HAD Scale Research Articles

Assessment of the level of anxiety-depressive disorders, quality of life, and therapy adherence in patients with plaque psoriasis

Relevance. The treatment of moderate and severe psoriasis poses significant challenges in clinical practice. This article is devoted to the analysis of real-world clinical practice in the treatment of plaque psoriasis, factors causing relapses of plaque psoriasis, the prevalence of anxiety and depressive disorders, and the assessment of the quality of life of patients with psoriasis using various systemic medications among patients who were observed in dermatovenereological dispensaries of the Central Federal District during the period 2022–2023.Objectives. To determine the optimal drug therapy for patients with plaque psoriasis based on comprehensive pharmacoepidemiological, clinical, compliance, and medication adherence assessments.Materials and methods. Retrospective comparative analysis of the medical records of 336 patients with plaque psoriasis (L40.0), moderate and severe. Two comparison groups: Group I — 166 patients receiving methotrexate and Group II — 170 patients receiving genetically engineered drugs. Patients were surveyed by physicians to confirm their therapy compliance. The levels of anxiety and depression were assessed using the HADS scale, and quality of life was assessed using the dermatological quality of life index — DLQI.Results. The highest rate of adherence to therapy (>80%) was recorded in the group of patients undergoing therapy with genetically engineered drugs and who had a high level of anxiety (r=0.202, p<0.05). In the group of patients with average adherence to the applied genetic engineering therapy (30–80%), a higher level of anxiety was associated with reduced adherence to treatment (r=–0.202, p<0.05). Average adherence to methotrexate (r =–0.249, p<0.05).Conclusions. An increased level of anxiety in patients undergoing therapy with genetically engineered drugs increased their adherence to treatment (r=0.202, p<0.05). The worse the quality of life of patients undergoing therapy with genetically engineered drugs, the less adherence.

Sensitivity of the hospital anxiety and depression scale HADS in stroke patients

Introduction. The validated Hospital Anxiety and Depression Scale HADS is recommended for screening symptoms of anxiety and depression in the routine practice of somatic doctors; it is also recommended by experts for use in rehabilitation medicine and frequently used in scientific research to assess the emotional state of stroke patients. At the same time, the literature provides various contradictory data on the sensitivity of this scale for stroke patients. Aim. To evaluate the detectability of emotional disorders in stroke patients using the HADS scale in comparison with the author’s computer program for studying the actual emotional state of the patient. Materials and methods. 60 stroke patients underwent inpatient rehabilitation in the National Medical Research Center for Rehabilitation and Balneology were randomly divided into 2 groups. 30 patients of Group 1 received a basic rehabilitation complex (aimed at correcting motor disorders); 30 patients of Group 2 received a basic rehabilitation complex in combination with a course of cognitive behavioral psychotherapy (CBT). To assess the emotional state at the beginning and at the end of rehabilitation, the HADS scale and the author’s computer program were used to study the actual emotional state of the patient. Statistical analysis was carried out using the Statistica-10 program. Results. The study groups were comparable in gender, age and clinical parameters. Initially, in patients of both groups, the median values of anxiety and depression on the HADS Scale corresponded to the norm, while the median values of the author’s methodology corresponded to a low level of comfort, the presence of fatigue, high levels of anxiety and depression. At the end of rehabilitation, according to the HADS Scale, significant positive dynamics was revealed in both groups, both for depression and anxiety (p 0.05), without significant intergroup differences. Whereas with the help of the author’s methodology, significant intergroup differences (p 0.05) were revealed, indicating a better positive dynamics of the emotional state in group 2, additionally receiving CBT. Conclusion. In comparison with the author’s program in stroke patients, the HADS scale is significantly less sensitive in the diagnosis of anxiety and depression, and does not reflect the established intergroup difference in the dynamics of emotional state after the use of the basic complex and its combination with CBT.

Quality of life and adaptation in older men and women with chronic cerebral ischemia

Objective. To study the quality of life and adaptation of elderly men and women with chronic cerebral ischemia.Materials and methods. The study included 65 patients (31 men and 34 women, mean age 81.6±1.1 years) diagnosed withchronic cerebral ischemia. The assessment of quality of life carried out by using the Russian version of the general questionnaire “SF-36 HEALTH STATUS SURVEY”. The level of asthenia studied using the MFI-20 questionnaire. Levels of anxiety and depression were determined using the HADS scale. Adaptive reactions studied in the leukocyte blood count by calculating the percentage of lymphocytes and segmented neutrophils.Results. The patients rated their quality of life low in all areas, including the areas of physical capabilities, psychological well-being and social activity. A high prevalence and varying degrees of severity of asthenia, anxiety and depressive disorders revealed in all patients, more pronounced in women. The formation of homeostatic blood reactions was observed, indicating a decrease in the level of adaptation.

The results of the assessment of burnout syndrome in outpatient clinic staff for the development of personalized rehabilitation

In conditions of increased workload on the medical staff of outpatient clinics, the need to preserve their physical and mental health, reduce the socially significant consequences of emotional burnout comes first, which makes it necessary to search for new directions of prevention, correction and rehabilitation using personalized medicine methods. The study aims to assess the state of health and the syndrome of emotional burnout in medical workers of the outpatient clinic. Specialists have examined 100 medical workers of outpatient and inpatient departments of the medical institution in equal numbers. The average age of outpatient medical staff was 49 [46;59] years, and inpatient — 43 [33;53] years. The average work experience of the examined medical personnel was the same both in outpatient settings (20 [16;28] years) and in hospital (20 [13;31] years). The authors have performed general clinical, laboratory and instrumental examinations. In addition to the standard examination scheme, the scientists assessed emotional burnout using the V.V. Boyko method and the quality of life according to the EQ-5D questionnaire in modification 3L and the hospital anxiety and depression scale HADS, and also conducted a questionnaire on a new coronavirus infection and the detection of post-COVID syndrome. As a result of the study, the authors proved a decrease in the psychological and physical components of the quality of life of medical workers, which are associated with both work experience and a new coronavirus infection. It was confirmed that according to the results of the Boyko questionnaire, employees of the outpatient clinic, compared with their colleagues from the hospital, often have a higher unfavorable total score. According to the results of the survey, we observe an improvement in the psychological and physical components of the quality of life of medical personnel after individual rehabilitation. This study showed the importance of assessing the state of health and emotional burnout syndrome in medical workers, high scores were revealed according to the Boyko questionnaire. Limitations. This study is limited to a sex-and-age sample of medical staff at a medical institution. Ethics. The study was conducted in accordance with the Helsinki Declaration "Recommendations for Doctors on Biomedical research in Humans" (2013), the World Association "Ethical Principles of Scientific Medical Research with Human Participation" as amended in 2000 and the "Rules of Clinical Practice in the Russian Federation", approved by Order of the Ministry of Health and Social Development of the Russian Federation No. 266 dated 06/19/2003, according to the developed protocol.

Stress-induced arterial hypertension: search for predictors

Background. Despite the existence of a clear cause-and-effect relationship between job strain and hypertension, there are still no clear criteria for defining stress-induced arterial hypertension (SIAH). Objective. Search for SIAH criteria, in particular predictors of hypertension in the workplace. Materials and methods. The study included volunteers experiencing stress in the workplace and not having hypertension. Before the start of the working day and at the end of the working day, the subject was surveyed, given questionnaires (Ch. D. Spielberg scale, Montgomery-Asberg MADRS scale, A. M. Vein scale, hospital anxiety and depression scale HADS), blood pressure and resting heart rate were measured, fasting blood was taken to determine the values of ACTH, TSH, T4, insulin, cortisol. All patients underwent ABPM on a working day and a day off. Results. According to ABPM (n=52), no signs of masked hypertension were detected, however, significant differences between workdays and weekends in the levels of maximum SBP and DBP during the daytime were noteworthy. In the group with maximum SBP>140 mm Hg during the daytime (SIAH, n = 34), on a workday there was an increase in the time index for SBP>30% (24 hours and day), characteristic of hypertension, and for DBP (24 hours and day), characteristic of borderline (possible) hypertension, the average DBP values during the day and at night were at the upper limit of the norm, which was significantly different from the Normotonic group (n = 19). On a weekday, the SIAH group also had significantly increased SBP (24 hours, day) and DBP (24 hours, day and night) indexes versus Normotonic. For all other indicators except ABPM, the groups were comparable. Conclusions. Taking into account the increase in the time index for SBP and DBP, it can be assumed that, against the background of stressful situations at the workplace, the subjects had short frequent increases in blood pressure, which have not yet led to a significant violation of self-regulation of blood pressure and the development of hypertension. An increase in the maximum values of systolic and/or diastolic blood pressure against the background of an increased time index on a working day are possible predictors of SIAH, in particular hypertension at the workplace.

ANXIETY, DEPRESSION, AND QUALITY OF LIFE OF NURSES WORKING IN PUBLIC HOSPITALS

Nursing is often described as the art of caring, providing holistic patient assistance without time restrictions. However, due to this nature of work, it is common for these professionals to present symptoms of mental illnesses such as anxiety and depression. This results in a reduction in the quality of life at work, directly affecting the efficiency of care provision. This study aimed to verify the presence of anxiety and depression symptoms, as well as the index of quality of life at work among nurses working in the inpatient sector of public hospitals in the city of Aracaju. Among the 128 professionals included in the sample, 46.1% presented anxiety symptoms and 30.5% depression symptoms, according to the HADS scale. Additionally, 66.4% of nurses reported an unsatisfactory quality of life at work index (QLWI). The majority of professionals who presented symptoms of both diseases were female; 17.2% had two employment bonds, and 19.5% reported an unsatisfactory QLWI. Therefore, it is possible to infer that the accumulation of employment bonds and the reduction in quality of life at work may have been determining factors for the development of these symptoms. It is concluded that it is extremely important to improve working conditions, safety, and remuneration, as well as increase the institutional appreciation and recognition of nursing professionals. This would contribute to raising the quality of life indices at work and reducing the need for multiple employment bonds.

Геронтологические особенности влияния новой коронавирусной инфекции на показатели интерлейкинового профиля, воспаления и эндогенной интоксикации у пациентов зрелого и пожилого возраста с ишемической болезнью сердца

Background: Coronary heart disease (CHD) is considered as an independent risk factor for COVID19, however, the indicators of inflammation and endogenous intoxication in patients with CHD 3-4 weeks after recovery from COVID-19 have not been the subject of scientific research. The aim of the study: Assessment of the gerontological features of the effect of the transferred new coronavirus infection on the indicators of the interleukin profile, inflammation and endogenous intoxication of mature and elderly patients with coronary heart disease in the early stages of recovery. Materials and methods: The study included 58 mature-age patients with coronary heart disease 3-4 weeks after recovery from COVID-19 of moderate severity, who made up the comparison group. The main group of patients was represented by 62 elderly people with coronary heart disease who had suffered a new coronavirus infection and were examined in the same way as the previous group, 3-4 weeks after recovery. The level of C-reactive protein and highly sensitive C-reactive protein in the blood was studied using the Nicomed-reader express analyzer, and antistreptolysin-O was studied using an immunoturbidimetric method on the Cobas 600 analyzer (Switzerland). The blood levels of bilirubin, urea, creatinine and sialic acids were studied using the ROKI biochemical analyzer. The content of systemic cytokines was determined by the Beckton Dickinson FACS Canto 2 (USA). The level of anxiety and depression was studied on the HADS scale. Results: 3-4 weeks after recovery from COVID-19, antistreptolysin-O levels ranged from 120.9 МЕ/ml to 208.1 МЕ/ml. Significant changes among the considered parameters of inflammation and endogenous intoxication in patients with coronary heart disease in old age during recovery from a new coronavirus infection were accompanied by a change in the content of highly sensitive C-reactive protein in peripheral blood. In the early stages of recovery after COVID-19, in elderly patients with coronary heart disease, the concentration of many studied cytokines in blood plasma remained elevated compared with those aged 45-59 years. The excess of reference values in both groups was found for IL-17, TNF-α and IFN-α, and among elderly patients – for IL-3, IL-4, IL-6, IL-7, IL-17. Conclusion: Antistreptolysin-O, highly sensitive C-reactive protein, C-reactive protein can be considered markers of recovery in patients with combined coronary heart disease in the early stages after a new coronavirus infection.

Anxiety-depressive disorders after COVID-19

The 2019 coronavirus (COVID-19) pandemic has reached more than 194 million people as of July 26, 2021, and continues to spread worldwide. During the course of the long pandemic, evidence of damage to various organs and systems, such as the nervous system and parts of it, began to emerge. Oxidative stress is one of the main causes of neuronal dysfunction and death, mainly due to excessive formation of reactive oxygen species and depletion of antioxidant reserves. Oxidative stress is characterized by an imbalance between the production of reactive oxygen species (ROS) and antioxidant defense mechanisms of the body. This process is involved in the onset and development of many neurological diseases. In this review, we analyzed and summarized the results of studies showing the association of neurological diseases, such as stroke, Parkinson's disease, and other neurological diseases, with excessive formation of oxidative stress products. This article aims to provide an overview of the relationship between oxidative stress and a range of neurological conditions, shedding light on the underlying mechanisms and potential therapeutic implications. Objective of the study was to determine the level of anxiety-depressive disorders among patients who underwent COVID-19. 90 people were examined and selected according to inclusion and exclusion criteria. To assess higher nervous functions, we used the hospital scales HADS I, HADS II, Beck depression scale. To date, our study has not found a clear link between the virus in the body and anxiety-depressive manifestations in patients, which may suggest that the main cause of the disorders lies in the social aspects of the pandemic.

Sexual function in patients with testicular neoplasm before specialized treatment methods. Clinical trial

Introduction. Testicular neoplasms (TN) are one of the most common oncological diseases among young men. Currently the sexual function of such patients remains understudied. The aim of the study was to assess the state of sexual function in men with testicular neoplasms before treatment.Material and methods. The cross-sectional continuous single-center study included 35 men with TN. The average age of patients was 34.2–8.2 years (95% CI: 31.4-37.1). The comparison group included 28 healthy volunteers, average age 30.5–4.9 years (95% CI: 28.6-32.4). Some social characteristics of the patient (marriage and children), the state of sexual function (using the IIEF-15 and ICF questionnaires), the level of anxiety and depression (according to the HADS scale), the levels of total and free testosterone, globulin-binding sex hormone (SHBG), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin were evaluated.Results. Patients in the main group showed a decrease in erection in 10 (28.6%), satisfaction with sexual intercourse in 12 (34.3%), impaired orgasmic function in 2 (5.7%), decreased libido and overall satisfaction in 9 (25.7%). Nonparametric analysis revealed a statistically significant decrease in libido (p < 0.05), satisfaction with sexual intercourse (p < 0.05) and overall satisfaction (p = 0.007) in patients of the main group compared with the control group. Patients with testicular neoplasms had disorders of the mental component – in 12 (34.3%), erection – in 20 (57.1%), neurohumoral – in 25 (71.4%), ejaculatory – in 10 (28.6%) patients. Subclinical depression was observed in 13 (37.1%) and clinically pronounced depression in 11 (31.4%) patients of the main group. Anxiety and depression were statistically significantly more common in the main group (p = 0.0013). The level of anxiety and depression was more pronounced in unmarried (p = 0.013) children-free patients (p = 0.025). Low levels of total testosterone were detected in 13 (39.4%), free testosterone in 12 (38.7%), LH in 11 (33.3%), FSH in 6 (18.7%) patients from the main group. Elevated levels of LH were recorded in 4 (12.1%), FSH in 4 (12.5%), prolactin in 2 (6.9%) and SHBG in 1 (5%).Conclusion. Patients with TN have a deterioration in sexual function compared to a healthy population of the same age group. The further studies are needed to access the influence of tumor histology and treatment of sexual function.

Post-Pandemic Evaluation: Impact of Covid-19 Pandemic on Medical Students’ Mental Health, Self-Esteem, Social Interactions, and Academic Progression in Malaysia

Covid-19 pandemic has brought drastic and unprecedented challenges to the medical education and medical students, affecting them physically, mentally and emotionally. While progressing through the post-pandemic recovery phase, it is crucial to comprehensively evaluate the pandemic’s consequences and tackle the underlying problems. To investigate the impact of Covid-19 pandemic on medical students’ mental health, social well-being, and academic progression. A cross-sectional study was carried out with voluntary sampling of students from both government and private medical schools in Malaysia. A self-administered online survey form containing three validated psychological tools was distributed (Hospital Anxiety and Depression Scale HADS, Rosenberg Self-esteem Scale, NIH Toolbox Social Relationship Scales). There were also questions regarding the challenges faced by medical students and their academic performance during Covid-19 pandemic. Scores of each questionnaire were tabulated, analyzed and interpreted according to their specific cut-points. Two hundred and thirteen responses were received. 89.2% (n = 190) were domestic students while 10.8% (n = 23) were international students. Out of 32 medical universities in Malaysia, the participants were from 19 of them (9 public and 10 private universities). About half of the participants had contracted Covid-19 infection during the study period (n = 124, 58.2%). Majority had chosen “Lack of on-campus learning and training session causing incompetency” as the most relevant impact of Covid-19 on their academic progression (n = 85, 39.9%). Above 90% of participants passed their Final Academic Assessment in 2020 (91.5%) and 2021 (93.9%). About half of them (n = 86, 40.4%) were having symptoms considerable of anxiety while only 19.2% (n = 41) were having symptoms considerable of depression. Majority had normal self-esteem (n = 177, 83.1%). For social relationship, around two-third of them had great social support and companionship. However, more than half had social distress. The median for the period of time having absolute online classes, absolute physical classes and hybrid classes were 18, 4, and 9 months, respectively. Having absolute online classes of >18 months was associated significantly with higher perceived hostility (16.49vs. 14.47, p = .012). In addition, being infected with Covid-19 was associated significantly with higher self-esteem (26.88vs. 25.85, p = .009). Large proportion of students were affected by Covid-19 pandemic. Absolute online classes has huge impact on emotions of medical students especially from the aspect of perceived hostility. Hence, implementation of online medical education during Covid-19 era requires modifications and improvements.

Transcranial electrical stimulation (TES) in patients with atopic dermatitis

BACKGROUND: Atopic dermatitis is the most common diseases in dermatology, among the main pathogenetic mechanisms of development of which a complex interaction of a genetically determined defect in the barrier function of the skin, an overactive state of the immune system is considered, and a neurogenic theory of disease development is not excluded, which is based on the relationship of anxiety-stress reactions and neuropsychiatric stresses with the occurrence of pathological changes on the skin. Modern atopic dermatitis therapy is characterized by the appointment of a large number of medications according to clinical recommendations, and the associated increase in allergic and toxic-allergic reactions dictates the need to search for new non-drug treatments for this disease. In order to prevent the pathological effects of stress, as well as to increase resistance to its damaging effects, activation of opioidergic mechanisms may be useful. AIM: To evaluate the effectiveness and acceptability of the transcranial electrical stimulation technique in patients with atopic dermatitis. MATERIALS AND METHODS: A controlled study was conducted among 60 patients with moderate atopic dermatitis, 33 women (55.0%) and 27 men (45.0%) aged 19 to 72 years. Transcranial electrical stimulation was carried out by a pulsed bipolar electrical stimulator with an acoustic effect "TRANSAIR-07", stimulation was carried out by an electric current with a frequency of 77.5 Hz and a duration of 3.5 ms. Patients underwent 10 procedures, 1 time a day, lasting 30 minutes, with a current of 1−3 mA. SCORAD, EASI, IGA, DLQI, HADS, and BDI scales were used to assess the dynamics of clinical manifestations. The assessment was carried out on the first and last day of treatment. RESULTS: During statistical data processing, when comparing the scales in the first and last days of the procedures, depending on the patient groups: the 1st group was the main one, received transcranial electrical stimulation treatment in combination with therapy, according to clinical recommendations, the 2nd group was the control group, received treatment according to clinical recommendations, without the use of transcranial electrical stimulation, significant improvement of itching indicators, clinical manifestations and improvement of quality of life after 4 weeks of therapy in both groups. A statistically more significant dynamics of the indicators of the main clinical scales in favor of combination therapy was established: according to the SCORAD scale ― in the main group from 47.50±2.25 to 21.00±1.00, in the control group from 47.00±2.00 to 39.00±1.75; DLQI ― in the main group from 8.00±2.00 to 2.00±0.75, in the control group ― from 8.50±1.50 to 5.00±1.00. CONCLUSION: The paper presents the positive results of our own research and presents data confirming the clinical effectiveness of transcranial electrostimulation in patients with atopic dermatitis compared with the traditional drug treatment of this disease, which allows us to recommend the treatment regimen we have proposed for widespread implementation in the practice of a dermatovenerologist.

Features of the impact of combat-related traumatic brain injury in the long-term period, depending on the severity and course of the injury on the cognitive sphere of patients

Background. The number of consequences of mine-explosive injuries, multiple gunshot and shrapnel wounds has increased significantly in the world of current events related to the conduct of full-scale military operations on the territory of Ukraine. In particular, cases of combat traumatic brain injury (TBI) have increased, which is becoming one of the most important problems. Purpose The purpose of the research was to study the characteristics of cognitive functions in patients with the consequences of a combat craniocerebral injury (bTBI) depending on the severity and catamnesis of the received injury. Materials and Methods. 350 patients Cognitive functions of 350 patients who suffered a combat traumatic brain injury (cTBI),was carried out using the Montreal scale of cognitive deficits (MoCA test). The assessment of neurological status was carried out by a routine method and NOS-TBI (Neurological Outcome Scale for Traumatic Brain Injury), the level of anxiety and depression was determined using the HADS scale. In addition, the state of cognitive functions was evaluated using a number of modern neuropsychological tests: the method of learning 10 words, which allowed to investigate memory processes (memorization, preservation and reproduction of information). Schulte’s tables were used to assess the pace of sensorimotor reactions, mental capacity, and the volume of active attention. Results. The results of the MoCA scale in patients with consequences of combat TBI of varying degrees of severity corresponded to mild cognitive decline: Mild cTBI 22.21 ± 0.29 points, cTBI (ST) 21.36 ± 0.33 points, Severe cTBI 21.32 ± 0.28 points. There was no statistically significant difference between MoCA values at different severity of combat TBI. A longer injury history had a negative effect on cognitive function in patients with Mild effects combat TBI and Severe combat TBI. Conclusions. As a result of the investigation, officials who contributed to the formation of cognitive deficits were identified: anxiety disorder (with mild effects combat TBI and severe combat TBI), anxiety-depressive state (with mild effects combat TBI with a follow-up period of up to 3 years and combat TBI (moderate) with follow-up). period more than 5 years), age (combat TBI (moderate) up to 7 years), neurological deficit (severe combat TBI, follow-up period in case of injury more than 5 years).

Characteristics of neurovegetative disorders in ischemic heart disease patients after coronavirus disease 2019 (COVID-19)

The aim of the study. To examine the frequency and spectrum of cognitive, anxiety-depressive, autonomic disorders and their interrelationship in patients with coronary heart disease (CHD) after COVID-19 infection. Materials and methods. The study involved 71 patients with CHD, stable angina pectoris FC II–III (age 69.0 [64.0; 76.0] years): group 1 (main) – 31 CHD patients after COVID-19; group 2 (comparison) – 40 CHD patients without COVID-19 history. Spectral and temporal HRV parameters were assessed using 24-hour Holter ECG monitoring, anxiety-depressive disorders (ADD) – using the HADS scale, cognitive status of patients – according to the MoCa scale. Results. CHD patients after COVID-19 had a higher frequency of ADD detection and a greater anxiety level (16 [10; 24] versus 10 [9; 13] points, p < 0.05), depression (14 [8; 20] versus 11 [10; 12] points, p < 0.05) as compared to patients without previous history of COVID-19. At the same time, the predominance of the anxiety component over the depressive one in patients of both groups has been revealed. In CHD patients after COVID-19, a decrease in the total MoCa scale score has been found as compared to patients without COVID-19: 24 [22; 26] versus 28 [26; 30] points, p < 0.05. There was an association between the total level of anxiety and depression and the severity of cognitive impairment (r = -0.36, p < 0.05). CHD patients exposed to COVID-19 showed an increased sympathetic and parasympathetic tone of the central nervous system within 24 hours, an increased LF/HF ratio during the active period, activation of slow-acting humoral regulation mechanisms amid increasing stress index and centralization index. In the group of patients with CHD after COVID-19, a wide range of correlations between the rate of ADD, cognitive disorders and HRV parameters has been found. Conclusions. Patients with coronary heart disease recovered from COVID-19 have shown an increase in the incidence and degree of ADD and cognitive disorder manifestations which was accompanied by autonomic dysfunction resulting in stress on the functional and adaptive state of the cardiovascular system. The association between ADD, autonomic and cognitive disorders in patients with coronary heart disease after COVID-19 has confirmed the common pathogenetic links of the disorders found.

Cultural adaptation and reproducibility of a dyspnea questionnaire in chronic obstructive pulmonary disease patients

Objective: To adapt to Brazilian culture and to evaluate the reproducibility of the dyspnea management questionnaire (DMQ-30) in patients with Chronic obstructive pulmonary disease patients. Methods: Cultural adaptation was carried out, where the first translated version passed through a committee of judges, including the author of the questionnaire and applied in eight patients. The new version went through retrograde translation and again by the commission for certification of no change in the original sense. The reproducibility consisted of two applications of the questionnaire with a 15-day interval by the same examiner in 50 Chronic obstructive pulmonary disease patients patients. We performed the correlation of the DMQ-30 questionnaire with the SF36, SGRQ and with HAD scale. To evaluate the reproducibility we used the intra-class correlation coefficient. For other correlations, we use the Pearson correlation coefficient. The significance level was established at 5%. Results: In the process of cultural adaptation the only altered term was "to play golf" for "to play pool". We found strong reproducibility of the total DMQ-30 (CCI 0.89), and in the dimensions: Dyspnea Intensity (CCI 0.82) Dyspnea anxiety (CCI 0.86), and Activity Avoidance (CCI 0.80). We observed moderate to strong correlation of SF36 with DMQ-30 (r = 0.72-0.40). We observed moderate to strong correlation of DMQ-30 with total SGRQ score (r = 0.69-0.41), and moderate correlation of DMQ-30 with HAD scale (r = 0.54). Conclusion: We were successful in the process of cultural adaptation with excellent reproducibility and good correlation with the SGRQ, SF36 and the HAD scale.

Clinical and economic analysis of the application of the method of three-dimensional reconstruction of lung tissue in the practice of tuberculosis institution

Background. The use of clinical and economic analysis in practical healthcare allows for a more rational use of the resources allocated by the state and contributes to the achievement of optimal indicators in terms of the quality of disease identification and the effectiveness of its treatment.
 Aim. To conduct a clinical and economic analysis of the prospects for introducing the 3D lung reconstruction method into tuberculosis practice, which is used to correct the level of adherence, reduce the severity of symptoms of anxiety and depression, and increase the effectiveness of chemotherapy.
 Materials and methods. In this scientific work, the results of treatment (more than 90 people) of newly diagnosed patients with destructive pulmonary tuberculosis, which were observed in the Nizhny Novgorod Regional Clinical Tuberculosis Dispensary, were used. The patients were divided into two groups. For the 1st group of patients, tactile lung models were made, among them a questionnaire was conducted using the MMAS-4 questionnaire and the HADS scale. For patients of the 2nd group, lung models were not made, and no survey was conducted. Each group was assessed the effectiveness of chemotherapy. Clinical and economic analysis of the cost of introducing the method of three-dimensional lung reconstruction into tuberculosis practice was carried out on the basis of two evaluation criteria «cost – effectiveness» and «cost-effectiveness increment» with additional mathematical calculations of the necessary indicators. The results obtained were compared with the existing known method of increasing adherence to tuberculosis treatment - the issuance of food packages.
 Results. Based on the results of the study, it was proved that the use of tactile models of the lungs in phthisiatric practice is more than 8 times cheaper than the method of issuing food kits with, in fact, comparable results of treatment effectiveness. If there is a need to increase the effectiveness of the treatment of tuberculosis patients by increasing the subsidy of food packages, the cost of one additional percent of efficiency is not economically viable.
 Conclusion. The clinical and economic analysis of the prospects for introducing the method of three-dimensional lung reconstruction into phthisiatric practice presented in the paper looks promising, which is confirmed by the performed mathematical calculations and comparisons, and can be recommended for use in the routine practice of phthisiatricians to correct the level of adherence of tuberculosis patients to chemotherapy, reduce the severity symptoms of anxiety and depression, as well as an increase in the effectiveness of treatment.

ASSOCIATION OF PROBLEMATIC USE OF SOCIAL NETWORKS WITH INDICATORS OF DEPRESSION ON THE HADS SCALE AMONG MEDICAL UNIVERSITY STUDENTS

The available literature data on the impact of social media on mental health are contradictory. Some studies report the benefits of using social media for mental health, including increased social support, strengthening connections and seeking help. In others, on the contrary, associations of problematic use of social networks with a number of psychosocial problems such as psychological stress, anxiety and depression have been identified. Purpose. To study the association of problematic use of social networks with indicators of depression on the HADS scale among medical university students. Materials and methods. 229 students of both sexes enrolled in the 3rd year of the medical faculty of the Medical University were examined. Problematic use of social networks was identified using the Russian-language version of the questionnaire «The Social Media Disorder Scale». The identification of depressive disorders and the assessment of severity were carried out using the Russian-language version of the hospital scale of anxiety and depression HADS. Results. It was found, that signs of depression were observed in 34,9% of the surveyed students and were statistically significantly more common among girls compared with boys. The frequency of problematic social media use among students with signs of depression was 36,4%. Among both the surveyed girls and boys the number of people with signs of depression in combination with problematic use of social networks was more than twice as high as in patients without problematic use of social networks. Conclusion. Associations of problematic use of social networks with indicators of depression on the HADS scale among students studying at a medical university have been revealed.

Evaluation of the effectiveness of the drug Cortexin in combination with the use of the application Aphasia.No (Afaziyam.Net) in the correction of speech disorders in patients with cerebral infarction

Assessing the effectiveness of using a complex that includes the use of the drug Cortexin and classes using the mobile application Aphasia.No (Afaziyam.Net) in working with speech disorders in patients with acute stroke. The study involved 71 patients aged from 40 to 85 years with diagnoses of the ONCM group (I63-I64), as well as complications aphasia, 50 of them consented to neuropsychological rehabilitation using the application Aphasia.No (Afaziyam.Net) and received the drug Cortexin as a peptide drug at a dose of 10 mg 2 times a day intramuscularly (IG). 21 patients made up the comparison group. To assess the effectiveness of the rehabilitation complex, the following psychodiagnostic methods were used: MoCA, MMSE, a set of tasks for the study of speech, writing, reading, and the HADS scale. The average score based on the results of a comprehensive study of speech, writing and reading in the group on day 2 in the hospital was: speech - 141.8±21.6 (normal - 262 points); writing - 20.5±4.23 (normal - 44 points); reading - 14.5±1.87 (normal - 29 points) points. An examination before discharge in IG showed the following results: speech - 214.3±15.9; writing - 31.5±4.5; reading - 24.4±4.7 points. The differences compared to the baseline and the 2nd group were statistically significant. The complex treatment used in the work can be recommended as an effective tool in working with speech disorders in patients with acute stroke. In addition, the program has a positive effect on the psycho-emotional state.

Results of a cohort single-center randomized study of the modulating effect of the drug Mexidol in the rehabilitation of patients who suffered acute cerebral insufficiency

Evaluation of the effect of pharmacological modulation of the rehabilitation process with the drug mexidol as an adjuvant component of the rehabilitation treatment of cognitive-emotional disorders in patients who have suffered acute cerebral insufficiency (ACI) due to acute cerebrovascular accident or traumatic brain injury. The study was conducted as a randomized interventional prospective study and consisted of 5 visits. Patients were divided into 2 groups: main (n=30, standard therapy + Mexidol IV 500 mg per day for 10 days, followed by Mexidol FORTE 250 orally, 1 tablet 3 times a day for 8 weeks) and control (n=30, standard therapy for 66 days). The study randomized 60 patients who underwent ACN and received rehabilitation treatment in accordance with regional routing. In the main group, there was an improvement in cognitive functions comparable to the control group (p<0.001, in both groups there was an improvement in the Schulte test «work efficiency» and «total execution time», according to the MoCA scale (visit 5 - 23.8±2.6 vs 22.9±31, p=0.227). A significant superiority of the main group over the control group was shown in such indicators as a decrease in anxiety (according to the HADS scale) (visit 4 - 2.6±2.4 vs 4.4±2.4, p=0.004), a decrease in the severity of depression (according to the Beck scale) (visit 3 - 7.5±4.5 vs 11.4±5.6, p=0.005). There was a tendency for the main group to be superior in terms of muscle strength (according to the MRC scale (visit 4 - 3.3±5.1 vs 2.1±2.2, p=0.051), level of vital activity (according to the ShRM - visit 5 - 2.9±0.7 vs 3.3±0.6, p=0.053). A statistically significant increase in the level of mobility of patients in the group using the drug Mexidol was proven compared to the control group (the difference in the Rivermead index at the 5th visit was 10.3±2.8 and 8.0±2.8, respectively, p=0.006), the average increase in the Rivermead index by visit 5 (5.4±2.1 vs 3.4±1.6, p<0.001). A decrease in intensive care aftereffects syndrome (ITS) scores was detected in both groups; a statistically significant decrease in the severity of ITS in relation to the previous visit was detected only in the group using the drug Mexidol (p<0.001). In the main group, the best indicators of the dynamics of systolic cerebral blood flow velocity and overshoot coefficient were also determined, compared to the control group. There were no adverse events recorded in the study. A positive modulating effect of Mexidol has been demonstrated in terms of accelerating the restoration of tolerance to cognitive loads, improving the psycho-emotional background by reducing symptoms of anxiety and depression, and secondary improving the results of motor rehabilitation in the early recovery period in patients who have undergone ACI, including those with manifestations of PIT syndrome. During the study, no adverse events were recorded, as well as significant differences in vital functions in the study groups, which indicates comparable safety of therapy in the control and main groups.

Состояние сексуальной функции у пациентов с новообразованием яичка до проведения специализированных методов лечения. Клиническое исследование

Introduction. Testicular neoplasms (TN) are one of the most common oncological diseases among young men. Currently the sexual function of such patients remains understudied. The aim of the study was to assess the state of sexual function in men with testicular neoplasms before treatment. Material and methods. The cross-sectional continuous single-center study included 35 men with TN. The average age of patients was 34.2–8.2 years (95% CI: 31.4-37.1). The comparison group included 28 healthy volunteers, average age 30.5–4.9 years (95% CI: 28.6-32.4). Some social characteristics of the patient (marriage and children), the state of sexual function (using the IIEF-15 and ICF questionnaires), the level of anxiety and depression (according to the HADS scale), the levels of total and free testosterone, globulin-binding sex hormone (SHBG), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin were evaluated. Results. Patients in the main group showed a decrease in erection in 10 (28.6%), satisfaction with sexual intercourse in 12 (34.3%), impaired orgasmic function in 2 (5.7%), decreased libido and overall satisfaction in 9 (25.7%). Nonparametric analysis revealed a statistically significant decrease in libido (p &lt; 0.05), satisfaction with sexual intercourse (p &lt; 0.05) and overall satisfaction (p = 0.007) in patients of the main group compared with the control group. Patients with testicular neoplasms had disorders of the mental component – in 12 (34.3%), erection – in 20 (57.1%), neurohumoral – in 25 (71.4%), ejaculatory – in 10 (28.6%) patients. Subclinical depression was observed in 13 (37.1%) and clinically pronounced depression in 11 (31.4%) patients of the main group. Anxiety and depression were statistically significantly more common in the main group (p = 0.0013). The level of anxiety and depression was more pronounced in unmarried (p = 0.013) children-free patients (p = 0.025). Low levels of total testosterone were detected in 13 (39.4%), free testosterone in 12 (38.7%), LH in 11 (33.3%), FSH in 6 (18.7%) patients from the main group. Elevated levels of LH were recorded in 4 (12.1%), FSH in 4 (12.5%), prolactin in 2 (6.9%) and SHBG in 1 (5%).

Neurometabolic therapy of mild cognitive impairment in patients with chronic cerebral ischemia

To evaluate the effect of a sequential therapy regimen with Mexidol (500 mg injections intravenously for 14 days) and Mexidol FORTE 250 (250 mg tablets 3 times a day for 60 days) on higher cortical functions in patients with moderate cognitive disorders in chronic cerebral ischemia. A comparative, prospective study included 63 patients with chronic cerebral ischemia with moderate cognitive impairment. All patients received basic therapy aimed at reducing risk factors (antihypertensive, antithrombotic drugs as indicated). Patients of the main group (30 people: 12 men, 18 women) received Mexidol intravenously 500 mg in 100 ml of 0.9% NaCl solution once a day for 14 days, then Mexidol FORTE 250 (film-coated tablets) 250 mg 3 times a day for the next 60 days. The comparison group consisted of 33 patients (14 men, 19 women) who received only basic therapy. The groups were comparable in terms of age, sex characteristics and severity of cognitive deficit. We examined cognitive status (MoCA scale, Frontal Dysfunction Battery, 10 Word Memorization tests), severity of asthenia (MFI-20 scale), anxiety and depression (HADS scale), patient's subjective assessment of the dynamics of the condition (CGI-improvement scale) in 1st, 14th and 74th±5 days of observation. On days 1 and 74±5 of observation, patients were examined using transcranial magnetic stimulation to study the neuronal activity of the cerebral cortex. In the main group, at the time of completion of taking Mexidol and Mexidol FORTE 250, a pronounced cognitive regression was noted (MoCA scale +3 points, difference with the comparison group 1 point (p<0.0001); Frontal Dysfunction Battery test +4 points, difference with comparison group 2 points (p<0.001); memory test «10 words» +2 points, difference with the comparison group 1 point (p<0.05), emotional (HADS anxiety scale -8 points, difference with the comparison group 3 points (p<0.001), depression -3.5 points, difference with the comparison group 1.5 points (p<0.01), asthenic disorders (MFI-20 scale -30 points, difference with the comparison group 15.5 points (p<0.01), improvement in the well-being of patients (CGI-improvement scale -2 points, difference with the comparison group 1 point (p<0.0001). According to the transcranial magnetic stimulation performed, a statistically significant decrease in the central motor conduction time at the level of 1 and 2 motor neurons of the pyramidal tract bilaterally from the start to the end of therapy with Mexidol and Mexidol FORTE 250 was determined (p<0.01). An inverse correlation was found between the time of central motor conduction and the results of the Frontal Dysfunction Battery test at the same time points with left-sided localization of 1 motor neuron (p<0.01). The results of a study of the use of sequential therapy with Mexidol 500 mg IV drip 1 time per day for 14 days followed by oral administration of Mexidol FORTE 250 1 tablet 3 times a day for 60 days indicate its clinical effectiveness and safety in patients with chronic cerebral ischemia with mild cognitive impairment, and also confirm its importance for preventing the progression of cognitive disorders.