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Vol 26, No 3 (2023)
- Year: 2023
- Articles: 5
- URL: https://rjmseer.com/1560-9537/issue/view/8339
- DOI: https://doi.org/10.17816/MSER.263
Original study articles
Regional features of disability of breast cancer patients in the Volgograd region
Abstract
BACKGROUND: Breast cancer (BC) is the leading oncological pathology in the female population of Russia. Analysis of regional features of disability of breast cancer patients is necessary when assessing the effectiveness of specialized medical care.
AIM: Study of the structure and dynamics of disability of BC patients in the Volgograd region.
MATHERIALS AND METHODS: The object of the study was BC patients who were recognized as disabled for the first time and repeatedly in the Volgograd region. The study period is 5 years from 2018 to 2022 with an annual analysis of the number of people with disabilities depending on age. Research methods: study of statistical forms, statistical analysis.
RESULTS: For 5 years of follow-up in the Volgograd region, the contingent of disabled BC patients included 11942: in 2018 — 2225, in 2019 — 2135, in 2020 — 2268, in 2021 — 2487, in 2022 — 2827 women. Of these, 1553 (13%) were young patients, 2780 (23.3%) were middle-aged and 7609 (63.7%) were elderly. The increase in the total number of disabled people over 5 years was 602 (27.1%): young by 130 (49.1%), middle-aged by 151 (29.5%) and elderly by 321 (22.2%) (p=0.003). The established disability groups were distributed among the entire contingent of disabled people: group I — in 831 (7.0%), group II — in 4526 (37.9%) and group III — in 6585 (55.1%) patients. There were no statistically significant differences in the distribution of disability groups depending on the age of the patients. At the initial examination, group I was found in 11.88% of patients, and group II in 39.25% of patients. At the second examination, group III — in 57.33% (an increase of 8.53% against 48.8% during the initial examination). There was a steady trend of a significant increase in the number of patients of all age groups with recurrent disabilities. An analysis of the work activity of patients showed that with the first and re-established disability, 43% were engaged in physical work, 33% — mental work, and 24% did not have a profession.
CONCLUSION: To reduce the number of disabled BC patients is needed the use of screening programs, medical rehabilitation to minimize the complications of treatment of breast cancer. The results obtained in the course of the study should be used at the level of regional health care to improve medical and social rehabilitation.
135-142
Application of International Classification of Functioning, Vital Disabilities and Health to assess the effectiveness of rehabilitation in a psychiatric hospital
Abstract
BACKGROUND: The International Classification of Functioning, Disability and Health ICF is an important tool for planning, implementing and evaluating the effectiveness of the rehabilitation process. In addition, the use of the ICF makes it possible to objectify the level of quality of medical care. However, this classification is not quite enough used in practice still, including psychiatric practice, where (due to the specifics of these patients) a certain adaptation is required (in terms of choosing the set of the most informative domains).
AIM: To evaluate the effectiveness of the rehabilitation of patients with mental disorders based on the use of the ICF.
MATERIALS AND METHODS: Using data from case histories and special questionnaires, 500 patients of the psychiatric hospital were studied — a number of domains included in the ICF were identified and analyzed (domains characterizing “body functions”, “activity and participation”, “environmental factors”): upon admission, on 10th day of treatment, upon discharge. The study was conducted for 6 months by an all-over method. The exclusion criteria were: age under 18 and over 80; the presence of acute psychotic symptoms at the time of examination; the presence of severe cognitive dysfunctions that prevent the assessment of functional limitations, vital activity and health; duration of hospitalization less than 10 days. Statistical analysis of the collected material was carried out using application programs in Microsoft Office Excel.10.
RESULTS: Among the examined patients, women accounted for 52.6% (263 people). In the age structure, 30.8% (154 people) were patients under 30 years of age; 24.2% (121 people) — 30–39 years old; 13.2% (96 people) — 40–49 years old; 12.8% (64 people) are 50–59 years old and 13.0% (65 people) are 60 years old and older. Average age — 39.5±0.6 years. In the nosological structure, 16.8% (84 people) were patients with organic mental disorders; 12.8% (64 people) — with mental and behavioral disorders associated with the use of psychoactive substances; 19.8% (99 people) — with schizophrenia, schizotypal and delusional disorders; 16.2% (81 people) — with mood disorders; 17.0% (85 people) — with stress-related neurotic disorders and somatoform disorders; 17.4% (87 people) with personality and behavior disorders in adulthood. Upon admission, the following disorders were the most pronounced: mental stability (which occurred in 80.6% of patients — 403 people); regulation of emotions — 390 people (78.0%); control of impulsive impulses — 382 people (76.4%); stability of attention — 388 people (77.6%); switching of attention — 376 people (75.2%); separation of attention — 374 people (74.8%); concentration of attention — 371 people (74.2%); psychomotor control — 354 people (70.8%). During the treatment, the prevalence of all identified disorders significantly decreased (differences in the proportion of patients with various disorders upon admission — on 10th day of treatment — upon discharge are statistically significant with a reliability of more than 95.5%).
CONCLUSION: This dynamic proves the effectiveness of rehabilitation in general and the importance of nursing intervention in particular.
143-154
Diagnostic and clinical significance of cell free DNA levels in patients with chronic heart failure
Abstract
BACKGROUND: Chronic heart failure CHF remains one of the main causes of disability in patients with cardiovascular diseases. Leading to the development of persistent dysfunctions of the entire body, CHF significantly reduces the quality of life and worsens the patient’s prognosis. Therefore, it is so important to promptly identify the disease and carry out optimal therapy, which will delay the onset of irreversible consequences.
AIM: Analysis of cell free DNA level of in the blood plasma in patients with chronic heart failure and identification of differences in the studied indicator depending on the clinical characteristics of the patient.
MATERIALS AND METHODS: The study included 67 patients diagnosed with chronic heart failure and 23 healthy volunteers who were in satisfactory health, who made up the comparison group. All subjects underwent a gender and age assessment, analysis of risk factors, anthropometric indicators with calculation of body mass index. In patients with CHF, clinical and biochemical blood tests were performed to determine NT-proBNP, lipid profile, glucose and creatinine; In addition, an instrumental examination was performed, including electrocardiography, echocardiography, fundus examination, ultrasound examination of the abdominal organs, chest radiography, and a 6-minute walk test to assess the functional class. The level of cell free DNA was determined according to the method of P.P. Laktionova, S.N. Tamkovich, E.Yu. Rykova (2005). In the study group of patients, the causes of CHF development were analyzed, and the presence of a history of myocardial infarction and its duration were separately taken into account.
RESULTS: The study established the average level of cell free DNA for patients with CHF (273.5±25.26 ng/ml) and in the comparison group (53.7±3.5 ng/ml), which is a statistically significant difference (p=0,00). Analysis of the causes of chronic heart failure revealed a combination of coronary heart disease and arterial hypertension as the main etiological factor; the number of patients in the study group was 58%. A decrease in exercise tolerance, revealed during the 6 minute walk test, is accompanied by an increase in the level of cell free DNA in the blood, with a progressive increase in concentration from functional class I (141.9±26.3 ng/ml) to functional class III (447.7±51.7 ng/ml). Among patients suffering from coronary artery disease, a history of myocardial infarction leads to an increase in the level of free circulating DNA by almost 2 times compared with patients with a stable course of coronary heart disease. Also, the level of free circulating DNA depends on the duration of acute myocardial infarction, demonstrating a significant difference between the early (440.8±87.6 ng/ml) and late recovery period (225.5±46.5 ng/ml).
CONCLUSION: Significant differences in cell free DNA levels were revealed between the group of patients with CHF and the control group, which allows us to consider this marker as a potential diagnostic criterion for CHF
155-164
Clinical and neurological aspects of endocrine disorders in Down syndrome in children
Abstract
BACKGROUND: Down syndrome is a common genetic pathology in which multiple defects are observed, including endocrine disorders of varying severity. Hypothyroidism occupies a leading position among all hormonal disorders in such children. However, the significance of hypofunction of the thyroid gland in the development and progression of cerebral dysfunction in children with trisomy 21 has not been sufficiently studied.
AIM: Assessment of the impact of endocrine pathology in children with Down syndrome on the state of neurological functions.
MATERIALS AND METHODS: We examined 50 children aged 3–5 years with complete trisomy of chromosome 21. At the same time, the number of boys was 13 (32%), girls — 27 (68%). Children of the main group had verified endocrine disorders associated with Down syndrome. Children in the control group had a confirmed diagnosis of Down syndrome, but did not have endocrine pathology, and their number was 10 people — 8 girls (80%) and 2 boys (20). Everyone underwent speech therapy and neuropsychological examination. Children of the main and control groups, in addition to standard biochemical and general blood tests, underwent a detailed laboratory study with determination of T3, T4, TSH levels. An advisory examination and dynamic observation by a speech therapist for 6 months. All children were assessed by a neurologist according to generally accepted methods.
RESULTS: Data have been obtained indicating a fairly widespread prevalence of thyroid dysfunction among patients with Down syndrome. However, clinical symptoms may not be specific due to their similarity to the phenotypic manifestations of a genetic disease. Thus, patients with clinically significant hypothyroidism had more severe cognitive impairment. There was a significantly lower level of psycho-speech development in 95.3±3.1% of cases (p <0.001) according to the results of comprehensive neuropsychological and speech therapy examinations. In the group of children with severe hypothyroidism, significantly more severe disorders of mental functions were encountered. At the same time, as thyroxine was prescribed in age-appropriate dosages for 3 months, the child’s condition improved, mnestic functions and voluntary attention improved in 60% of patients in the main group. In 70% of cases, there was an improvement in the evacuation function of the gastrointestinal tract, in 65% there was a normalization of the humidity and temperature of the skin.
CONCLUSION: Timely diagnosis of thyroid gland dysfunction is an important preventive measure for genetic abnormalities associated with multiple comorbid pathologies, such as trisomy 21, Down syndrome. Timely correction of existing disorders can improve the quality of life of such children and their relatives and can contribute to their adequate socialization and adaptation in modern society.
165-172
The effect of sarcopenic obesity and age-related ophthalmopathology on the state of basic functional activity
Abstract
BACKGROUND: Along with an increase in the number of elderly and senile populations, there will simultaneously be an increase in the prevalence of age-associated ophthalmopathology and sarcopenic obesity, which can potentially contribute to a decrease in patients’ activities in everyday life, but the latter remains practically unexplored, and if analyzed, then without the use of special scales for patients with visual organ pathology or quality of life indicators.
AIM: To study the effect of sarcopenic obesity and age–associated ophthalmopathology on the activities of patients in everyday life.
MATERIALS AND METHODS: 125 mature and elderly patients suffering from sarcopenic obesity combined with cataract and 138 patients of similar age with sarcopenic obesity combined with glaucoma were examined. Sarcopenic obesity was detected by the presence of obesity with a body mass index ≥30,0 kg/m2 and sarcopenia on the scale of the European Working Group on Sarcopenia in older people, supplemented by carpal dynamometry.
RESULTS: It was found that, in comparison sarcopenic obesity with age-related cataracts, it has a more significant effect on changing activities in daily life, contributing to the formation of complete dependence on outside help (12,18 points) compared with sarcopenic obesity and glaucoma (10,18 points) (p <0,001), when moderate dependence on others was found. However, regardless of the nosology of the ophthalmic disease, in both clinical groups, the leading limitations of activities in daily life were needle threading (1,84±0,03 vs 1,52±0,02 points), nail clipping (1,75±0,03 vs 1,43±0,04 points), respectively.
CONCLUSIONS: The results obtained can be used in gerontology in the implementation of measures to correct and maintain functionality in the daily life of patients with sarcopenic obesity combined with glaucoma and cataracts.
173-180
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