[Phenotypes of bronchial asthma during the health resort period and personalized programs of medical rehabilitation]. / Fenotipy bronkhial'noi astmy na sanatorno-kurortnom étape i personalizirovannye programmy meditsinskoi reabilitatsii.

INTRODUCTION: Bronchial asthma (BA) is a relevant social and medical problem in our country and around the world. Currently, phenotypes of the disease are distinguished. One of the original decisions in phenotypes distinguishing is the use of cluster analysis. However, the concept of BA phenotypes at the health resort period of rehabilitation has not yet been formed. AIM: To determine the BA phenotypes upon admission of patients to a health resort medical rehabilitation (HRMR) using cluster analysis and to offer personalized rehabilitation programs. MATERIAL AND METHODS: 518 patients with asthma who underwent HRMR on the southern coast of Crimea were examined. Each patient received clinical, functional and laboratory examination. HRMR included correction of long-term treatment according to the severity of asthma, climate therapy, respiratory therapy, educational programs, and physiotherapeutic procedures. We applied cluster analysis in order to identify BA phenotypes. Description statistics methods were used for phenotype-cluster characterization, comparative analysis - for determination of reliable phenotypic characteristics and relation of the effectiveness of HRMR and phenotypes. RESULTS: A model of three phenotype-clusters was developed. The first cluster included patients with BA of moderate severity, uncontrolled course, frequent exacerbations, history of atopy, a tendency to obesity, moderately reduced external respiration function, fixed airway obstruction, high adherence to long-term therapy with medium doses of inhaled glucocorticoids (ICS) combined with long-acting ß-2 agonists (LABA). Cluster 2 included patients with mild asthma, controlled or partially controlled course of the disease, with rare short exacerbations, late onset, preserved external respiration function and exercise tolerance, but low adherence to long-term therapy with medium and low doses of ICS. Cluster 3 included patients with moderate to severe BA, uncontrolled course, with early onset, frequent and prolonged exacerbations, severe symptoms, significantly reduced external respiration function with fixed obstruction, decreased exercise tolerance, but low adherence to long-term therapy (4th stage) with high doses of ICS in combination with LABA and long-acting anticholinergics. A close relationship was found between phenotypes-clusters and the achieved effects: a significant increase in the control of BA and a high efficiency of rehabilitation in patients of the 1st and especially 3rd clusters and low in the 2nd cluster. The optimal rehabilitation programs for each of the selected cluster phenotypes were determined. CONCLUSION: The cluster model developed with the help of artificial intelligence has demonstrated high prognostic value in the determination of the effectiveness and change of control over the course of asthma as a result of HRMR. Personalized HRMR programs are suggested.

[The nephroprotective potential of peloid therapy used for the rehabilitation of the patients presenting with chronic pyelonephritis]. / Nefroprotektivnyi potentsial peloidoterapii v reabilitatsii bol'nykh khronicheskim pielonefritom.

This review article presents the data on the mechanism of action of peloid therapy from the perspective of its defibrosing effect, the structure and functions of the extracellular matrix under the normal and pathological conditions. In addition, role of this treatment modality in the progression of tubulointerstitial fibrosis which determines the severity and prognosis of chronic pyelonephritis is considered. The researchers are currently carry out the extensive studies aimed at the search of the methods for the primary and secondary prevention of chronic pyelonephritis. A wide range of pharmacotherapeutic modalities are currently used for this purpose. Moreover the development of long-acting anti-relapse medications is currently underway along with the further improvement of high-tech reconstructive surgical methods for the intervention on the organs of the urinary system. At the same time, the nephroprotective potential of the natural physical factors, such as therapeutic muds, e.g. peloids, remains poorly explored even though their well apparent thermophysical properties, unique organic and mineral composition, and saturation with biologically active compounds are well known long ago. The systemic response to peloid therapy manifests itself as the changes in the metabolism of the intercellular matrix and collagen of the connective tissue associated with the alterations in the process of fibrogenesis and the development of tubulointerstitial disorders. The direct and indirect influence of peloids on the connective tissue is possible. The indirect effects are attributable to the peloid impact on the antioxidant status, immunity, hormonal regulation, and metabolic processes. These findings suggest the necessity of the relevant experimental and clinical studies for the evaluation of the influence of peloid therapy on the structure and metabolism of the connective tissue in the kidneys including dynamics of the markers of inflammation, proliferation and fibrogenesis, and the hormonal status of the patients suffering from chronic pyelonephritis based on the application of the modern technologies in accordance with the requirements of evidence-based medicine.

[The influence of the comprehensive spa and health resort-based treatment on the system of hormonal regulation in the women presenting with gynecological pathology depending on the plasma prolactin level]. / Vliianie kompleksnogo sanatorno-kurortnogo lecheniia na sistemu gormonal'noi reguliatsii u zhenshchin s ginekologicheskoi patologiei v zavisimosti ot urovnia prolaktina.

AIM: The objective of the present study was to evaluate the influence of the comprehensive spa and health resort-based treatment on the system of hormonal regulation in the women presenting with bacterial vaginosis and concomitant chronic inflammatory diseases of the pelvic organs depending on the plasma prolactin level. MATERIAL AND METHODS: We investigated the indicators of hormonal regulation in 186 women suffering from bacterial vaginosis and concomitant chronic inflammatory diseases of the pelvic organs depending on the level of prolactin in blood plasma. The first group consisted of 128 women with the normal plasma prolactin levels whereas the second group was comprised of 58 women having hyperprolactinemia. The relevant laboratory data were obtained before and after peloid therapy. RESULTS: The application of the therapeutic peloids for the treatment of the women presenting with the normal level of prolactin in blood plasma was shown to contribute to the positive clinical dynamics of the patients' condition and have a modulating effect on the level of pituitary hormones as well as a stimulating effect on the function of the ovaries. The peloid therapy given to the women with hyperprolactinemia exacerbates the hormonal imbalance as a result of the increase of the initial level of prolactin, discoordination of the hormonal regulation at the level of the pituitary-ovarian system, and enhancement of the adrenal gland function regardless of the level of prolactin. CONCLUSION: The results of the study give evidence of the possibility to use the plasma prolactin level as an indicator of the effectiveness of the spa and health resort-based treatment of the women presenting with gynecological pathology. Moreover, they suggest the necessity of a differentiated approach to the application of the therapeutic peloids for the treatment of gynecological patients with the disturbances of the hormonal regulation taking into consideration the initial level of prolactin in the blood plasma and the presence of hyperprolactinemia prior to the prescription of the spa and health resort-based treatment including peloid therapy.

[The influence of electrosleep therapy on the dynamics of the parameters of biorhythmic hormonal activity in the children presenting with extrasystolic arrhythmia in the course of the spa and resort-based treatment].

UNLABELLED: Heart rhythm disorders occupy a leading place in the modern structure of cardiovascular diseases in the children. At present, the role of stress-induced reactions in the development of more than a thousand diseases has been proved. Rehabilitation of systemic manifestations of extrasystolic arrhythmia (EA) in the children is only scarcely described in the literature. AIM: The objective of the present work was to improve the effectiveness of the spa and resort-based treatment of the children presenting with extrasystolic arrhythmia taking advantage of the available information about the different biorhythmic activities of the stress-realizing and stress-limiting systems. MATERIAL AND METHODS: The study included 60 children presenting with EA, who received a standard combination of spa and resort-based therapeutic modalities in conjunction with electro-sleep therapy. RESULTS AND DISCUSSION: The study revealed desynchronization of the endocrine functions in the children with EA that manifests itself as the increased secretion of cortisol and adrenaline, suppressed melatonin and ACTH production, mismatched daytime and nocturnal hormonal levels. The daily bio-rhythmic profile influenced the formation of circadian-type extra systola in the children. The most unfavorable clinical and electrocardiographic patterns were observed in the children with the mixed and night-type arrhythmia. The complex of rehabilitation measures practiced at the Evpatoriya health resort including electro-sleep therapy made it possible to balance the activities of the stress-limiting and stress-implementing systems of the body in the form of normalization of the altered levels of adaptive hormones, ordering of biorhythmical hormonal relationships, and reduction of the number of extrasystoles. The most pronounced effect of the treatment was observed in the group of children with a rare and day-type of arrhythmia to whom electrosleep was prescribed. It is concluded that the significant decrease in the frequency of night-type and mixed-type extrasystoles under effect of electro-sleeptherapy allows to recommend the treatment modality being considered for the correction of this type of heart rhythm disorders.

[Dermatoglyphics in children with constitutional exogenous obesity]. / Dermatoglifika pri konstitutsional'no-ékzogennom ozhirenii u detei.

The results of investigation of dermatoglyphics were analyzed in 544 children suffering from constitutional exogenous adiposity. The results of population-based studies of a regional medicogenetic counselling service (1240 persons) were taken as control data. Dermatoglyphic changes included papillary patterns intensified at the expense of loops and twists. An increase in the atd angle value, a-b count in boys, the presence of additional triradii, abnormal endings of the main palm lines, a reduced C line, the absence of the C triradius in patients with constitutional exogenous adiposity as well in their relatives of the 1st degree of kinship were revealed.