Vol 25, No 3 (2022)

BACKGROUND: The number of premature infants in the world and Russia increases annually, becoming a medical and social problem. Despite the achievements of modern neonatology and improvement of reproductive and intensive care technologies, more than 15 million infants are born prematurely annually worldwide. Prematurity is the leading cause of approximately one million neonatal deaths annually, one of the main causes of under-five mortality, and a significant contributor to morbidity in adulthood. The development of comprehensive approaches to medical and social rehabilitation of children with disability and born with very low and extremely low birth weight requires statistical substantiation.

AIM: To examine statistical indicators of primary and secondary disabilities in children born with very low and extremely low birth weight.

MATERIALS AND METHODS: This retrospective study analyzed medical and expert records, medical and social examination reports, and data extracted from the Federal State’s Unified Automated Vertically Integrated Information Analytic System of medical and social examination. By continuous sampling, statistical indicators of primary disability in children aged 0–3 years, who were born with very low and extremely low bodyweight, were evaluated and compared with those of children born with normal weight. Complete rehabilitation rates from reassessments in the study group were also explored.

RESULTS: The statistical analysis demonstrated a trend toward an increase in the incidence of primary and secondary disabilities in children born with very low and extremely low bodyweight. The average complete rehabilitation rate during the study period was 0.6%, which was more than three times lower than that of preterm children (1.95%) and was reduced to a few isolated cases. Compared with adult rehabilitation, children’s rehabilitation potential and more favorable rehabilitation prognosis do not always allow elimination or compensation for existing disabilities after reaching not only the average age of equalization but also throughout early childhood.

CONCLUSION: In recent years, the rapid development of advances in neonatal medicine with the use of high-tech medical systems has led to a significant increase in the survival rate of preterm infants. The high risks of disability due to prematurity, peculiarities of major disabilities, and need for medical and social rehabilitation and habilitation in this population warrant further investigation.

BACKGROUND: The importance of studying the toxic effects of mercury and its compounds in patients aged 18 years and older is due to the continuing high levels of disability and loss of the professional ability to work (PAW). An analysis of the indicators of acute and chronic disability from occupational diseases in the Russian Federation in 2019 showed that there is a high level disability. Among occupational diseases in the Republic of Mordovia, the problem of mercury toxicity remains acute because of the industrial use of mercury or its compounds. The victims often suffer several mental and physical disorders simultaneously, which significantly complicates the process of rehabilitation and habilitation, and the socialization of patients exposed to the toxic effects of mercury and its compounds.

AIM: The aim was to determine the level of mental, neuromuscular, skeletal and movement-related (statodynamic) disorders arising from the toxic effects of mercury and its compounds in different age groups. Additionally, to study the relationship between the degree of loss of PАW because of occupational diseases, and the presence of complications due to concomitant diseases.

MATERIALS AND METHODS: The subjects of the study were patients aged 18 years and older who lost their PAW because of the toxic effects of mercury and its compounds, International Classification of Diseases, 10th revision (ICD-10) code: T56.1. A comprehensive study of patients who were newly or previously recognized as disabled was done by the Bureau of Medical and Social Expertise of the Republic of Mordovia. They assessed the degree of impairment of mental and statodynamic function for the period of 2015 to 2020. Data collection and processing, comparative analyses, expert assessment of the level of mental and statodynamic function disorders, and the status of the main and concomitant diseases and their complications was done.

RESULTS: For occupational diseases caused by the toxicity of mercury and its compounds, several assessments were done: the degree of loss of PAW, the need for medical, social and vocational rehabilitation, and classification of the patient as disabled as a result of occupational and general diseases in the presence of concomitant pathology. The percentage loss of PAW was determined: in 24.32% of cases. The percentage PAW loss and proportion of cases was 10% in 20.11% of cases, 20% in 13.41%, 30% in 12.34%, 40% in 1.28%, 50% in 3.85%, 60%, in 2.57%, 70% in 0.14%, and 80%, in 21.96%, respectively.

CONCLUSION: The toxic effect of mercury and its compounds caused disorders of mental functions. The minor-to-moderate and pronounced were most often detected, at 72.11%. The proportion of unaffected persons was 21.96%. Impairment of statodynamic function was detected in 2.63% of cases, and cardiovascular system function, 2.07%. There were sensory disorders in 0.71%, endocrine system and metabolic disorders in 0.14%, and blood and immune system abnormalities in 0.36%. The age categories were represented by two groups of persons: with persistent moderate and severe disorders of the body functions; persons from 45 to 59 years old inclusive; who had moderate, severe and significantly pronounced disorders, and the category of 60 year old patients.

BACKGROUND: Studies have shown that, in 2019, malignant neoplasms were the major cause of adult disability in the Russian Federation. Thus, it is important to study functional disorders in this group of patients.

AIM: To conduct a comparative analysis of the degree of statodynamic impairment caused by malignancies, based on the location of the neoplasm, the tumor stage, and complications. Further, to justify the need for specialized diagnostic equipment for objectively analyzing the degree of statodynamic dysfunction.

MATERIALS AND METHODS: A prospective study was carried out on a group of disabled people aged 18 years and older, with malignant neoplasms (ICD code–10: C00–C97). These patients were initially recognized as disabled, and had further assessment of their degree of disability by the Bureau of Medical and Social Expertise of the Republic of Mordovia. The specialized diagnostic equipment used by the office for expert and rehabilitation diagnostics to assess impairment of statodynamic function was an ergometer with a diagnostic track and a power platform “ZEBRIS FDM-T, N/R COSMOS.” Indicators were analyzed using a software module which assess the degree of the musculoskeletal and nervous system dysfunction. We performed the collection and processing of data, and a comparative analysis. We also conducted an expert assessment of the dependence of the impairment of statodynamic functions on the main and concomitant diseases, and their complications.

RESULTS: The analysis of statodynamic functions in cancer patients showed that the patients with impaired statodynamics averaged 11.24% of the study population. The proportions according to tumor type were 72.4% for malignant neoplasms of bones and articular cartilage, to 5.06% for malignant neoplasms of the thyroid gland and pheochromocytoma. A high percentage of patients with impaired statodynamic function had malignancies of the brain, spinal cord and meninges (C70–C72), 41.7%. In cases of malignant neoplasms that were inaccurately designated, secondary, and were unspecified localizations or with metastases without an identified primary focus after radical treatment (C76–C80) the proportion was 40.0% relative to the group with these diagnoses. Due to complications of the underlying disease, pronounced and significantly pronounced impairment of statodynamic functions were found in the C70–C72 International Classification of Diseases, 10th revision (ICD-10) codes, which correspond to neoplasms of the brain, cerebellum, and spinal cord. Significantly expressed and moderate disorders were found in the C64–C68 ICD-10 codes, corresponding to malignant neoplasms of the kidney, renal pelvis, and bladder. Moderate and insignificant dysfunctions of statodynamics were detected in C50, malignant neoplasm of the mammary gland.

CONCLUSION: The chronic impairments of statodynamic function in cancer patients are most pronounced in cancers of bone and articular cartilage, and the brain and spinal cord. The prognosis of patients with malignant neoplasms depends on the stage of the disease, the site of the neoplasm, and the initial treatment. Relapses, tumor metastases, and complications of therapy play an important role in the functional disorders seen during follow up. High-tech diagnostic equipment such as “ZEBRIS FDM-T, H/R COSMOS” allows accurate clinical assessment of the functions associated with movement. This provides an objective basis for the clinical and expert classification of the severity of impaired statodynamic functions of the body.