Use of exogenic phosphocreatine in ICU rehabilitation of patients with COVID-19 (pilot study)

The objective: to establish the possible effectiveness of exogenous phosphocreatine as a component of pharmacological support during the resuscitation stage of rehabilitation measures in critically ill patients with COVID-19.Subjects and Methods. Within a randomized study, 21 patients diagnosed with COVID-19 were divided into two groups: Group 1 (patients received the infusion of exogenous phosphocreatine as part of intensive care) and Group 2 (patients received standard intensive care) against the background of rehabilitation measures. Patients were assessed for muscle strength using the MRC scale, exercise tolerance by Borg rating, oxygenation parameters, routine clinical laboratory blood tests, dependence on respiratory support, outcome on day 10 of therapy, and hospital outcome.Results. The effectiveness of the use of the exogenous phosphocreatine as a component of pharmacological support during the resuscitation stage of rehabilitation measures in critical patients has been confirmed by positive dynamics: an increase in muscle strength (the MRC score in the group receiving exogenous phosphocreatine on day 10 was 0.5 points higher) and an increase in exercise tolerance (Borg rating in the group receiving exogenous phosphocreatine on day 10 was 1.5 points higher), significant increase in oxygenation based on arterial blood saturation data, and significant increase in lymphocyte count by 25% in the group receiving exogenous phosphocreatine.Conclusion. Exogenous phosphocreatine is a candidate drug for pharmacological support during resuscitation stage of rehabilitation of critical patients with COVID-19.

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.

Aligning Patient’s Ideas of a Good Life with Medically Indicated Therapies in Geriatric Rehabilitation Using Smart Sensors

New technologies such as smart sensors improve rehabilitation processes and thereby increase older adults’ capabilities to participate in social life, leading to direct physical and mental health benefits. Wearable smart sensors for home use have the additional advantage of monitoring day-to-day activities and thereby identifying rehabilitation progress and needs. However, identifying and selecting rehabilitation priorities is ethically challenging because physicians, therapists, and caregivers may impose their own personal values leading to paternalism. Therefore, we develop a discussion template consisting of a series of adaptable questions for the patient–physician encounter based on the capability approach. The goal is to improve geriatric rehabilitation and thereby increase participation in social life and well-being. To achieve this goal, we first analyzed what is considered important for participation on basis of the capability approach, human rights, and ethics of care. Second, we conducted an ethical analysis of each of the four identified dimensions of participation: political, economic, socio-cultural, and care. To improve compliance with rehabilitation measures, health professionals must align rehabilitation measures in an open dialogue with the patient’s aspiration for participation in each dimension. A discussion template based on the capability approach allows for a proactive approach in patient information and stimulates a critical assessment of treatment alternatives while reducing the risk of imposing personal values.

PROCEDURE FOR FORMING AN EFFECTIVE SELECTION PROCESS RATIONAL REHABILITATION MEASURES FOR TREATMENT GYNECOLOGICAL DISEASES

В статье рассматривается ряд методов интеллектуальной поддержки принятия решений в диагностике и лечении гинекологических заболеваний. При применении высоких медицинских технологий возрастает роль лечащего врача (ЛВ), который по-прежнему остается лицом, принимающим решение (ЛПР). Однако применение этих методов принятия решений должно увязываться с логикой деятельности ЛВ, быть доступно для практического использования, освобождать ЛВ от "рутинной" работы и способствовать целенаправленному и эффективному лечебно-диагностическому процессу. Процессы диагностики и лечения гинекологических заболеваний характеризуются большим числом переменных и определяются индивидуальными характеристиками пациенток, рядом неопределенности при выборе тактики лечения. Процедура математического описания процессов лечения состоит из выбора метода моделирования в условиях неоднородностей. Выбор тактики лечения сводится к поиску эффективных алгоритмов, индивидуализирующих особенности каждой больной в процессе лечения, и позволяет врачу на основе опыта и интуиции принимать адекватные решения в любой момент времени. Вот почему, прежде всего, при выборе рациональных реабилитационных мероприятий в условиях неполной априорной информации требуется интеллектуальная поддержка принимаемых решений ЛВ. Для интеллектуальной поддержки принимаемых решений применяются методы имитационного эксперимента, основанные на априорной информации лечащего врача и эксперта для организации и алгоритмизации диалогового режима в ускоренном и реальном масштабе времени. Рассматривается алгоритмическая процедура процессов лечения The article discusses a number of methods of intellectual support for decision-making in the diagnosis and treatment of gynecological diseases. With the use of high medical technologies, the role of the attending physician (PD) increases, who still remains a decision-maker (DM). However, the application of these decision-making methods should be linked to the logic of the drug's activity, be available for practical use, free the drug from "routine" work and contribute to a purposeful and effective treatment and diagnostic process. The processes of diagnosis and treatment of gynecological diseases are characterized by a large number of variables and are determined by the individual characteristics of patients, a number of uncertainties in the choice of treatment tactics. The procedure for the mathematical description of treatment processes consists of the choice of a modeling method under conditions of inhomogeneities. The choice of treatment tactics is reduced to the search for effective algorithms that individualize the characteristics of each patient in the treatment process, and allows the doctor, based on experience and intuition, to make adequate decisions at any time. That is why, first of all, when choosing rational rehabilitation measures in conditions of incomplete a priori information, intellectual support for the decisions made by the dispensary is required. For the intellectual support of the decisions made, the methods of the simulation experiment are used, based on the a priori information of the attending physician and the expert for the organization and algorithmization of the dialogue mode in accelerated and real time. An algorithmic procedure for treatment processes is considered

ABOUT REHABILITATION OF PATIENTS WITH LONG-TERM CONSEQUENCES OF COVID-19

Новая коронавирусная инфекция и ее отдаленные последствия занимают особое место в научной медицине и практическом здравоохранении. Появление COVID-19, распространение его среди населения земного шара, появление все новых штаммов поставило перед специалистами здравоохранения задачи, связанные с быстрой диагностикой инфекции, вызванной новым коронавирусом, оказанием специализированной медицинской помощи, включая диагностику, лечение, первичную и вторичную профилактику, медицинскую реабилитацию. Реабилитация пациентов, перенесших COVID-19, имеет важнейшее значение для восстановления трудоспособности и сохранения здоровья этой категории граждан. Эффективная организация и полноценная реализация реабилитационных мероприятий, достижение целей и задач медицинской и социальной реабилитации определяют социальные последствия пандемии как для конкретного индивида, так и для общества и государства в целом. Статья посвящена изучению и анализу возможностей применения рефлексотерапии в комплексе реабилитационных мероприятий пациентов с отдаленными последствиями новой коронавирусной инфекции COVID - 19. Дальнейшее совершенствование системы реабилитации, включая расширение и оптимизацию применения средств и методов реабилитационных мероприятий, будет способствовать повышению качества и эффективности оказания медицинской помощи, преодолению негативных последствий перенесенной новой коронавирусной инфекции COVID-19 The new coronavirus infection and its long-term consequences occupy a special place in scientific medicine and practical healthcare. The emergence of COVID-19, its spread among the world's population, and the emergence of new strains have set health professionals tasks related to the rapid diagnosis of infection caused by the new coronavirus, the provision of specialized medical assistance, including diagnosis, treatment, primary and secondary prevention, and medical rehabilitation. Rehabilitation of patients who have undergone COVID-19 is of crucial importance for the restoration of working capacity and the preservation of the health of this category of citizens. Effective organization and full implementation of rehabilitation measures, achievement of goals and objectives of medical and social rehabilitation determines the social consequences of the pandemic both for a particular individual and for society and the state as a whole. The article is devoted to the study and analysis of the possibilities of using refloxotherapy in a complex of rehabilitation measures for patients with long-term consequences of a new coronavirus infection COVID - 19. Further improvement of the rehabilitation system, including the expansion and optimization of the use of means and methods of rehabilitation measures, will contribute to improving the quality and effectiveness of medical care, overcoming the negative consequences of the new coronavirus infection COVID-19

EARLY REHABILITATION OF CRITICAL TESTICULAR ISCHEMIA WITH ACUTE TORSION IN CHILDREN

Introduction. Acute testicular torsion is an urgent condition characterized by chorda spermatica turn and torsion with its vessels along vertical or horizontal axis. This condition results in testicular ischemia and loss of organ in case of lack of timely medical care. If a child is operated on within 6-12 hours their chance for complete recovery is decreased to 70 %. The timeline of 12-24 hours leaves only a 20% chance to keep a testicle. After 24 hours since the beginning of the condition there is virtually no chance to keep organ’s viability. The goal of the research is an optimization of early rehabilitation of critical testicular ischemia in children with acute testicular torsion. Material and methods. Over the period of the years 2010 – 2021 54 children with testicular torsion were observed and treated. Eight children got to a hospital as in-patients within first six hours from condition establishment, eight patients turned to a hospital within the period of 6.1-12 hours, 11 patients addressed hospital after 12.1-16 hours, 16 patients did so after 16.1-24 hours, and 11 patients addressed hospital after more than 24 hours since condition had been established. All patients with testicular torsion were admitted to a hospital in an urgent manner, their general condition was assessed as "moderate". Time before surgery was limited (up to 1 hour from the moment of hospitalization). Therefore, the examination of patients was minimized by a general blood test, a general urine test (83.3 %), determination of blood group and Rh-factor, measuring arterial pressure. A testicle was verified as viable in 12 children (22.2 %). Genital gland necrosis was diagnosed in 22 patients (40.8 %), they underwent orchophuniculectomia. Critical testicle ischemia was diagnosed in 20 boys (37 %). All patients were operated on. In all cases operation started not later than an hour after hospitalization. For 45 children operation was performed via inguinal access (83.3 %), transscrotal access was used in 9 patients (16.7 %). In all cases when a testicle was viable invasive detorsion with further orchiopexy was used. All children who underwent testiculectomy were hospitalized later than 16 hours after the onset of the disease. All boys with critical testicle ischemia underwent rehabilitation measures during operation. Results. Among children with genital gland critical ischemia 10 patients (52.6 %) recovered completely. Children who had been hospitalized during 6-12 hours after the onset of the disease were discharged from a hospital ward on the 5-7 day after operation. Two children (25 %) in this group had further testicle autolysis. Among children who addressed for healthcare support within 12–16 hours after the condition establishment, two patients (18.2 %) recovered completely. Five patients (50 %) had testicle autolysis in the postoperative period. Conclusions. 1. Critical testicular ischemia is observed in 35.2 % children with acute testicular torsion. 2. Early rehabilitation measures include a complex of conservative and operational approaches implemented in pre-operational, intra-operational and early post-operational periods. 3. Timely and full-fledged rehabilitation measures implementation allows to improve results of operational treatment and save affected genital gland with critical ischemia in 50 % of patients.

Rationale for using nutrient complexes with vitamin and mineral compositions in rehabilitation schemes for patients who have undergone viral infections (literature review)

The results of the previous studies have shown that the use of nutrient complexes with vitamin and mineral compositions in rehabilitation schemes for patients who have undergone viral infections, including COVID-19, is an important link in rehabilitation measures and post COVID-19. The article pathogenetically substantiates the use of biologically active food supplements containing vitamins A, D3, E, C, B1, B2, B3, B5, B6, folic acid, zinc, vanadium, catechins, proanthocyanidins, flavonoids and glycyrrhizic acid.

The effect of brain neurotrophic factor gene polymorphism on the effectiveness of therapeutic and rehabilitation measures in patients with psychostimulant dependence

Justification. Along with the rising consumption of psychostimulants, the number of patients with dependence on psychostimulants is increasing all over the world and in Russia in particular. At the same time, the number of patients with dependence on drug combinations is increasing, most of which are psychostimulants. Aim. The aim of the work is to develop a personalized approach to the therapy of patients with dependence on psychostimulants, taking into account the polymorphism of the neurotrophic factor gene of the brain. Material and methods. 305 patients with dependence on psychostimulants, men and women from 18 to 50 years old, were studied. Depending on the drug used and their combinations, as well as the presence of comorbid psychiatric pathology, all patients were divided into 6 groups. Research methods: molecular-genetic, clinical-psychopathological, catamnestic, statistical (parametric and nonparametric methods using Statistica 10.0 programs of STAT Soft Inc., USA). The effect of polymorphism of the neurotrophic factor gene of the brain on the effectiveness of therapeutic and rehabilitation measures in patients in different groups was evaluated. Results. It was found that patients who use only psychostimulants and psychostimulants with cannabinoids, having a homozygous (GG) genotype of the neurotrophic factor gene of the brain, are longer in the rehabilitation program and have the longest remissions. Conclusion. Polymorphism of the neurotrophic factor gene of the brain affects the effectiveness of therapeutic and rehabilitation measures in patients with dependence on psychostimulants.

Changes in zooplankton communities of the Lebyazhye system restored lakes

Ponds rehabilitation projects for the purpose of eco - rehabilitation following significant anthropogenic impacts or degradation are becoming more frequent but not always successful. Therefore, the experience of the restoration of the Lebyazhye system lakes in Kazan city (Russia) is interesting. Previously, the lake system used to consist of four ponds, but due to water catchment area reduction, the area of the lake system also decreased, and only one lake remained. The restoration of the Lebyazhye system lakes was carried out in 2017 and included the deepening of the basin of the Bolshoe and Svetloe Lebyazhye lakes to 4 m, the sealing of the bed of future ponds with bentonite mats, supplying water from Izumrudnoye lake through a pressure water conduit and filling the basin of the lakes with water. The research is devoted to the study of the restoration of zooplankton communities in the Lebyazhye system lakes. For this purpose, the indicators of zooplankton communities before and after eco-rehabilitation measures were compared. After the implementation of eco-rehabilitation measures, significant changes in environmental parameters were observed: the salinity of water decreased, the oxygen content in the water, pH increased. In zooplankton communities, the species richness and diversity increased, new species appeared, as well as those that lived in the lake system earlier before eco-rehabilitation measures were taken.

The Use of Bioacoustic Stimulation of the Respiratory System in Complex Medical Rehabilitation at a Health Resort Facility for Patients who have had COVID-associated Pneumonia

BACKGROUND: In the context of the COVID-19 pandemic, the relevance of rehabilitation measures for patients with COVID-associated pneumonia has increased. AIM: The study aimed to review the effect of bioacoustic stimulation of the respiratory system (BSRS) with high-intensity low-frequency sounds on the dynamics of functional indicators of the respiratory system and the cardiovascular system, as well as indicators of psychoemotional and somatic states, the severity of post-traumatic stress disorders (PTSD) and cognitive capabilities in patients who have had COVID-associated pneumonia in the process of their medical rehabilitation at a health resort immediately after treatment of the disease in a hospital. MATERIALS AND METHODS: The randomized controlled open parallel prospective clinical study involved 28 patients undergoing medical rehabilitation after suffering moderate to severe COVID-19 complicated by community-acquired bilateral polysegmental pneumonia (COVID-associated pneumonia) of moderate to severe severity. Spirometry, pulse oximetry, compression oscillometry, bioelectrography, Mississippi Scale (civil version), and cognitive speed test were used to assess the functional parameters of the respiratory and cardiovascular systems, as well as indicators of psychoemotional and somatic states, the intensity of PTSD and cognitive abilities of patients before and after the course of rehabilitation measures. RESULTS: According to significant differences in changes in the indexes of external respiration, cardiac activity, psychological status, and the intensity of PTSD in patients of the main and control groups before and after a course of rehabilitation measures, it has been reliably established that the use of BSRS as a part of a complex of rehabilitation measures significantly increases the effectiveness of medical rehabilitation at a health resort for patients after COVID-associated pneumonia. CONCLUSION: The possibility and feasibility of using medical technology of BSRS with high-intensity low-frequency sound in complex medical rehabilitation of patients after COVID-associated pneumonia at the health resort stage have been scientifically substantiated.