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Vol 24, No 4 (2021)
- Year: 2021
- Articles: 6
- URL: https://rjmseer.com/1560-9537/issue/view/5381
- DOI: https://doi.org/10.17816/MSER.244
Original study articles
Neurological disorders and аbilitation with transcranial micropolarization in children with Down syndrome
Abstract
BACKGROUND: Down syndrome is common, insufficiently well-studied genetic pathology, which leads to early disability of the children’s population. In this pathology leads neurological disorders of different severity. Currently, the methods of correction of the existing cerebral deficit in such children are actively being developed. Correction of mental function help to socialize children with Down syndrome.
AIMS: to study the effectiveness of transcranial micropolarization in the complex therapy of neurological disorders in children with Down syndrome.
MATERIALS AND METHODS: Ability using the transcranial micropolarization method by N.Yu. Kozhushko allows reliably to improve the existing cerebral dysfunction in the Down syndrome.
RESULTS: According to the results of testing on a 10-point scale for assessing speech function, 6 months after the procedures, there was a significant improvement in the indicators of expressive and impressive speech, speech attention, as well as positive dynamics in the formation and improvement of neatness skills. Undesirable effects were noted in isolated cases and were manifested by a short-term sleep disturbance or arousal after a session of transcranial micropolarization.
CONCLUSIONS: The method of transcranial micropolarization adapted by N.Yu. Kozhushko, can be recommended for complex habilitation for patients with Down syndrome. Timely corrected neurological symptoms can improve the quality of life of such children and their families, and contribute to their timely adaptation in society.
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Adherence to the main prognosis-modifying drugs and the control of risk factors for coronary artery disease in patients after coronary stenting
Abstract
BACKGROUND: Adherence to drug therapy in patients with coronary artery disease is quite low nowadays, both in patients with myocardial infarction and in patients with chronic forms of coronary artery disease.
AIMS: of our work was to assess adherence to drug therapy (aspirin and statins) and control of risk factors for coronary artery disease in patients undergoing coronary stenting 12 months after endovascular treatment.
MATERIALS AND METHODS: The study included 279 patients, of whom 3 groups were formed. Patients of group 1 (n=96) personally visited the National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, adherence to the prescribed therapy and its effectiveness were assessed during the examination by a cardiologist, and if necessary, it was corrected. Patients of group 2 (n=95) contacted the study coordinator remotely. Patients of group 3 (n=88) were monitored by a general practitioner and visited a cardiologist at the National Medical Research Center of Cardiology according to the decision of the general practitioner.
RESULTS: At baseline, adherence to therapy in all groups was low and did not differ significantly between groups. 12 months after stenting, groups 1 and 2 showed a significant increase in the number of highly adherent individuals (from 17 to 33 and from 13 to 42, respectively, p <0.05), as well as a significant decrease in the number of individuals with low adherence to treatment (from 63 to 42 and from 67 to 36, respectively, p <0.05). The adherence to antiplatelet drugs was higher than to statins: 57.9% of people reduced the dose or stopped taking statins. After the follow-up time, there was a significant decrease in systolic blood pressure in groups 1 and 2 and a significant decrease in diastolic blood pressure in group 2. In group 2, a significant decrease in the number of smokers was noted: from 46.3 to 31.6% of the total number of patients in the group (p <0.05).
CONCLUSION: Active monitoring of patients by a cardiologist both during the visit and remotely contributes to an increase in adherence to drug therapy and improves control of risk factors for coronary artery disease.
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Quantitative characterization of persistent disorders of blood and immune system functions using a score in patients with HIV infection for reflection in the International Classification of Functioning, Disability and Health
Abstract
BACKGROUND: There is a need to optimizethe continuity between the various organizations involved in the rehabilitation of the sick and disabled. The application of the International Classification of Functioning, Disabilities and Health will allow overcoming the existing barriers of interdepartmental interaction.
AIMS: to create a scoring system for persistent disorders of the blood and immune system as determinants of ICF in patients with HIV infection.
MATERIALS AND METHODS: A random sampling method was used to perform a retrospective analysis of 100 protocols for conducting a medical and social examination of citizens with HIV infection and AIDS. The average age of those surveyed was 39 years. Men predominated (64%). The first group of disability is set at 21%, the second ― 45%, the third group ― 25%.
RESULTS: The most significant persistent disorders of body functions in patients with HIV infection were identified in the immune system (p ≤0.01).
CONCLUSIONS: The relationship between the severity of persistent disorders of the immune system and the disability group was revealed: among the disabled of the first and second groups, severe and extremely severe problems were statistically significantly more common (p ≤0.01), which confirms the possibility and necessity of using the international classification of functioning in people with HIV infection/AIDS in the form of a scoring as a way to reflect the quantitative characteristics of persistent disorders of the blood and immune system, including in disabled people.
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Treatment of pain syndrome after total hip arthroplasty associated with femora nerve entrapment
Abstract
BACKGROUND: The problem of pain syndrome after total hip replacement remains unresolved, including 3.5% of all revision interventions performed for pain of unclear etiology.
AIMS: to study the clinical picture of the pain syndrome that occurs after total hip replacement that is not associated with mechanical and septic instability of the components of the endoprosthesis; to develop methods for correcting the pain syndrome.
MATERIALS AND METHODS: The examination was carried out by patients (n=23) with complaints of pain in the groin and on the anterior surface of the thigh, who had a history of primary total hip replacement performed ≥3 months ago. The circumference of the hip was measured for the patients, and a visual assessment of the pose in an upright position was carried out. Stimulation electroneuromyography of the conductive function of the motor fibers of the femoral nerve was performed on both sides at the level of the inguinal ligament, the parameters of terminal latency (L, ms) and the amplitude of the M-response (A, mV) were evaluated. Needle electroneuromyography of the iliac muscle was performed in order to diagnose its pathological shortening before the start of treatment and 6 months after its completion. A complex of rehabilitation measures has been developed, including therapeutic blockade of the femoral nerve, physiotherapy treatment and individual physical therapy classes. Treatment results were evaluated using a visual analog scale (VAS), Oswestry and DN4 questionnaires before and after therapy.
RESULTS: Pathological changes of the femoral nerve from the operated joint were revealed in 23 (100%) patients. Needle electroneuromyography data indicated pathological shortening of the ilio-lumbar muscle in 19 (82%) of them. The quality of life according to Oswestry is 49.34±15.63%, the level of pain syndrome according to VAS is on average 8.00±1.50 points, the average DN4 score is 4.35±1.58. The length of the hip circumference was 2.20±0.65 cm in favor of a healthy lower limb. When performing a femoral nerve blockade at the level of the inguinal ligament, the level of pain syndrome 5–10 minutes after administration of the drug was, according to VAS, 1.42±1.01 points. After 1 month from the start of rehabilitation treatment , the results of the survey are as follows: VAS 0.91±1.12 points, DN4 1.0±1.50 points, Oswestry 16.78±5.79%. The difference in the length of the hip circumference averaged 1.56±0.55 cm in favor of a healthy limb. The results of stimulation electroneuromyography after 6 months against the background of ongoing rehabilitation treatment showed an increase in the amplitude of the muscle response from total hip replacement by an average of 0.76 mV; according to needle electroneuromyography, normalization of the tone of the ilio-lumbar muscle on both sides was demonstrated.
CONCLUSIONS: In patients in the postoperative period of total hip replacement, pain syndrome is associated with the formation of compression-ischemic neuropathy of the femoral nerve from the side of the operated joint, which is due to a decrease in the tone of the rectus femoris muscle and a stable pathological tone of the ilio-lumbar muscle on the operated side. Comprehensive restorative treatment aimed at eliminating perineural inflammation, the release of pathologically shortened muscles, as well as muscle retraining, give a positive result in the rehabilitation of patients with pain syndrome in the late postoperative period of total hip replacement.
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Diseases of the circulatory system as a cause of repeated disability of the adult population
Abstract
BACKGROUND: The article presents the nosological structure of repeated disability of the adult population of Moscow due to diseases of the circulatory system.
AIMS: The study of the nosological structure of repeated disability of the adult population of Moscow due to a class of diseases of the circulatory system.
MATERIALS AND METHODS: The object of the study was “Information on the medical and social examination of persons aged 18 years and older” (form 7-social security, 2013–2019). Research methods: documentary, data copy, statistical and graphic.
RESULTS: It was found that in the nosological structure of disability the first ranking place was taken by persons who were repeated recognized as disabled due to cerebrovascular diseases, the second ― due to coronary heart disease, the third ― due to “Other diseases of the circulatory system”. In the age-sex structure of repeated disability men repeated recognized as disabled and elderly repeated recognized as disabled prevailed. Limitations of various types of life activity of the third degree predominantly took place among repeated recognized as disabled due to cerebrovascular diseases. The prevailing group of disability was III group.
CONCLUSIONS: The results of the analysis of the features of the nosological structure of repeated disability due to diseases of the circulatory system by age, gender and severity are the scientific and practical basis for planning and effective implementation of medical and social rehabilitation of disabled people
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Short communications
Using the provisions of the International Classification of Functioning in the assessment of disability in people with HIV infection aged 18 years and older
Abstract
To date in Russia continues the spread of HIV/AIDS. At the stage of secondary lesions in HIV infection, the patient has persistent violations of the functions of various organs and systems of the body, which reduce the quality of life, lead to a restriction of human life, which requires assistance from society and the state. The Russian Federation has established a system of economic, legal, and social measures to support disabled people, as well as all citizens with HIV infection. The establishment of a disability group, its causes, timing, time of onset, and the needs of a disabled person in various types of social assistance is assigned to federal institutions of medical and social expertise.
A retrospective analysis of 100 protocols of medical and social examination of citizens with HIV infection was carried out by random sampling/AIDS in federal state institutions of medical and social expertise of St. Petersburg and other regions of Russia in the period from 2017 to 2020. The purpose of our study was the possibility of including the provisions of the International Classification of Functioning, disability and Health in the assessment of categories of disability in people with HIV-AIDS. The frequency and severity of disability, designated in the form of domains of the international classification of functioning “Activity and participation” in the group of patients under consideration, were studied, while the most striking or generalizing domain was taken from each section, characterizing the restriction of each category of vital activity established in a disabled person with HIV infection (d599 unspecified Self-care; d450 Walking; d230 Daily routine; d350 Conversation; d710 Basic interpersonal interactions; d859 Work and Employment, other specified and unspecified).
According to the results obtained, the most common functional disorders lead to restrictions in daily activity (self-care and everyday life) and in the main areas of life (education, work and employment). Violations of physical and cognitive functions as the process progresses have a significant impact on the ability to work of AIDS patients, limiting their choice of occupations and leading to termination of employment.
The International Classification of Functioning, Disability and health is a convenient tool that reflects the level of functioning of an individual at various stages of the disease.
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