify themselves with the disease and realize the necessary measure of their own responsibility in the treatment process (from 48 to 60). Clinical and social factors of optimal degree of stigmatization and successful rehabilitation of cardiology clinic patients are identified (resources): the patients higher education and the familys tendency to low-protecting position potentially contribute to the treatment and rehabilitation of cardiology clinic patients with moderate severity of their somatic condition. Clinical and social factors (anti-resources) that prevent the formation of an optimal degree of stigmatization and successful rehabilitation of patients are identified: the operative type of treatment, the overprotective position of the family, which is not justified by a real need, and the low level of education. It is established that the absence of pronounced pathocharacterological features and difficulties in interpersonal interaction of patients with an average level of stigmatization is an argument for determining this level of stigmatization as a resource. According to the results of the study the tasks for the medical psychologist of the cardiology clinic are set: 1) diagnostic, which consists in determining the level of stigmatization, analyzing the ratio of the degree of stigmatization and the degree of severity of cardiovascular pathology, studying individual resources and anti-resources (attitude to the disease and treatment, pathocharacterological features and interpersonal features); 2) psychocorrective, which consists in forming an adequate position in relation to the disease and treatment of patients and their families, restoring intra-family ties, changing inadequate responses to the disease, creating realistic attitudes to treatment in patients and their family members. Conclusion. The average degree of stigmatization is formed in patients in the absence of a pronounced personal and interpersonal problems, allowing them to receive social support in the conditions of restrictions imposed by the disease, and adapt to it. The average level of stigmatization in this case acts as an additional psychological resource for patients.

Morgellons Disease: The Spread of a Mass Psychogenic Illness via the Internet and Its Implications in Hand Surgery

Somatic manifestations of mental illness sometimes occur in patients presenting to hand specialists. These conversion disorders can also occur in groups, a phenomenon known as “mass psychogenic illness.” The increasing penetrance of the Internet and social media in modern society has greatly facilitated the interaction of patients with others with similar disorders. One example relevant to hand surgery is “Morgellons disease,” a disorder popularized in 2002 and characterized by a firm belief in foreign material extruding from the skin, leading to nonhealing, self-inflicted ulcerations and excoriations. A series of 4 patients collected through an informal survey of hand surgeons regarding experience with Morgellons disease is reviewed and discussed. All patients in the series presented with a chief complaint of foreign material extruding from the hand. In 1 case, the complaint was made by a young patient’s mother. In none of the patients were foreign bodies identified, although 2 patients demonstrated significant ulcerations and scars from self-excoriation. Three patients had a somatic condition affecting the hand or upper extremity, 1 directly related to self-excoriation and 2 unrelated. Treatments, workups, and ultimate outcomes varied among patients. Patients presenting with Morgellons disease often undergo multiple unnecessary tests and are at risk of inappropriate procedures. It is therefore important that providers have a compassionate understanding of the involved psychology. Herein, we offer an approach to the recognition of and treatment strategies for these patients.

Course Of Post-Infarction Depression Taking Into Account The Time Of Its Once

A study of 341 patients with an established diagnosis of acute myocardial infarction was carried out. The patients are divided into 2 groups. The first, main, included 233 patients with acute myocardial infarction, who subsequently developed depressive disorders, confirmed clinically and using diagnostic scales; the second group consisted of 108 patients who also had acute myocardial infarction, but did not subsequently suffer from symptoms of depression. Clinical and dynamic observation of patients in the postinfarction period was carried out with control of the condition in a month, three months, six months, 12 months after myocardial infarction. Clinical observation was used to detect the presence of symptoms of depression. Among patients with MI with DS in the first days after MI, more than half (51.1%) reported a permanent decrease in mood more often than other symptoms, i.e. these patients showed an affective component of depression, while the ideator component of depression, which manifested itself in thinking retardation to one degree or another, was in 27.5% of patients, motor retardation (motor component) was detected in 21.5% of those observed. In patients with almost the same frequency, the anxious and melancholic type of affect was noted (47.0% and 41.2%, respectively), the dysphoric type of affect was found in 11.8% of cases, which is 4 times less than anxious and 3.5 times less than the melancholic type. In cases of prolonged depression, the severity of affective disorders more often directly correlated with the severity of the physical condition. If not so long-term depressive episodes were largely due to "their own vision of the disease", the severity of their symptoms depended on the conversation with the doctor and the information received from him, the degree of awareness of his diagnosis, possible complications, and not very much depended on the general somatic status itself. then the course of prolonged depression in patients worsened with the aggravation of the cardiological and general somatic condition of patients. Psychosomatic parallelism in the majority of protracted depressions was manifested by the generalization of asthenic symptom complexes (increased general weakness, intolerance to exertion, lethargy, adynamia, severe daytime sleepiness in combination with early insomnia) with deterioration of the somatic state. At the same time, it was noted that with prolonged depression, there were always more or less pronounced cognitive disorders (reduced memory for past events, limited ability to comprehend what was happening around, remember new information, impaired concentration). Postinfarction depressive episodes lasting up to six months can be attributed to nosogenies; depressive episodes of postinfarction genesis with a protracted course, probably with a high degree of confidence can be attributed to somatogenias.

ELECTROCONVULSIVE THERAPY FOR MENTAL DISORDERS DURING PREGNANCY AND THE POSTPARTUM PERIOD

Electroconvulsive therapy is a method of treating mental disorders that is still used today. It is thanks to electroconvulsive therapy that high rates of remission are achieved in patients. The main clinical indications for electroconvulsive therapy are severe depression with a high risk of suicide, life-threatening somatic conditions due to depression. Electroconvulsive therapy is usually used in the first and second trimesters of pregnancy as a last-line method of choice if there are convincing indications for its administration, to quickly eliminate the symptoms. When performing electroconvulsive therapy, the risks of using anesthesia, side effects, severity of the somatic condition, as well as the risks of not using this therapy are evaluated. Although electroconvulsive therapy is considered to be a safe and effective method for treating mental patients if necessary measures are taken to reduce potential risks, it is extremely rarely used to treat women with mental disorders during pregnancy and the postpartum period.