[The use of transcranial micropolarization in the acute period of severe traumatic brain injury in children]. / Primenenie transkranial'noi mikropolyarizatsii v ostrom periode tyazheloi cherepno-mozgovoi travmy u detei.

Traumatic brain injury, which is often considered as a silent epidemic, is a public health problem. The duration of acute recovery period remains a commonly used criterion for injury severity and clinical management. In this connection, the first stage of medical rehabilitation is carried out in the conditions of resuscitation and neurosurgery department in the hospital providing specialized care. Rehabilitation techniques such as postural training, phase verticalization, individual kinesiotherapy, transcranial micropolarization and etc. are used. OBJECTIVE: To assess the effectiveness of using transcranial micropolarization in acute period of severe traumatic brain injury in children. MATERIAL AND METHODS: The study on the effectiveness of using transcranial micropolarization in acute period of severe traumatic brain injury in 85 children, divided into 2 groups, was carried out. The study group (42 patients) received the transcranial micropolarization on the 2nd day after severe traumatic brain injury. The control group (43 patients) received only rehabilitation in neurosurgery department. The neurological status in the patients of both groups was assessed on the 2nd day after severe traumatic brain injury in resuscitation department, and after 1, 3 and 6 months. RESULTS AND CONCLUSION: The inclusion of transcranial micropolarization in the early medical rehabilitation of children with severe traumatic brain injury increases consciousness level in a shorter period of time, that predicts early patient's socialization.

[Transcranial magnet therapy in comprehensive therapy of migraine]. / Primenenie transkranial'noi magnitoterapii v kompleksnom lechenii migreni.

Migraine is a primary form of headache characterized by throbbing unilateral attacks, increased sensitivity to light and sound, accompanied by nausea and/or vomiting, lasting from 4 hours to 3 days. Developing and implementing new methods of pain relief is an urgent task of modern medicine. One of the safest and most commonly recommended methods is transcranial magnet therapy (TMT). OBJECTIVE: To evaluate the effect of TMT on improving the effectiveness of comprehensive therapy in patients with migraine. MATERIAL AND METHODS: A blind, randomized, placebo-controlled clinical trial was conducted, including 50 patients with migraine divided into three groups (the main group received TMT; the comparison group received low-frequency magnet therapy with a magnetic pulse duration of 250 µs; the control group received treatment with placebo device). The objectives were to study the TMT effect on reduction of the frequency and intensity of headache attacks, the severity of associated symptoms, reduction of medications use, including analgesics, in patients with migraine, as well as to evaluate the statistical difference in the effectiveness of magnetic therapy with different magnetic pulse ratio on all of the above parameters in study patients. RESULTS: According to the study data, a positive effect of TMT on the patients' condition was observed. After treatment, 76.9% of the patients in the main group had a reduction of headache intensity compared to the control group (35%) and a 47.8% decrease in analgesics use. In the main group, a reduction of nausea (73.3% of patients), acousticophobia (77.8% of patients), and photophobia (81.8% of patients) was noted. The HADS scale showed a 44.3% reduction in anxiety and depression in the main group. CONCLUSION: The clinical efficacy of TMT in patients with migraine has been demonstrated. In clinical practice, it is reasonable to use TMT to improve the treatment effectiveness in patients with migraine.

[Application of the ICF in assessing the effectiveness of magnetotherapy in patients with viral pneumonia associated with COVID-19]. / Primenenie MKF v otsenke effektivnosti magnitoterapii u patsientov s virusnoi pnevmoniei, assotsiirovannoi s COVID-19.

The number of patients who have had pneumonia caused by COVID-19 is increasing every month. However, despite the ongoing treatment, the consequences of this disease are possible, which may appear in the short term or after a while. Pneumonia associated by the new coronavirus infection COVID-19 is characterized by the presence of such complications as cough, shortness of breath, fatigue, sleep disturbances, appetite disorders, etc. Often, pneumonia leads to dysfunctions of the respiratory system, higher mental functions, functions of the cardiovascular system and, unfortunately, possible disability. The search and implementation of new methods of physical rehabilitation is an urgent task of modern medicine. Low-frequency magnetotherapy is one of the safest and most commonly recommended treatments for pneumonia. The development of new methods of medical rehabilitation for patients with pneumonia associated with COVID-19, using physical factors such as low-frequency magnetotherapy, laser therapy is one of the leading fields. Magnetotherapy is included in the recommendations of the Ministry of Health of the Russian Federation for the purpose of anti-inflammatory, decongestant, reparative-regenerative action; improvement of microcirculation, acceleration of the resorption of infiltrative changes (Temporary methodological recommendations «Medical rehabilitation for a new coronavirus infection (COVID-19)¼, version 2 of 31.07.2020). International rehabilitation practice of using the International Classification of Functioning, Disability and Health (ICF) advises to use it as a tool that allows you to objectively determine the state of health of patients, determine the prognosis of impaired functions and evaluate the effectiveness of ongoing rehabilitation measures. OBJECTIVE: To assess the effectiveness of the use of low-frequency magnetotherapy in the complex medical rehabilitation of patients who have had pneumonia in the phase of convalescence according to the International Classification of Functioning, Disability and Health. MATERIAL AND METHODS: The study included 200 patients who had suffered from pneumonia associating by COVID-19 and whose average age was 54.3±5.8 years. 1st (main) group (n=100), against the background of standard therapy on the 16th day after discharge from the hospital, received low-frequency magnetotherapy on the ALMAG-02 apparatus («Elamed¼, Russia) daily for 10-20 minutes, a course of 15 procedures. The 2nd group(control) included 100 patients who underwent low-frequency placebo-magnetotherapy on the ALMAG-02 apparatus («Elamed¼, Russia). In order to assess the dynamics of clinical and laboratory data and the effectiveness of treatment, control methods were used in this study in accordance with the Temporary Clinical Recommendations of the Ministry of Health of the Russian Federation. Each patient was evaluated for the severity of the initial manifestations of respiratory failure using the mMRC scale (Degree of Shortness of breath) and the Borg scale, and the quality of life of patients was assessed on the EQ-5D scale. Also, at the time of inclusion in the study and during the control examination after the completion of prospective follow-up, the Individual profile of patients was determined in accordance with the international classification of functioning (ICF) with the data of the «Individual Registration Card of the clinical trial participant¼. RESULTS AND DISCUSSION: In 43% (43 people) of patients of the 1th group, an improvement in respiration functions was noted with lung auscultation and with spirometry, an increase in the vital capacity of the lungs by 28.2% (p=0.0021), an increase in chest excursion by 53.1% (p=0.0019) a decrease in the level of shortness of breath by 50% and Borg by 33.3% (p=0.0016). According to the data of the quality of life questionnaire (EQ-5D), the patients of the main group showed an improvement in the quality of life by 23% (p=0.0019). In the 1st group of patients, there was a decrease in moderate disorders in the domains «b152 - emotion functions¼ in 45% of patients; «b440 - respiratory functions¼ in 87% of patients; «b455 - exercise tolerance functions¼ in 74% of patients; «b134 - sleep functions¼ in 30% of patients; «d450 - walking¼ in 100% of patients. In the general blood analysis of patients of the 1st (main) group, there was a relief of leukocytosis, normalization of the erythrocyte sedimentation rate (ESR). In the 1st group a decrease in the duration of being on the sick list was observed for 3.4±0.2 days. CONCLUSION: The inclusion of low-frequency magnetic therapy in the complex rehabilitation of patients who have suffered pneumonia associated by COVID-19 contributes to improving the function of external respiration of patients, regression of residual infiltrative changes in the lungs after pneumonia, relief of residual manifestations of the inflammatory process, reducing the duration of the rehabilitation period and the duration of disability, improving the general well-being of patients, increasing tolerance to physical exertion, normalization of the psycho-emotional state and, as a result,, restoring activity in everyday life and improving the quality of life of patients. The researchers did not register any side effects and side effects of magnetic therapy from ALMAG-02 apparatus (Elamed, Russia).

[Efficacy and safety of magnet therapy using portable device for knee osteoarthritis. 55-week double-blind study results]. / Effektivnost' i bezopasnost' primeneniya magnitoterapii s pomoshch'yu portativnogo apparata pri lechenii osteoartrita kolennykh sustavov. Rezul'taty dvoinogo slepogo 55-nedel'nogo issledovaniya.

Instrumental physiotherapeutic treatment using portable devices is optimal for patients with rheumatic diseases due to the devices' greater accessibility. However, there are still issues concerning the efficacy of physical factors generated by portable equipment in osteoarthritis (OA), mostly due to the limited evidence. OBJECTIVE: To study the efficacy and safety of long-term use of the portable magnet therapy device ALMAG+ (Almag Active) in knee OA (KOA). MATERIALS AND METHODS: A double-blind, randomized, placebo-controlled, prospective, 55-week clinical trial of the medical device was conducted. The study included patients with primary and secondary (associated with immunoinflammatory rheumatic diseases) KOA stages I-III according to Kellgren-Lawrence diagnosed using generally accepted criteria (R. Altman et al., 1986). Enrollment of patients with secondary KOA was allowed given that the remission or low disease activity was achieved. During the study patients had to receive steady drug therapy. No intra-articular injections of glucocorticosteroids, hyaluronic acid, PRP, and physiotherapy procedures for knees (electrotherapy, shockwave therapy, heat therapy, hydrotherapy, peloid therapy) were allowed three months or less before the enrollment and throughout the study. According to the approved protocol, 77 patients (mean age 52.73±12.97 years) from two research centers participated in the study: 32 (41.6%) were males, and 45 (58.4%) were females. Primary KOA occurred in 41 (52%) patients, 36 (46.8%) patients had secondary KOA (associated with rheumatoid arthritis, ankylosing spondylitis, Sjögren's disease, psoriatic arthritis, systemic lupus erythematosus, or diffuse scleroderma). All patients received NSAIDs as a concomitant therapy, 24.7% received diacerein, 28.6% received disease-modifying anti-rheumatic drugs, 2.6% received methylprednisolone up to 8 mg/day, and 9% received biologic therapy. After randomization, 40 (52%) patients received placebo treatments (Group 1) and 37 (48%) received active treatments (Group 2). Both groups were comparable in the main parameters. The proportion of smokers was higher in Group 2, but the difference was not statistically significant. During the 55-week follow-up, three courses of 18 daily home magnet therapy procedures each were performed. RESULTS: In both groups, starting from week 5 of the study, an improvement of pain on movement and at rest according to VAS compared to the baseline (p<0.01 at all assessment time points) was observed, which can be explained by a pronounced placebo effect, often observed in OA. The improvement of pain at rest was more prominent in Group 2 vs. Group 1 at Week 21 (p=0.038) and Week 55 (p=0.017) of the study, probably due to the anti-inflammatory effect. The overall WOMAC index score was also lower in Group 2 vs. Group 1 at Weeks 21 and 55 (p=0.03 at both time points). The mean articular cartilage thickness, determined by ultrasound, reduced in Group 1 and remained practically unchanged in Group 2 (p=0.011). No adverse events associated with the use of the ALMAG+ (Almag Active) device, according to the attending physician, and no exacerbations of immunoinflammatory rheumatic diseases during the study period were reported. CONCLUSION: The results of a double-blind, placebo-controlled study of magnet therapy using a portable device demonstrated analgesic, anti-inflammatory, and structure-modifying effects of this type of physiotherapeutic treatment. No adverse events and exacerbations of rheumatic diseases associated with the study treatment have been reported.

[Efficacy of Low-Frequency Magnetic Therapy in Patients with COVID-19 Pneumonia]. / Effektivnost' nizkochastotnoi magnitoterapii u patsientov, perenesshikh pnevmoniyu, vyzvannuyu COVID-19.

The number of patients who have had pneumonia caused by COVID-19 is increasing every month. However, despite the ongoing treatment, the consequences of this disease are possible, which may appear in the short term or after a while. Pneumonia caused by the new coronavirus infection COVID-19 is characterized by the presence of such complications as cough, shortness of breath, fatigue, sleep disturbances, appetite disorders, etc. Often, pneumonia leads to dysfunctions of the respiratory system, higher mental functions, functions of the cardiovascular system and, unfortunately, possible disability. The search and implementation of new methods of physical rehabilitation is an urgent task of modern medicine. Low-frequency magnetotherapy is one of the safest and most commonly recommended treatments for pneumonia. OBJECTIVE: To assess the effectiveness of the use of low-frequency magnetotherapy in the complex medical rehabilitation of patients who have had pneumonia in the phase of convalescence. MATERIAL AND METHODS: The study included 52 patients who had suffered from pneumonia caused by COVID-19 and whose average age was 56.2±5.7 years. Group I (main) group (n=30), against the background of standard therapy on the 16th day after discharge from the hospital, received low-frequency magnetotherapy on the ALMAG-02 apparatus (Elamed, Russia) daily for 20 minutes, a course of 10-12 procedures. In the second (control) group (n=22), therapy was carried out in accordance with the Temporary Clinical Recommendations of the Ministry of Health of the Russian Federation for the prevention, diagnosis and treatment of new coronavirus infection COVID-19 (version 8.1 of 01/10/2020), as well as the Temporary Clinical recommendations for medical rehabilitation for a new coronavirus infection (version 8.1 of 01/10/2020). Evaluation method: spirometry using a spirographMIR (Italy), chest excursion, rehabilitation routing scale (RRM), quality of life questionnaire (EQ-5D), Borg scale for patient assessment of exercise tolerance, ECG, oxygen saturation in the blood. RESULTS AND DISCUSSION: The patients of the 1st group showed an increase in the vital capacity of the lungs by 16.4% in comparison with the 2nd (control) group; an increase in chest excursion by 45.6%, a decrease in the level of shortness of breath from moderate to mild by 64.1%, a decrease in disabilities by 62.7%, compared with the second (control) group. According to the data of the quality of life questionnaire (EQ-5D), the patients of the main group showed improvements in general mobility (mobility) by 44.5%, everyday activity by 26.1%, a decrease in pain/discomfort by 47.9%, anxiety and depression by 42.2%, compared with the control group (p=0.001). CONCLUSION: The inclusion of low-frequency magnetic therapy in complex rehabilitation contributes to the regression of respiratory disorders, reduces the level of anxiety and depression, reduces pain and discomfort, thereby improving the patient's quality of life.

[Clinical effectiveness of «thresholdless¼ low-frequency transcranial magnetic stimulation in patients with ischemic stroke]. / Klinicheskaya effektivnost' «besporogovoi¼ nizkochastotnoi transkranial'noi magnitnoi stimulyatsii u patsientov s ishemicheskim insul'tom.

PROBLEM RELEVANCE: As you know, complete successful recovery in stroke patients occurs only in 8% of cases, 20% need constant care. The use of innovative rehabilitation technologies, namely «thresholdless¼ low-frequency transcranial magnetic stimulation, will speed up the process of restoring impaired functions, increase independence in everyday life and, accordingly, the quality of life. AIM OF STUDY: To evaluate the effectiveness of use of low-frequency «thresholdless¼ transcranial magnetic stimulation in the treatment of patients in acute period of ischemic stroke. MATERIALS AND METHODS: The study included 93 patients aged from 49 to 68 years on second-third days of ischemic stroke. The 1st (main) group (n=48) received low-frequency «thresholdless¼ transcranial magnetic stimulation from the «Diamag¼ apparatus (AlMag-03) daily for 20 minutes, course - 8-10 procedures, with the background of drug treatment, and in addition to classes with an exercise therapy instructor and an occupational therapist. In the 2nd (control) group (n=45), standard therapy was carried out in accordance with the Procedure for rendering medical care to patients with stroke, only with the exception of physiotherapy. Assessment methods: clinical and neurological examination, indicators of duplex scanning of brachiocephalic vessels, Rivermead mobility index, modified Rankin scale, FIM scale (Functional Independence Measure), Hospital anxiety and depression scale (HADS). RESULTS AND DISCUSSION: In patients of the 1st (main) group, an increase in the linear velocity of blood flow in the internal carotid artery on the side of lesion was revealed by 18.1% when compared with the 2nd (control) group (p=0.042); mobility increased by 42.1%, functional independence in everyday life - by 38.1%, muscle strength - by 50%, compared with the 2nd (control) group (p=0.0005). According to the HADS scale, in 29 (60.8%) patients of the main group, psychoemotional disorders were not detected, neither a single case of significantly expressed symptoms of depression (p<0.0001). CONCLUSION: The inclusion of low-frequency transcranial electromagnetic stimulation in complex rehabilitation leads to the regression of movement disorders, reduces the level of anxiety and depression, improves daily activity and, as a consequence, the quality of life.

[Physical factors in the treatment of patients with spondylarthritis]. / Fizicheskie faktory v terapii patsientov so spondiloartritami.

Therapy of patients with spondylarthritis (SA) remains one of the most difficult problems of modern rheumatology. Its relevance is due to the high frequency of damage to people of working age, the progressive course of the disease and early disability. The basis of SA therapy is a combination of pharmacological and non-pharmacological methods. The article published studies on the use of physiotherapy in patients with SA. An analysis of the literature data indicates the existence of a sufficiently large number of publications confirming the feasibility of using physical factors in the treatment of patients with SA. It is shown that an integrated approach to the treatment of this group of patients provides the greatest efficiency. However, studies on the use of physiotherapy in patients with SA with a high level of evidence are clearly not enough. Still unresolved issues related to the approval of clinical recommendations for therapy with physical factors, the features of the use of physiotherapy depending on the degree of activity and the stage of medical rehabilitation. The development and approval of clinical recommendations for the use of physical factors in the complex therapy of patients with SA is one of the urgent tasks of modern rheumatology and medical rehabilitation.

[Assessment of need in nutritional support in patients with the consequences of central nervous system injuries]. / Potrebnost' v nutritivnoi podderzhke u patsientov s posledstviiami travm tsentral'noi nervnoi sistemy.

Traumatic brain injury (TBI) and spinal cord injury (SCI) are most common causes of death and disability in young patients. Metabolic changes occur immediately after the acute injury of the central nervous system. However hypermetabolic response in SCI is less pronounced compared to that in TBI that could be explained by the weakness of denervated muscles and hypodynamia. Following SCI, the level of resting energy expenditure is lower comparison to that calculated using the Harris-Benedict formula. Indirect calorimetry corresponded to class II (B) medical evidence, is recommended as a method for assessment of energy expenditure in the acute stage of TBI and SCI as well as in their consequences. Nutritional support is favorable and safe and therefore, it should be used as soon as possible. Many studies provide evidence that nutritional support leads to the replenishment of energy expenditure, reduce catabolic processes and nitrogen loss thus minimizing the risk of complications that in future decrease the extent of disability and increase quality-of-life of patients with the consequences of central nervous system injuries.

[Ximedon-electrophoresis in rehabilitation of patients with systemic scleroderma]. / Ksimedon-élektroforez v vosstanovitel'nom lechenii bol'nykh sistemnoi sklerodermiei.

A double blind placebo-controlled trial performed in 56 patients with scleroderma systematica showed effectiveness of a domestic drug ximedon--a pirimidine compound--applied during electrophoresis on the affected skin, limbs. The addition of ximedon-electrophoresis to rehabilitation program for scleroderma systematica improved the condition in 77.8%, microhemocirculation in 72.2%, reduced the area of the affected skin by 9.8% (p < 0.05), skin induration in 55.6% of patients.