Improvement In General Well-being Research Articles

Are Virtual Complementary and Integrative Therapies as Effective as In-Person Therapies? Examining Patient-Reported Outcomes Among Veterans with Chronic Musculoskeletal Pain.

Background: Virtual complementary and integrative health (CIH) therapy availability increased during the COVID-19 pandemic, but little is known about effectiveness. We examined the perceived effectiveness of in-person and virtual CIH therapies for patients with chronic musculoskeletal pain who recently started using CIH therapies. Methods: The sample included Veterans (n = 1,091) with chronic musculoskeletal pain, identified in the Veterans Health Administration's electronic health record based on initiation of CIH therapy use, who responded to VA's Patient Complementary and Integrative Health Therapy Experience Survey during March, 2021, to August, 2022. Using multivariable models with self-guided virtual (apps or videos) delivery as the reference, we compared patient-reported outcomes (pain, mental health, fatigue, and general well-being) associated with any yoga, Tai Chi/Qigong, or meditation use delivered: (1) only in-person, (2) only virtually with a live provider, (3) only virtually self-guided, (4) virtually self-guided + virtually provider-guided, or (5) hybrid in-person + virtual (self-or provider-guided). Results: Under 10% of Veterans reported only in-person use; 54% used only virtual formats and 36% a hybrid of in-person and virtual. Forty-one percent reported improvement in general well-being, 40.6% in mental health, 37.1% in pain, and 22.7% in fatigue. Compared with Veterans using only self-guided virtual CIH therapies, Veterans using only in-person therapies were more likely to report improvement in fatigue (odds ratio [OR]: 1.8, confidence interval [CI]: 1.1-3.1) and general well-being (OR: 1.7, CI: 1.0-2.6). Conclusions: Many patients perceived health improvements from CIH therapies, with in-person users reporting more improvement in fatigue and well-being than those using virtual sessions and similar improvements in pain and mental health for in-person and hybrid users.

Food-Related Quality of Life in Inflammatory Bowel Disease: Translation and Validation of Food-Related Quality of Life to the Portuguese Language (FR-QoL-29-Portuguese)

Introduction: Food-related quality of life (FR-QoL) has been shown to be an important patient-reported outcome in inflammatory bowel disease (IBD). We aimed to translate and validate a Portuguese version of the FR-QoL-29. Methods: This was a case-control cross-sectional study undertaken at a tertiary hospital. After obtaining the original authors’ authorization, both forward and backward translations of the original FR-QoL-29 were performed by bilingual researchers. After an IBD expert’s revision and the input of a small group of patients, a final version was obtained. Portuguese IBD patients were prospectively recruited from the outpatient clinic of a tertiary hospital and completed the questionnaire at two timepoints (0 and 4 weeks). Reliability (internal consistency, test-retest, and intraclass correlation [ICC]), validity (content and convergent validity, and hypothesis testing using Spearman’s correlations), and responsiveness (Student t tests) were analysed. Results: 239 patients (mean age 50.1 [SD = 15.3 years], 56.5% female) and 87 (36.4%) patients answered the questionnaire at the first and second timepoints, respectively; 126 controls answered the questionnaire. Overall, the FR-QoL-29-Portuguese showed excellent internal consistency (Cronbach’s α = 0.97) and good test-retest reliability (ICC = 0.78 [95% CI: 0.64–0.85]). FR-QoL moderately correlated with health-related quality of life, measured by the SIBDQ-PT (R = 0.49; p < 0.05). Lastly, the questionnaire revealed appropriate responsiveness when patients reported an overall improvement in general well-being (mean improvement 25.88 [SD = 32.50]; p < 0.05). Discussion/Conclusions: We present an adaptation and validation of the FR-QoL-29 tool for Portuguese IBD patients. The FR-QoL-29-Portuguese is a reliable and valid tool shown to be responsive to changes in general well-being.

Fatigue and sleep quality improvement through complete decongestive therapy in postmastectomy lymphedema: An investigative analysis

ObjectiveTo evaluate the effects of complete decongestive therapy (CDT) on cancer-related fatigue, sleep quality, and lymphedema-specific quality of life using validated and reliable questionnaires in cancer patients being commendable.Material and methodsThis prospective study includes 94 patients who had postmastectomy lymphedema syndrome. The demographic characteristics of the patients were recorded. The participants’ stages of lymphedema (The International Society of Lymphology), Hirai Cancer Fatigue Scale (HCFS) score, Pittsburgh Sleep Quality Index (PSQI) Global score, lymphedema-specific quality of life questionnaire (LYMQOL-ARM) score, and Global health status were recorded before and after CDT.ResultsThe mean age of the patients was 58.49 ± 10.96 years. Strong correlations were found between the severity of edema and global health status. There was a significant positive relationship between the HCFS score, PSQI Global score, LYMQOL-ARM score, and CDT. After decongestive physiotherapy, the majority of the lymphedema stages were downstaging (p < 0.05), respectively. There was also a trend toward improvement in general well-being (p < 0.05).ConclusionCancer-related fatigue and sleep disturbance can persist for years after surgery in women with breast cancer. This can negatively affect the patient physically, socially and cognitively. Our study, which is the first study to investigate the HCFS score in postmastectomy patients and the relationship between PSQI Global score and CDT. The findings identify the risk factors that affect these outcomes in women with lymphedema and can provide valuable insights for targeted interventions and improved patient care.

New horizons in comprehensive rehabilitation of melanoma patients: improved outcomes through an integrated approach to immunotherapy

Abstract. The article discusses the importance of a comprehensive rehabilitation approach for melanoma patients when treated with immunotherapy. By focusing on innovative treatments, the study highlights the need to integrate nutritional support, physical therapy, magnetic therapy, and psychological support to improve quality of life and enhance the effectiveness of immunotherapy regimens. Purpose of the study: to evaluate the impact of the multidisciplinary rehabilitation program on physiological functions, psycho-emotional well-being, general antitumor effect, and quality of life of patients with melanoma. Materials and methods. The study included 135 patients diagnosed with melanoma who received a course of immunotherapy. In the study group (the main group), a complex of rehabilitation techniques (magnetic therapy, therapeutic exercises, nutritional support, psychological support) was used, while in the control group, the patients did not undergo the accompanying comprehensive rehabilitation program. Treatment effectiveness was assessed in accordance with iRECIST 1.1 criteria; to assess the quality of life, the Russian version of the EORTC QLQ-C30 questionnaire was used. Results. The patients of the study group showed an improvement in their general physical condition and a decrease in the intensity of some side effects of treatment. The patients in the control group also showed changes in their health status, but they were less pronounced compared to the study group. Adverse events during treatment occurred in 55 % of the patients in the study group and in 74 % of the patients in the control group. The patients in the study group noted an improvement in quality of life by 25 %, while in the patients in the control group this indicator was 12 %. An 18 % improvement in general condition was noted by the patients in the study group, while the patients in the control group noted an 8 % improvement in general well-being. Conclusion. The implementation of the multidisciplinary rehabilitation approach, including nutritional support, therapeutic exercises, magnetic therapy, and psychological support, demonstrates significant improvements in symptom management and quality of life in melanoma patients undergoing immunotherapy.

ALGORITHM OF SECONDARY PREVENTION OF KIDNEY DISEASES AND URINARY TRACT IN OUTPATIENT CLINICS

Aim effectiveness evaluation of the medical staff actions algorithm an outpatient polyclinic institution during the secondary prevention of kidney and urinary tract diseases.&#x0D; Material and methods. This article presents an assessment of the effectiveness of the algorithm developed on the basis of a previously conducted medical and social study, which consists in conducting secondary prevention of exacerbations of the urinary system by prescribing drinking mineral water, diet, physical activity and a protective regimen under the remote control of medical workers with the determination of indicators of the quality of life of patients (on the Wisconsin Questionnaire). The developed algorithm represents the sequence of actions of medical personnel during remote monitoring of patients with pyelonephritis, urolithiasis, urethritis and cystitis. To assess the effectiveness of the proposed algorithm, a survey was conducted among outpatient clinic doctors with more than 10 years of experience using a specially developed questionnaire (score from 1 to 10). To assess the consistency of doctors' opinions, the concordance coefficient was calculated; a high degree of agreement between doctors' opinions in assessing the main indicators was considered at the value of the Kendal W coefficient 0.7. To assess the significance of the obtained concordance coefficient, the 2 criterion was calculated at a significance level of 0.05.&#x0D; Results. An analysis of the answers of doctors showed that this algorithm can be used as an alternative to sanatorium treatment for the prevention of exacerbations of diseases of the urinary system.&#x0D; Conclusions. The study of the possibility of using medical and organizational measures for the secondary prevention of exacerbations of diseases of the kidneys and urinary tract, presented in the algorithm, makes it possible to achieve an improvement in general well-being in patients under dispensary observation. Algorithm received a positive assessment from doctors of outpatient clinics.

Рухова активність дітей з особливими освітніми потребами у процесі змішаного навчання: стан та тенденції

Ensuring the proper level of motor activity in conditions of mixed education of children with special educational problems has become especially relevant in terms of their health care. The purpose of the article is to identify the advantages and disadvantages of mixed learning in ensuring the appropriate level of motor activity for children with special educational problems. Material and methods. At the theoretical level, general scientific methods were used: theoretical analysis, systematization, comparison of different views on the investigated problem, generalization of data from scientific and methodological, and special literature. At the empirical level, the method of a descriptive inclusive survey implemented in an online format was used. The results. It was found that before the introduction of the quarantine, the level of motor activity of children with special educational problems, which reached 90 % of the norm, was ensured during classes by inclusive physical education. During the quarantine, a significant deterioration in the motor activity of children with special educational problems was investigated. At this stage, an increase in the level of motor activity in extracurricular time has been established based on the recommendations received in classes on inclusive physical education in the conditions of mixed education, which was introduced in connection with martial law. These results are conclusions from the answers of 87.7 % of respondents, who at the same time noted that the level of daily physical activity did not decrease in the conditions of mixed training (100 % of respondents). 89.2 % of respondents noticed an improvement in general well-being based on increased forms of motor activity. Conclusions. The advantages and disadvantages of the organization of mixed education in ensuring the appropriate level of motor activity of children with special educational problems are revealed. Among the advantages, the following are highlighted: providing effective feedback, promoting the implementation of a differentiated individual approach, the ability to motivate to carry out independent motor activity, a positive effect on the emotional sphere, and expanding the opportunities for children with special educational problems to receive information. As for the shortcomings, the most important are the shortcomings of a technical nature, Internet failures, and the low level of methodical materials that would contribute to increasing the share of independent motor activity of children with special educational problems, lack of communication and interaction with classmates.

Controlled hypoxia-hyperoxytherapy as a component of a targeted approach in the rehabilitation of patients with multimorbidity: a single-center, randomized, placebo-controlled, prospective study

BACKGROUND: Multimorbidity is one of the most important public health problems, leading not only to a deterioration in the functional abilities of an individual, but also to an increase in the disability of the population, which determines the need to use effective measures in the treatment and rehabilitation of patients with multimorbid pathology.&#x0D; AIM: The aim of this study was to evaluate the effect of a two-week medical rehabilitation program including the respiratory therapy method based on short-term intermittent exposure to hypoxia and hyperoxia on the dynamics of hypoxia-inducible factor-1 (HIF-1) and C-reactive protein in patients with multiple chronic diseases. The novelty of this study is due to the peculiarities of the study group — patients with multimorbid pathology.&#x0D; MATERIALS AND METHODS: A single-center, randomized, placebo-controlled, prospective study (NCT05053672, ClinicalTrials.gov) included 42 patients aged 43 to 68 years with multimorbid pathology: generalized osteoarthritis — 61.9%, knee OA — 21.4%, hip OA — 16.7%, controlled arterial hypertension stage I–II — 90.5%, post-Covid syndrome — 100%. Patients were randomized into 2 groups by the method of numbered identical containers. According to clinical and demographic characteristics of patients, concomitant pathology, C-reactive protein and HIF-1 levels, the studied groups were comparable. The main group (27 patients) received a course (8–10 sessions) of individually dosed hypoxy-hyperoxytherapy on the basis of biofeedback (reoxytherapy) against the background of the standard complex of medical rehabilitation. The comparison group (15 patients) received sham reoxy therapy (placebo treatment) along with standard rehabilitation.&#x0D; RESULTS: The data obtained as a result of the study in multimorbid patients using reoxy-therapy clearly demonstrated reduction of clinical symptoms, improvement of general well-being according to visual analogue scale and decrease of C-reactive protein as a classical marker of inflammation against the background of stabilization of HIF-1 dynamics.&#x0D; CONCLUSION: The use of biofeedback-based short-term intermittent exposure to hypoxia and hyperoxia (reoxy therapy) in patients with different initial characteristics in terms of clinical health status and multimorbid pathology is reasonable taking into account modern personalized approaches to medical rehabilitation.

Allergic rhinitis: a comprehensive view of the problem

Currently, allergic sensitization is considered as one of the key causes of the development of chronic inflammatory processes in the nasal cavity and paranasal sinuses. The choice of optimal drugs for the treatment of allergic rhinitis still remains a relevant, socially significant and interdisciplinary problem. The article analyzes the modern strategy for the treatment of allergic rhinitis and assesses the incidence of comorbid pathology associated with allergic sensitization in patients with this pathology. In accordance with the latest clinical guidelines, a discussion of a stepwise approach to the treatment of allergic rhinitis was carried out. Based on data from a number of studies, the advantages of prescribing intranasal corticosteroids (InGCS) and leukotriene receptor antagonists (ALR) in the treatment of allergic rhinitis, including when combined with bronchial asthma and chronic rhinosinusitis with nasal polyps, have been identified. Among the officially registered drugs for the basic treatment of allergic rhinitis, the characteristics of the original intranasal spray mometasone furoate and the leukotriene receptor blocker montelukast are described in detail. The discussion describes the possibilities of potentiating the effects of topical corticosteroids through combination with leukotriene receptor antagonists. A clinical example demonstrates the feasibility of using a combination of the intranasal corticosteroid Nasonex with the leukotriene receptor blocker Singulair to control the course of allergic rhinitis and chronic rhinosinusitis with nasal polyps and, as a consequence, prevent the development of remodeling of the respiratory tract mucosa in such patients. During a follow-up examination after 3 months of therapy, the patient noted a subjective improvement in general well-being, nasal breathing, sense of smell, normalization of sleep, and a significant decrease in nasal discharge. There is no need for decongestants, sneezing is not a concern, and there is no respiratory discomfort. The combined use of ALR and InGCS enhances the anti-inflammatory effect of therapy.

Peculiarities of the influence of natural factors on the functional state of the body of school-age children

This article reveals the essence and content of hardening procedures as the most effective methods of acclimatization and their impact on the functional state of the body of school-aged children. The need is outlined and the main approaches to the use of water procedures are outlined, which are an effective means of preventing colds and somatic diseases, a reliable means of preserving and strengthening health, and increasing work capacity.&#x0D; A description of the physiological essence of hardening is given, which consists in the effect on the body of cooling, high temperature, and sunlight, as a result of which it recovers, improves health, and increases performance.&#x0D; The use of water in the hardening system, which has a high heat capacity, was investigated. Of all the hardening factors, the procedures (cold washing, rubbing, wrapping, dousing, baths, gargling) are the most powerful and quick and normalize blood pressure and appetite, give a feeling of freshness, special lightness in the body and a good mood.&#x0D; The need to apply systematic methods of hardening in educational institutions has been proved, and it has been found that the complex application of natural factors on the body of students allows to improve the functional state of school-age children, has a positive effect on the work of the cardiovascular and respiratory systems, the immune system, and the psycho-emotional state of children, contributes to the improvement the level of physical fitness and physical capacity of schoolchildren, improves well-being and mood.&#x0D; An analysis of the effectiveness of the use of complex means of hardening with students of the 11th grade was carried out, where positive changes were noted, both in the group of girls and in the group of boys. It has been proven that the use of various hardening methods gives quite effective results. Children get sick less often, the body's resistance to infections increases.&#x0D; The technique we developed consisted in the complex application of hardening means and recreational swimming. The procedures selected by us allow not only to improve the health of children, but also to raise the emotional background of the lesson. Improvement in general well-being and appetite, restful sleep, increased emotional tone, balanced mood, high mental and physical capacity, absence of colds, increased interest in life - these are indicators of the effectiveness of hardening procedures.

FRI334 A Case Of Delayed Onset Sheehan's Syndrome With Diabetes Insipidus

Abstract Disclosure: S. Inkollu: None. A. Estrada: None. Introduction: Sheehan's syndrome (SS) is characterized by hypopituitarism that develops due to ischemic pituitary necrosis from severe postpartum hemorrhage. The frequency of SS has declined in developed countries as the result of modern obstetric care. It may present immediately after delivery or many years later with delay up to 32 years after the inciting event.1 SS is characterized by anterior pituitary dysfunction, while diabetes insipidus (DI) is an uncommon complication with an estimated frequency of 5%.2 Here, we present a case of a 58-year-old woman with late onset SS 33 years after delivery, complicated by DI. Clinical Case: A 58-year-old female was referred to endocrine clinic for hypothyroidism with TSH 4.98 mIU/mL (0.27-4.20) and undetectable free T4 (fT4) at &amp;lt;0.1ng/dL (0.8-1.6). Her symptoms included fatigue, dizziness, cold intolerance, dry skin, and hair loss for the past two years. On further questioning, patient reported that she was unable to lactate or menstruate since her last childbirth 33 years ago in Thailand, but never sought evaluation since she had completed her family. She was able to breastfeed her previous 3 children. On examination, she appeared well oriented but lethargic, withdrawn and pale. Axillary and pubic hair was absent. Pituitary hormonal panel demonstrated panhypopituitarism with fT4 &amp;lt;0.1 ng/dL, ACTH 14.2 pg/mL (7.2-63.3), cortisol 0.5 mcg/dL (10-20), prolactin 0.9 ng/mL (4.8-23.3), insulin like growth factor-1 of 10 ng/mL (56-194) and FSH 1.2U/L (25.8-134.8 postmenopausal). MRI of the pituitary showed a partially empty sella turcica. A diagnosis of SS was made and the patient was started on prednisone and levothyroxine. Shortly after starting prednisone, she developed significant polyuria and polydipsia. Given concern for DI unmasked by steroids, she was started on desmopressin 1mcg PO daily. Workup for DI was not done due to financial stressors. She showed marked improvement in general well-being and all her symptoms with hormone replacement. Conclusion: SS is not as rare as assumed in developed countries like USA, likely due to migrant women and unawareness of physicians regarding possibility of late onset SS. DI, though uncommon, still occurs with SS and can be masked by adrenal insufficiency on initial presentation. Clinicians should be aware of this condition as early diagnosis and treatment of SS improves quality of life along with morbidity and mortality to a great extent. Reference: 1. Otsuka F, Kageyama J, Ogura T, Hattori T, Makino H. Sheehan's syndrome of more than 30 years' duration: an endocrine and MRI study of 6 cases. Endocr J. 1998 Aug;45(4):451-8. doi: 10.1507/endocrj.45.451. PMID: 9881893. 2. Keleştimur F. Sheehan's syndrome. Pituitary. 2003;6(4):181-8. doi: 10.1023/b:pitu.0000023425.20854.8e. PMID: 15237929. Presentation: Friday, June 16, 2023

Peculiarities of the Course of Arterial Hypertension and Stable Coronary Heart Disease in Conditions of Distress and the Feasibility of Additional Therapy

Today, in Ukraine in war conditions there are the powerful and long-term stress factors in the population, according to the intensity of the constant negative psycho-emotional impact theses stress factors form a state of distress. Distress, as an additional significant pathogenetic reason, affects the change in the prevalence and course of cardiovascular diseases. The article describes the stages and individual changes caused by distress. Diagnostic algorithms for the assessment of patients with arterial hypertension and coronary heart disease in distress conditions for a differentiated change in therapy are provided, namely the strengthening of the basic recommended therapy or the inclusion in the treatment of additional therapy: phytotherapy or vasoactive biosupplements. Among the last mentioned substances, donors of nitric oxide (NO), whose main substrate for synthesis in the body is L-arginine, have undoubted advantages. According to modern studies and meta-analyses, the use of L-arginine improves the endothelial function of blood vessels, has antioxidant properties, thanks to which it has been proven that it decreases blood pressure, reduces the feeling of anxiety, improves physical performance, reduces the number of angina attacks, including microvascular one, has a positive effect on the lipid profile in general, with a probable decrease in the level of triglycerides. Our own data on the oral use of the L-arginine biosupplement with a decrease in the variability of blood pressure, the frequency of cardiac pain, and an improvement in general well-being are presented. The presence of population-wide distress reactions makes it possible for the patient to use the supplement independently to alleviate/eliminate maladaptive effects from the cardiovascular and central nervous systems.

THE EFFECT OF HYDROXYZINE ON AKATHISIA AND OTHER NEUROLOGICAL SIDE EFFECTS OF ANTIPSYCHOTICS IN THE TREATMENT OF PARANOID SCHIZOPHRENIA

Side effects of antipsychotic drugs are the most urgent problem in the pharmacotherapy of schizophrenia. Medications used to correct side effects of various pharmacological groups, including correctors of cholinolytics, tranquilizers-benzodiazepines, have severe side effects, which justifies the search for no less effective and at the same time safer alternatives. The aim of the study was to evaluate the corrective effect of Hydroxyzine on akathisia and other neurological disorders that develop as side effects of antipsychotic therapy. Materials and methods. The study analyzed the severity of side effects in 43 patients suffering from paranoid schizophrenia receiving monotherapy with antipsychotics, before their administration, on the 7th and 21st day after the start of taking Hydroxyzine. The severity of side effects was assessed by the ESRS scales and the scale of evaluating drug-induced akathisia. Results. A significant corrective effect of Hydroxyzine on akathisia and other neurological side effects of antipsychotics was shown on the 7th day of Hydroxyzine therapy, the severity of Parkinsonism, dyskinesia, akathisia and tremor significantly decreased. Patients noted an improvement in general well-being, a decrease in the level of anxiety associated with the disease, staying in a psychiatric hospital, side effects of psychopharmacotherapy. Hydroxyzine significantly reduced the severity of akathisia, assessed both objectively and subjectively by patients. There was a decrease in the need of patients to move, to change the position of the body, improved sleep, reduced emotional stress. In general, Hydroxyzine had a positive effect in the form of a decrease in pathological motor activity and a decrease in the severity of emotional manifestations associated with the side effect of antipsychotics, which persisted on the 21st day of Hydroxyzine therapy in the absence of clinically significant undesirable side effects. Conclusions. The results of the study show the effectiveness of Hydroxyzine for correcting neurological side effects of antipsychotics along with good tolerability and substantiate the possibility of expanding its use in the complex therapy of paranoid schizophrenia.

Bodywork and Singing Voice: An Educational Tool for Voice Optimization

ABSTRACT Bodywork applied to vocal technique is an increasingly used tool in teaching practice. However, there is little research that can provide evidence of its effectiveness. This research is an exploratory and descriptive case study that investigates the self-perception of 14 voice major students after receiving a bodywork program. The main objective is to analyze if a bodywork program designed for singers affects the emission and vocal quality and, therefore, may be a good pedagogical tool in voice education. The body-mind method applied is the Méthode de Libération de Cuirasse © (MLC). To conduct the intervention, the participants performed different vocal tasks and answered a questionnaire to reveal their perceptions in relation to vocal emission, body balance, frame of mind, and degree of well-being before and after each of the sessions of bodywork. Two months after the last session, a second questionnaire was administered and a free narrative of the lived experience of participants was collected for subsequent analysis and interpretation. Results showed more comfort when singing, greater harmonic richness, greater facility in the high register, and better breath control as well as an improvement in general well-being and state of the body.

10-year results of simultaneous combined procedures of coronary artery stenting and transcatheter aortic valve implantation: a clinical case

Introduction. In recent years, transcatheter aortic valve implantation (TAVI) has become routine clinical practice in treatment of severe aortic stenosis in patients with high surgical risk. Timing of endovascular procedures is a key issue in management of patients with severe aortic valve stenosis and concomitant coronary heart disease. To date, there is no consensus on the advisability and necessity of performing simultaneous procedures of TAVI and coronary artery stenting. The long-term (over 10 years) outcomes of combined percutaneous coronary interventions in patients with severe aortic stenosis and coronary heart disease are not fully studied. Results and Methods. We described a long-term outcome in a 75-year-old female patient with marked aortic stenosis (maximum gradient = 103 mm Hg, mean gradient = 62 mm Hg, AVA area = 0.37 cm2), NYHA class II and hemodynamically significant coronary lesions. Given the high surgical risk (logistic EuroScore = 27.72%, STS = 17.21%), the patient underwent the following simultaneous procedures upon vital indications: coronary artery stenting and transcatheter aortic valve implantation with 23-mm Edwards Sapien XT prosthesis. There were no major intra- and perioperative complications. At the control examination 7 months later, the patient had no complaints. She reported an improvement in general well-being and increased tolerance of physical activities. The transprosthetic aortic blood flow parameters were as follows: peak gradient = 13 mm Hg; mean gradient = 7 mm Hg; V max = 1.8 m/s; there were 2 paraprosthetic fistulas with Grade 1–2 regurgitation. A control angiogram showed no restenosis in the coronary artery stents. 10 years after simultaneous interventions, hemodynamic parameters of the functioning aortic valve prosthesis were within the normal ranges. Control coronary angiography revealed satisfactory outcomes of coronary artery stenting. Conclusions. Simultaneous procedure of transcatheter aortic valve implantation combined with coronary artery stenting is feasible, effective, and safe. This technique can be used to treat patients with extremely high risk for open heart surgery. Keywords: aortic stenosis, transcatheter aortic valve implantation, coronary heart disease, coronary arteries, single-stage endovascular procedures

Efficiency of the transcranial magnetic stimulation in the treatment &#x0D; of occupational polyneuropathy

Introduction. In occupational polyneuropathies, along with sensory and autonomic disorders, excessive sensory input can lead to the development of excitation foci in various parts of the central nervous system, clinical significance of which is currently insufficiently studied.&#x0D; The aim of the study was the evaluation of the clinical effects of the transcranial magnetic stimulation in the dorsolateral zone of the prefrontal cortex in mine workers with occupational polyneuropathy. &#x0D; Materials and methods. There were examined thirty six workers of coal mining enterprises of Kuzbass with a proven diagnosis of polyneuropathy of the upper extremities, the average age was 50.2±3.7 years, and the average work experience was 23.4±3.5 years. To confirm polyneuropathy, the parameters of sensory conduction along the nerves of the upper extremities were investigated using electroneuromyography, nerve conduction velocity along the median and ulnar nerves was determined. The assessment of autonomic rcontrol was carried out using spectral analysis of heart rate variability. The functional brain status was determined by an electroencephalogram.&#x0D; Results. The patients complained of pain in the extremities, numbness and paresthesia. According to electroneuromyography, there was a decrease in the nerve conduction velocity along the somatic sensory nerves of the upper extremities, a reduction in the power of oscillations in all frequency ranges of the heart rate variability spectrum, which was more pronounced in the high frequency range. Transcranial magnetic stimulation of the prefrontal cortex zone of the right hemisphere was performed with a stimulus with a frequency of 1 Hz for 5 min, over a course of 5 procedures, after which a statistically significant increase in the average nerve conduction velocity along the somatic sensory nerves of the upper extremities, and a rise in the spectral parameters of the heart rate variability were observed. An increase in the alpha rhythm index at the electroencephalogram indicated an amplification of the integrative brain activity, which provided a wide range of regulatory processes. The patients noted a decrease in the intensity of pain, the severity of sensitive disorders, and improvement in general well-being.&#x0D; Limitations. The study is limited to the number of mine workers with a proven diagnosis of upper extremity polyneuropathy, without cardiac arrhythmias, structural damage and metal implants in the brain.&#x0D; Conclusion. Transcranial magnetic stimulation of the dorsolateral zone of the prefrontal cortex is effective in correcting sensory and autonomic disorders in occupationally caused polyneuropathy by activating suprasegmentary autonomic centers involved in systemic adaptation processes. It is promising to further expand the list of stimulation targets and create effective protocols for the use of transcranial magnetic stimulation.

A Case report of Resistant Hypertension due to Renal Artery Stenosis: Long Term Sufferings of a Middle-Aged Gentleman

Atherosclerotic renal artery stenosis is the leading cause of reno-vascular hypertension and is prevalent in elderly patients (over 65 years) and those with resistant hypertension. This article presents a case report of a 60-year-old gentleman who presented with resistant hypertension resulting in heart failure and significant morbidity. The patient's medical history included frequent hospitalizations with uncontrolled hypertension, flash pulmonary edema and heart failure. Despite multiple hospitalizations, the underlying cause of his condition remained unrecognized until further investigation revealed left sided renal artery stenosis as the culprit lesion. Successful renal artery angioplasty resulted in the resolution of the patient's high blood pressure and improvement of general well-being. This case highlights the potential for resistant hypertension due to renal artery stenosis to be overlooked, particularly in patients with multiple comorbidity. It is important to consider the possibility of renal artery stenosis in patients with uncontrolled blood pressure with recurrent pulmonary oedema, not responding to multiple anti-hypertensive drugs in the highest possible dose. Bangladesh J Medicine 2023; 34(2): 163-167

COMPLEX REHABILITATION OF ISCHEMIC HEART DISEASE PATIENTS AFTER CORONARY BYPASS OPERATION WITH THE USE OF BIOLOGICALLY ACTIVE ADDITIVES

Aim: The purpose of the work was to study the possibility of using Dihydroquercetin in rehabilitation programs for patients with coronary artery disease after Coronary artery bypass grafting (CABG) surgery in order to increase the effectiveness of rehabilitation, which has notable scientific and practical significance. Materials and Methods: The methodological basis of the research is based on systemic, historical, terminological, and informational approaches. Results: The results of the study showed the high clinical effectiveness of Dihydroquercetin in the complex medical rehabilitation of patients with coronary artery disease who underwent the operation. The pill intake did not affect indicators of carbohydrate and lipid metabolism, which indicates its metabolic neutrality. None of the patients had any worsening of the condition, increased frequency of angina attacks, or episodes of painless ischemia. All patients indicated good tolerability of the drug, and improvement in general well-being (reduction or disappearance of shortness of breath, decrease in pain intensity, increase in activity, improvement in sleep). The implementation of the optimized rehabilitation program also contributed to the improvement of the psycho-emotional state of the patients. Conclusions: Сomplex medical rehabilitation of patients with coronary heart disease after Coronary artery bypass grafting surgery according to a program with the inclusion of Dihydroquercetin helps to improve the rheological properties of blood, strengthen the active vasomotor mechanisms of MC regulation, improve indicators of central and peripheral hemodynamics, blood oxygenation, increase in exercise tolerance, improve psycho-emotional the condition, which ultimately ensure an increase in the rehabilitation effect.

КЛИНИЧЕСКИЙ СЛУЧАЙ ТЯЖЕЛОЙ ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИИ, ПРОТЕКАЮЩЕЙ С ДЕСТРУКЦИЕЙ ЛЕГОЧНОЙ ТКАНИ

The сommunity-acquired pneumonia is a widespread pathology of the respiratory organs, which occupies a leading place in the structure of morbidity and mortality from infectious diseases in developed countries. The patients with severe community-acquired pneumonia present the greatest problem for physicians. Despite the available diagnostic and treatment methods, including modern antibacterial medicine, mortality in this category of patients remains high, and treatment is complex and expensive. The purpose of the analysis of this clinical case was to study risk factors, features of clinical manifestations, differential diagnosis and therapy in patients with severe community-acquired pneumonia occurring with lung tissue destruction. In the clinical case, the patient had the background of such risk factors as a long smoking history with a smoker index of 60 pack/years with the formation of chronic obstructive pulmonary disease; alcohol abuse; toxic-alimentary damage to the liver; facts of aspiration on the background of vomiting; prolonged stay in a horizontal position, due to secondary toxic-metabolic polyneuropathy with severe motor disorders. The break in antibiotic therapy developed community-acquired bilateral polysegmental pneumonia, severe form with cavities, destruction of both lungs caused by multiresistant gram-negative microflora, complicated by the development of respiratory failure of degrees 2, polyserositis, and anemia. The patient underwent an extended examination in accordance with the Federal clinical guidelines for the diagnosis and treatment of community-acquired pneumonia. Differential diagnosis was carried out with pulmonary tuberculosis, lung cancer, new coronavirus infection. In the treatment, according to clinical recommendations, controlled oxygen therapy, combined antibiotic therapy taking into account the data of the antibiogram, mucolytic, antioxidant therapy, treatment of underlying diseases and symptomatic therapy were carried out. Against the background of the treatment, the patient showed positive clinical, laboratory and radiological dynamics, in the form of an improvement in general well-being, normalization of laboratory parameters and partial resorption and a decrease in the volume of decay cavities in the lungs.

Iron deficiency and postcovid syndrome: a clinical case

Postcovid syndrome is a serious public health problem affecting millions of people worldwide. There is a growing body of evidence that people may exhibit symptoms after organ damage developed during the acute phase of COVID‑19, while others experience new symptoms after a mild infection, without any evidence of acquired organ or tissue damage. In this regard, understanding the determinants and regulators of COVID‑19 and postcovid syndrome pathology is an important clinical challenge that will enable better management of future variants and pandemic waves. There is presumably a close relationship between iron homeostasis, COVID‑19, and postcovid syndrome, the pathogenetic aspects of which have yet to be determined. Nevertheless, the available literature already indicates that iron deficiency and iron deficiency anemia (without inflammatory anemia) in patients with postcovid syndrome occur in 30% and 9% of cases, respectively. Given the importance and urgency of this problem and the fact that one in three patients with postcovid syndrome may have iron deficiency, this article presents a case from clinical practice in which a patient with postcovid syndrome was found to have iron deficiency and iron deficiency anemia, and treatment of this condition and disease resulted in improvement in general well-being and regression of symptoms. Thus, the effects of COVID‑19 on iron metabolism exist, and they can be corrected. The use of oral iron preparations, in particular iron sulfate, allows optimal therapeutic and clinical effects in this clinical situation along with a good tolerability and safety profile.

Active Study: Impact of Voxelotor on Sleep Quality, Physical Activity, and Patient-Reported Outcomes

Background: Sickle cell disease (SCD) is an inherited disorder in which sickle hemoglobin (HbS) polymerization causes red blood cell sickling, resulting in complications such as chronic hemolytic anemia, vaso-occlusion, end-organ damage, and decreased quality of life. Voxelotor is a first-in-class HbS polymerization inhibitor approved in the US for the treatment of SCD in patients aged ≥4 years. The pivotal phase 3 HOPE and phase 2a HOPE-KIDS 1 trials demonstrated the safety and efficacy of voxelotor in increasing hemoglobin (Hb) and decreasing hemolytic markers. Objective: Here we report Hb response, patient-reported quality-of-life (QOL) outcomes, and safety data from the ongoing ActIVe study (NCT04400487), a phase 4, multicenter, open-label study evaluating the effect of voxelotor on physical activity, sleep quality, and overall well-being in patients with SCD. Methods: Patients aged 12 to 55 years with SCD received voxelotor 1500 mg/day for up to 24 weeks across 10 US sites. QOL assessments were completed during baseline (BL) run-in before the start of voxelotor. Hb levels were measured via laboratory assessments at BL and at weeks 2, 12, and 24. The proportion of patients with any increase in Hb from BL was noted. Patient-reported outcomes were evaluated using the Patient Global Impression of Change (PGI-C) scale, the National Institutes of Health Patient-Reported Outcome Measurement Information System-43 (PROMIS-43) for adults (>17 years), PROMIS-37 for adolescents (≤17 years), and a 10-point numeric rating scale (NRS) for pain intensity. A minimum response deemed meaningful was interpreted at the group level as a ≥5-point change from BL (CFB) in PROMIS domains and a ≥2-point change on the NRS. Clinicians' perceptions of the impacts of voxelotor on patients' overall health status were captured using the Clinical Global Impression of Change (CGI-C). All treatment-emergent adverse events (TEAEs) were recorded from the time of consent/assent to 28 days after the last dose of voxelotor. Results: A total of 25 patients were enrolled, with a median (range) age of 20.0 (12-51) years; 64.0% of patients were female and 92.0% were Black or African American. Two (8.0%) patients permanently discontinued voxelotor due to non-compliance and loss to follow-up. A total of 14 of 18 (78%) patients had an increase in Hb at week 24; the mean (SD) increase was 0.53 (0.839) g/dL. Clinicians reported an improvement in health status among 84.6% (11/13) of patients at week 24: 7.7% (1/13) were "very much improved," 46.2% (6/13) were "much improved," and 30.8% (4/13) were minimally improved; 2 patients had no change. At week 24, 92.9% (13/14) of patients self-reported improved health status: 21.4% (3/14) were "very much improved," 42.9% (6/14) were "much improved," and 28.6% (4/14) were minimally improved; 1 patient reported minimally worse health status. At week 24, 14 patients (9 adults, 5 adolescents) completed PROMIS measures; improvements in the mean CFB were reported across several PROMIS health domains. In adults, a meaningful CFB was found for both fatigue and pain interference. Some domains reached near-meaningful improvements, including anxiety, sleep disturbance, and ability to participate (in social roles/other activities), and others improved more modestly (Table 1). While some domains improved among adolescents, none reached a meaningful level (Table 2). A total of 18 (72.0%) patients had ≥1 non-SCD-related TEAE, and 3 (12.0%) patients had ≥1 grade 3 non-SCD-related TEAE. No non-SCD TEAEs of grade 4 or higher were reported. The most common non-SCD-related TEAEs (>10%) were diarrhea (32.0%), headache (20.0%), nausea (20.0%), and vomiting (12.0%). Conclusions: Over three-quarters of voxelotor-treated patients achieved an increase in Hb at week 24, and most patients and clinicians reported improvement in patients' overall health status. The PROMIS data in voxelotor-treated adults provided insights into improvements in general well-being, such as fatigue, pain interference, and ability to participate; most notable were fatigue and pain interference, both of which reached a CFB threshold considered meaningful. The safety profile reported in ActIVe is consistent with previous studies of voxelotor treatment. Overall, results suggest that voxelotor-treated patients may experience improvements in QOL, including in their physical and emotional well-being. Funding: Global Blood Therapeutics. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal