[The effectiveness of the use of non-drug treatment complexes and their impact on quality of life indicators, the psychosomatic status of patients with residual brucellosis with lesions of the musculoskeletal system]. / Effektivnost' primeneniya kompleksov nemedikamentoznogo lecheniya i ikh vliyanie na pokazateli kachestva zhizni, psikhosomaticheskii status patsientov s rezidual'nym brutsellezom s porazheniem oporno-dvigatel'nogo apparata.

Secondary focal lesions of the musculoskeletal system that occur with residual brucellosis are characterized by a variety of localizations and simultaneous damage to several groups of joints, a deterioration in the quality of life and a high percentage of disability in people of working age. At present, there are many different schemes for the treatment and rehabilitation of developed residual brucellosis, in which, in addition to the "basic" course, including systemic anti-inflammatory therapy, much attention is paid to physiotherapeutic procedures, but the choice of the most effective treatment tactics remains an unresolved problem. PURPOSE OF THE STUDY: To determine the effectiveness of the use of options for non-drug methods of treatment in the complex rehabilitation of patients with residual brucellosis with lesions of musculoskeletal system. MATERIAL AND METHODS: Study included 140 patients treated for osteoarthritis of brucellosis etiology, who were divided into three groups matched by age, gender, average duration and stage of the disease, place of residence. Patients of all groups received standard medical treatment and different sets of physiotherapeutic procedures: in the 1st group (45 patients) - electrophoresis of novocaine on the knee joints, therapeutic massage of the cervical-collar zone; in the 2nd group (45 patients) - magnetotherapy on the area of the knee joints, sinusoidal modulated currents (SMC) on the shoulder joints, decimeter wave therapy of the lumbosacral zone (DMW-therapy); in the 3rd group (50 patients) - magnetic laser therapy on the shoulder, elbow, knee joints, therapeutic massage of the lumbosacral zone. Complaints, clinical symptoms, goniometry results, and blood parameters were assessed: ESR, C-reactive protein, fibrinogen, before the start of treatment, immediately after the course of rehabilitation, and after 6 and 12 months. At the same time, testing was carried out according to the SF-36 Health Status Survey questionnaire to monitor the quality of life. RESULTS: The applied scheme of drug treatment in combination with magnetic laser therapy and therapeutic massage in the 3rd group made it possible to achieve a significant reduction in arthralgic syndrome, a statistically significant increase in the range of motion in the joints, positive dynamics of laboratory data and an improvement in the psychological state and quality of life of patients compared to other observation groups. CONCLUSION: The results of the study indicate the high efficiency of magnetic laser therapy in the complex treatment of patients with residual brucellosis with lesions of the musculoskeletal system.

[Change of immune status parameters, clinical symptoms and health related quality of life patients with postmastectomy syndrome depending on the used rehabilitation complexes]. / Izmenenie pokazatelei immunnogo statusa, klinicheskikh simptomov i kachestva zhizni patsientok s postmastektomicheskim sindromom v zavisimosti ot primenyaemykh kompleksov reabilitatsii.

Regardless of the chosen methods of breast cancer treatment, more than 85% of patients develop postmastectomy syndrome (PMES) after a course of therapy, which significantly worsens their quality of life and psychological state. Relatively recently, physical factors began to be used in the conservative treatment of PMES and the results of the use of various rehabilitation therapy complexes were evaluated. OBJECTIVE: To assess the effectiveness of the use of some physiotherapy methods in the rehabilitation of patients with PMES according to clinical parameters, markers of endothelial dysfunction, and the results of a questionnaire. MATERIAL AND METHODS: 185 patients suffering from PMES were examined. They were divided into 4 groups: in the 1st group (control, 61 patients) basic treatment was used (physiotherapy exercises, photomatrix therapy, manual lymphatic drainage massage of the affected upper limb, pneumatic compression); in the 2nd group (43 patients) - basic treatment + sinusoidal modulated currents to the area of the muscles of the thoracic girdle; in group 3 (42 patients) - basic treatment + electrostatic therapy of the upper limb on the side of the operation; in the 4th group (39 patients) - basic treatment + SMC therapy + electrostatic therapy. Before and after the rehabilitation course, clinical symptoms, blood counts for interleukins (IL) 6, 8, 10, homocysteine were assessed, testing was carried out according to the SF-36 (Short Form Medical Outcomes Study) questionnaire, WAM (Well-being, activity, mood) questionnaire, Hamilton depression scale. RESULTS: There was a tendency to a decrease in the quantitative parameters of the immune status: the mediators of the acute phase of inflammation - pro-inflammatory interleukins (IL-6, IL-8), homocysteine and anti-inflammatory interleukin (IL-10). A statistically significant decrease of length of circumference of the affected upper limb was recorded in patients of groups 3 and 4, which electrostatic therapy was used in the rehabilitation program. Lymphatic edema of the upper limb was decreased statistically significant by 33.25% in the 3rd group, by 35.45% in the 4th group. According to the data of the Mirage multicenter study, parameters of the physical and mental components of health of the SF-36 questionnaire after a course of rehabilitation therapy ware significantly approached to the average population parameter in all groups. There was an objective improvement in the general well-being of the patients, an increase in activity and mood according to the data of the WAN questionnaire and psychological state according the Hamilton scale. CONCLUSIONS: Inclusion of electrostatic therapy procedures, sinusoidal modulated currents in the rehabilitation program, significantly enhances the therapeutic effect, promote to reduce the edema of the upper limb, increase the range of motion of the shoulder joint, which has a positive effect on the quality of life andemotional state of patients. The level of IL-6, IL-8 tends to decrease, which indicates the absence of tumor growth and systemic inflammatory reactions. Decrease of the level of IL-10 and homocysteine confirms the safety of the use of physical factors in the treatment of PMES.

[Efficacy and safety of botulinum toxin type A (IncobotulinumtoxinA) in the treatment of patients with cerebral palsy]. / Éffektivnost' i bezopasnost' primeneniia botulinicheskogo toksina tipa A (IncobotulinumtoxinA) pri lechenii patsientov s detskim tserebral'nym paralichom.

AIM: To assess the safety and clinical and neurophysiological efficacy of xeomin in children with spastic equinus and equinovarus foot deformity in cerebral palsy. MATERIAL AND METHODS: Sixty-four patients with spastic forms of cerebral palsy (levels I-IV on the GMFCS) were enrolled into this multi-center open-label comparative randomized trial. The patients were administered xeomin or botox once, each drug being administered to 32 patients. Efficacy was evaluated based on clinical characteristics (the modified Ashworth scale, goniometry) and electromyography data. The subjects were observed for 3 months (90±7 days) after injections. The incidence, severity and intensity of adverse events (AE) was also determined. RESULTS: Treatment with xeomin according to the suggested protocol has proven its high clinical efficacy. The efficacy was demonstrated by significant, stable and long-term decrease in the gastrocnemius muscle tone: in the xeomin group, the score on the modified Ashworth scale decreased from 2.6±0.49 points at baseline to 1.8±0.54 points (р<0.000001, paired t-test; р<0.000004, Wilcoxon test). In the botox group, this score decreased from 2.4±0.56 points to 1.6±0.45 points (р<0.000001, paired t-test; р<0.000002, Wilcoxon test). The increased range of ankle joint movements at passive and voluntary feet extension. In the xeomin group, the significant proportion of patients (45.1%) moved to the group of lower spasticity defined as less than two score points on the modified Ashworth scale. The clinical data fully matched the changes in electromyography parameters, which were characterized by the lower amplitude and area of the target muscle (lateral and medial gastrocnemius heads) M-responses. AE developed in three patients (9.4%) administered xeomin and in two patients (6.3%) administered botox. The AE recorded in the study are described in the recommendations on the use of xeomin and botox. In three cases (50.0%), AE intensity was determined as mild, in the remaining three cases (50.0%) as moderate. CONCLUSION: The results have shown the safety and efficacy of xeomin in the treatment of gastrocnemius spasticity in pediatric patients with cerebral palsy. These data are confirmed by the lack of significant differences in any clinical or electromyography parameters with the results in the reference group administered botox.

[The First Russian Consensus on the Multilevel Abobotulinumtoxin A Injections in Spastic Forms of Cerebral Palsy]. / Pervyi Rossiiskii konsensus po primeneniyu mnogourovnevykh in''ektsii abobotulinumtoxin A pri lechenii spasticheskikh form detskogo tserebral'nogo paralicha.

Spasticity treatment is one of the key aspects of the contemporary cerebral palsy (CP) rehabilitation that influences on the effectiveness of other methods. The paper presents the first Russian document that unites the recommendations for the BTA treatment of CP and could be used as the guideline for the multilevel injections. The Russian consensus on the multilevel botulinum toxin A (BTA) treatment of spastic CP is based on the international data and the results of national studies. The authors describe typical CP spasticity patterns in the upper and lower extremities, give recommended intervals for the BTA (Abobotulinum toxin A) dosages for the whole injection procedure and for the separate muscles. The method of dosage calculation for functional segments is also described. Attention is paid to the frequency, optimal intervals between the repeated injections and the whole duration of BTA treatment. The authors discuss effectiveness and safety of BTA, factors that potentially influence the results of the injections, including ultrasound and electromyography control, and indications for the continuation and termination of treatment.

[The development of organization of medical social care of patients with epilepsy].

The article represents the major issues and priority trends of enhancement of organization of medical social care of patients with epilepsy. It is emphasized that only the integrated approach to overcome the mentioned issues on both federal and regional level will favor the increase of availability of specialized medical care to patients with epilepsy and their quality of life.

[Lamotrigine in treatment of women with epilepsy].

The paper presents the review of literature on the age aspect of using lamotrigine in pubertal period, in women of reproductive age, during pregnancy and lactation and in climacteric period. Special attention is drawn to the low teratogenic potential of this drug used as a monotherapy. It has been concluded that lamotrigine is expedient to be used in treatment of partial and generalized epilepsy in women.

[The organization of integrated care to children with epilepsy].

In the Stavropol Kray four-stage system of caring patients with epilepsy is developed. It is consisted of local physician-district neurologist-epileptologist of consultative polyclinic of kray pediatric hospital-psycho-neurologic department of kray pediatric hospital. The implementation of treatment standards permitted to ultimately approximate the actual care to the patient with epilepsy.

[The analysis of certain social aspects of epilepsy issue].

The article deals with the results of sociological study of relatives of children suffering with epilepsy in Stavropolski Krai. The purpose of study was to investigate the major significant issues caused by this diagnosis to determine the public attitude to epilepsy. The revealed issues can be used for development of management decision-making to further enhance the epilepsy medical service to provide the effectiveness of treatment and the increase of quality of life of epilepsy patients. The implementation of WHO program "To expose the epilepsy" is discussed.

[The experience of enhancement of curative preventive care to children with epilepsy status].

The results of analysis of prevalence and morbidity of epilepsy in the children population of Stavropol Kray are presented. The experience of organization of medical care to epileptic children is discussed and the directions of its enhancement as well. The priorities in the development of prevention of epilepsy in children are determined. It is emphasized that the implementation of comprehensive set of organizational methodological activities and modern handling in diagnostics, treatment and prevention of epilepsy contributed both into decrease of relative quantity of patients with psychic disorders and mental deficiency in general and decrease of quantity of disabled children being under observation in Kray children epileptological center.