[The effect of low-frequency electrostatic therapy on immunoinflammatory reactions in patients with acute myocardial infarction after endovascular myocardial revascularization at the inpatient stage of medical rehabilitation]. / Primenenie nizkochastotnoi elektrostaticheskoi terapii v korrektsii immunovospalitel'nykh reaktsii u bol'nykh s ostrym infarktom miokarda posle endovaskulyarnoi revaskulyarizatsii miokarda na statsionarnom etape meditsinskoi reabilitatsii.

PURPOSE OF THE STUDY: To study the effect of complex rehabilitation with the inclusion of low-frequency electrostatic therapy on the dynamics of immune status in patients with myocardial infarction (MI) after endovascular myocardial revascularization. MATERIAL AND METHODS: The state of the immune status was studied in 68 patients with MI after percutaneous coronary intervention (PCI) - coronary angioplasty with stenting, admitted to the inpatient stage of medical rehabilitation. RESULTS: The study proved the involvement of the immune system in a complex set of reactions occurring in patients with myocardial infarction after PCI. Significant correlations between biochemical and immunological markers of inflammation and risk factors for cardiovascular diseases have been established. Carrying out complex rehabilitation measures using low-frequency electrostatic therapy at the stationary stage of medical rehabilitation helps to reduce the activity of the inflammatory process and eliminate the immunological imbalance in MI patients after endovascular myocardial revascularization. CONCLUSION: The inclusion of low-frequency electrostatic therapy in the medical rehabilitation complex has a significant immunocorrective effect on the parameters of cellular and humoral immunity, the ratio of pro- and anti-inflammatory cytokines, which justifies the prospects for its use in the rehabilitation of patients with myocardial infarction.

[Comprehensive medical rehabilitation using therapeutic physical factors including hydrokinesiotherapy in a pool with mineral water and its effect on circadian rhythms of arterial pressure and autonomic regulation in patients with arterial hypertension and with chronic psychoemotional stress]. / Kompleksnaya reabilitatsiya lechebnymi fizicheskimi faktorami s vklyucheniem gidrokinezioterapii v basseine s mineral'noi vodoi i ee vliyanie na tsirkadnye ritmy arterial'nogo davleniya i vegetativnuyu regulyatsiyu u bol'nykh arterial'noi gipertoniei i s khronicheskim psikhoemotsional'nym napryazheniem.

OBJECTIVE: To study the effect of the course-based comprehensive rehabilitation using the therapeutic physical factors of the Belokurikha resort, including hydrokinesiotherapy in a pool with mineral water on the circadian rhythms of arterial pressure and its autonomous regulation in patients with arterial hypertension (AH) associated with chronic psychoemotional stress (CPES). MATERIAL AND METHODS: The study involved 83 patients with stage I-II grade 1-2 of AH, whose professional activities were associated with CPES. Each participant had 24-hours Holter blood pressure monitored, and cardiointervalography (CIG) was performed before and after the medical rehabilitation course. The rehabilitation complex of the main group (II) included medication therapy for AH, diet, morning hygienic gymnastics, manual massage, total magnet therapy, and hydrokinesiotherapy in a pool with mineral water. Patients in the comparison group (I) were exposed to similar therapeutic physical factors with identical parameters of the procedures, except hydrokinesiotherapy, which was replaced by full baths with mineral water. RESULTS: Medical rehabilitation using the therapeutic physical factors of the Belokurikha resort with hydrokinesiotherapy in a pool promotes a decrease in the activity of a sympathetic nervous system and increase of vagal effects contribute to the regulation of vital functions of the AH patients, associated with CPES, thus minimizing the frequency of abnormal daily profiles night-peaker and over-dipper to 12.5% and 1.78% of cases, respectively, and increasing the percentage of subjects with its normal type (dipper) to 57.1% (p=0.039). CONCLUSION: The study results show the benefits of hydrokinesiotherapy in a pool with mineral water as a part of the course-based comprehensive rehabilitation in patients with hypertension and chronic psychoemotional stress in terms of normalizing circadian rhythms of arterial pressure and optimizing the activity of higher autonomous centers, which largely determine the cardiovascular system performance in this setting.

[On the assessment of medical rehabilitation effectiveness in patients with chronic obstructive pulmonary disease in the resort setting]. / K voprosu ob otsenke effektivnosti reabilitatsii bol'nykh khronicheskoi obstruktivnoi bolezn'yu legkikh na kurorte.

Despite significant successes of health resort rehabilitation in patients with chronic obstructive pulmonary disease (COPD), the assessment of rehabilitation effectiveness remains challenging for resort physicians in Russia. OBJECTIVE: To perform a comparative analysis of methods for assessing the medical rehabilitation outcomes in COPD patients in the resort setting. MATERIAL AND METHODS: The study involved 71 patients with stage I-II COPD, with bronchitis (66.2%) and mixed (COPD + asthma, 33.8%) phenotypes in the clinical remission phase. The mean age of the patients was 57.0±9.8 years, and the mean duration of disease was 7.8±5.1 years. Within 14 days, all patients received an identical set of rehabilitation measures with natural and preformed physical therapeutic resort factors. Before and after the medical rehabilitation course, clinical, laboratory, functional tests and questionnaires were performed on each patient. The effectiveness of course-based complex rehabilitation was assessed using one of three methods: CAT (COPD [chronic obstructive pulmonary disease] Assessment Test), the International Classification of Functioning, Disability and Health (ICF), the COPD control and control stability criteria system. RESULTS: Comparison of the three methods of assessment of COPD patients' rehabilitation outcomes in resort settings showed that the CAT score is the easiest to use, the least time-consuming, highly valid, and informative. According to the CAT score, the resort medical rehabilitation effectiveness was 96.4%, with «improvement¼ and «significant improvement¼ recorded in 82.1% of cases. The use of ICF provides reliable information about the rehabilitation complex effect on the main pathogenetic links of the disease, which allows proper adjusting of rehabilitation procedures to improve effectiveness in the resort setting. Specified grades of ICF domains make it possible to translate qualitative and quantitative attributes inherent to a particular subject into points. The points trend during the medical rehabilitation indicates its effectiveness in terms of recovery of specific functions impaired by the disease. At the same time, the ICF does not allow to rank the medical rehabilitation outcomes in the resort setting in terms of the currently accepted concepts of «significant improvement,¼ «improvement,¼ «slight improvement,¼ «no change,¼ «deterioration,¼ which limits its application in resorts. We believe that assessment of rehabilitation outcomes based on COPD control and control stability is not applicable to resort setting due to possible discrepancy between the impression formed in a short time (14 days) about these characteristics of the pathological process and the actual status, as well as due to lack of knowledge about the effect of achieved/not achieved disease control on the choice of rehabilitation technology. CONCLUSION: A simple and highly informative CAT score can be recommended to assess the effectiveness of resort medical rehabilitation in patients with chronic obstructive pulmonary disease.

[Leukocyte indices of patients with bronchial asthma: informative significance of use].

AIM: Determination of informativeness of leukocyte indices in patients with bronchial asthma, who have comorbid diseases in clinical remission of asthma. MATERIALS AND METHODS: The work based on a single examination of 225 patients with bronchial asthma. Criteria for inclusion in the study are following: the presence of a verified diagnosis of bronchial asthma, the phase of clinical remission. The patients have been divided into 4 groups, taking into account the type of comorbid diseases: the 1 group (53 patients) bronchial asthma was combined with lesions of the upper gastrointestinal tract; the 2 group (73 patients) with allergic rhinitis; the 3 group (76 patients) with hypertension; the 4 group (23 patients) comparison group: the patients without comorbid pathology. According to the clinical blood analysis, 10 leukocyte indices were calculated for each group of patients and their values were analyzed taking into account the frequency and severity of deviations from the reference values. Mathematical processing of the material was carried out using the statistical software package SPSS13.0 for Windows. RESULTS: Using leukocyte indices, it has been revealed that even during the period of clinical remission, almost all examined patients with BA have endogenous intoxication, the severity of which increases in comorbid diseases. Intoxication was inflammatory in nature and, according to the data of leukocyte indices, was due to the presence of persistent inflammation (local and systemic) and during clinical remission. Violation of immunological reactivity has been revealed in most of the examined patients. The presence of correlation relationships of leukocyte indices with a number of biochemical and immunological indicators allows one to exclude the latter from the plan of examination of patients without reducing the quality of their examination: for example, in the conditions of polyclinics, small hospitals, and resorts. Eight leukocyte indices that are the most informative at BA have been selected. CONCLUSION: Additional information about the condition of BA patients who have comorbid diseases during clinical remission can be used to develop programs for their comprehensive treatment and rehabilitation.

[The evaluation of the effectiveness of cardiac rehabilitation of the patients after percutaneous coronary interventions]. / Otsenka éffektivnosti kardioreabilitatsii patsientov posle chreskozhnykh koronarnykh vmeshatel'stv.

BACKGROUND: Notwithstanding the current abundance of the methodological approaches to the evaluation of the outcomes of medical rehabilitation, the criteria for the effectiveness of the combined influence of the curative physical factors are still inadequate and remain at variance with the principles of evidence-based medicine. AIM: The objective of the present study was to develop a method for the evaluation of the effectiveness of the rehabilitation activities in the patients presenting with the acute coronary syndrome following endovascular cardiac interventions. MATERIAL AND METHODS: This work is based on the results of a prospective single-center cohort-based clinical study involving the subjects who had undergone myocardial infarction following endovascular cardiac surgical interventions. The duration of the patient's participation in the study was 21 days. RESULTS: We have developed the integrative approach to the creation of the unified multi-criteria system for the evaluation of the effectiveness of the treatment of the patients presenting with cardiovascular diseases after percutaneous coronary interventions (PCI). In addition, the step-by-step description of this technology is presented. The algorithm for the calculation of the integrated health index and the evaluation of the overall effect of the rehabilitation activities was proposed based on the assessment of the clinical, laboratory, and functional indicators of the health status together with the psychological characteristics of individual patients. It is proposed to consider an integrated health index as a parameter for estimating the rehabilitation potential of the patients suffering from cardiovascular diseases after percutaneous surgical interventions. CONCLUSION: The proposed system for the evaluating of the effectiveness of comprehensive medical rehabilitation differs from analogous intellectual products in that it excludes the subjective interpretation of the severity of clinical symptoms associated with the concrete pathological process and makes impossible the arbitrary determination of the weight of the peculiar features of the patient's condition. Moreover, it allows to reduce the parameters of different types chosen as the criteria for the evaluation of the effectiveness of rehabilitation to the standardized values, to obtain an unambiguous numerical expression of the results of the rehabilitative treatment, and to compare the outcomes of the rehabilitation activities based at different treatment and prevention settings.

[Complex use of naphthalane and nonselective chromotherapy in gonarthrosis treatment in rolling stock workers].

Complex treatment using naphthalane applications with nonselective chromotherapy covered 64 engine operators of locomotive crews, aged 40-69 years, having 1-3 stage knee osteoarthrosis. Findings are that optimized treatment schedules effectively reduce intensity of pain, improve functional state of the joints involved, increase life quality of the patients, have no side effects. Comparative analysis of the treatment results showed that efficiency of combined naphthalane and nonselective chromotherapy exceeds isolated naphthalane effects.

[Prenosologic criteria of health disorders and cardiovascular risk factors in workers engaged into nuclear industry].

Prophylactic study among workers engaged into main production of Siberian chemical enterprise (Seversk city) revealed high frequency of cardiovascular risk factors (overweight, hypodynamia, dyslipidemia, arterial hypertension), low level of adaptational potential and integral somatic health parameter as prenosologic criteria of cardiovascular diseases. The results necessitate recommendations to supplement periodic medical examinations with studies aimed to reveal early criteria of health disorders, and determine priority directions to specify prophylactic measures in nuclear industry workers.