Complex Rehabilitation Research Articles

Psychometric network analysis in rehabilitation research: A methodological demonstration in depression symptoms of veterans and service members at 1 and 2 years after traumatic brain injury.

Psychometric network analysis (PNA) is an application of dynamic systems theory that can inform measurement of complex rehabilitation phenomena such as depressive symptom patterns in veterans and service members (V/SMs) after traumatic brain injury (TBI). This study applied PNA to the Patient Health Questionnaire-9 (PHQ-9), a common measure of depressive symptoms, in a sample of V/SMs with TBI at Years 1 and 2 (Y1-2) postinjury. A sample of 808 V/SMs with TBI participated, 594 contributing PHQ-9 data at Y1 and 585 at Y2. Participants were recruited while or after receiving inpatient postacute rehabilitation from one of five Veterans Affairs Polytrauma Rehabilitation Centers. The networks were stable and invariant over time. At both times, network structure revealed the cardinal depressive symptom "feeling down, depressed, or hopeless," as evidenced by its strength centrality. In the Y1 network, the suicidal ideation node was connected exclusively to the network through the guilt node, and in the Y2 network, the suicidal ideation node formed a second connection through the low mood node. The guilt node was the second most influential node at Y1 but was replaced by anhedonia node at Y2. This study demonstrated the potential of PNA in rehabilitation research and identified the primacy of feeling down, depressed, and hopeless after TBI at both Y1 and Y2, with guilt being the second most influential symptom at Y1, but replaced by anhedonia at Y2, providing supportive evidence that the relationships among depressive symptoms after TBI are dynamic over time. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Мeans of restorative treatment of children of younger school age sick of bronchial asthma in rehabilitation institutions

Bronchial asthma is a problem of extreme urgency, as morbidity and mortality from it are constantly increasing throughout the civilized world. Among chronic diseases of respiratory organs, pathology occupies a leading place. In different countries, its prevalence varies from 10 to 15%. This is associated with high disability and mortality of patients with BA. Based on the analysis of literary and other sources of information, theoretical material on the use of means of restorative treatment for children of primary school age with bronchial asthma in rehabilitation institutions was studied and selected. Among the diseases of the respiratory system in children, various forms of bronchial asthma occupy a prominent place in the development of children's disability. Morbidity and mortality from it are constantly increasing throughout the civilized world. The article discusses the issues of non-drug treatment of bronchial asthma in children. The relevance of the problem of rehabilitation of children with bronchial asthma is due to the urgent need to facilitate their life and adaptation to the environment, as well as to improve the level of self-care. Accordingly, physical therapy of such children occupies an important place, because it improves their physical condition, contributes to the effective correction of functional insufficiency of the respiratory system, provides training of the cardiovascular system, which leads to better activity of the child in educational activities and adaptation in society. The aim of the study. Theoretical substantiation of the necessity and essence of the use of physical therapy in the complex rehabilitation of children of primary school age, patients with bronchial asthma, in rehabilitation institutions. Research methods. Analytical review of literary and information sources, study of the state of the issue and systematization of modern scientific and methodological knowledge and results of practical experience of leading specialists in physical rehabilitation regarding the issue of rehabilitation of children with bronchial asthma. Literary sources (scientific articles, textbooks, manuals, dissertation research abstracts) are selected from the electronic databases of the National Library of Ukraine named after V.I. Vernadskyi, Web of Science, PubMed and others.

The effects of complex rehabilitation on monocytes proinflammatory cytokine (IL-1Β) secretion in obese patients with ischemic heart disease

The effects of complex rehabilitation on monocytes proinflammatory cytokine (IL-1Β) secretion in obese patients with ischemic heart disease

Evaluation of the efficiency of rehabilitation interventions in patients after unilateral biportal endoscopic discectomy

Background. Unilateral bi-portal endoscopic discectomy (UBED), as other surgical methods of treatment, may require the use of additional rehabilitation interventions in the recovery process of patients. Unfortunately, studies on the effectiveness of nonpharmacological methods in the postoperative period for these patients are insufficient. The study purposed to evaluate the effectiveness of a rehabilitation intervention program in the patients who have undergone UBED. Materials and methods. The study was conducted at the Department of Neurosurgery of the Spine and Spinal Cord of the Ivano-Frankivsk Regional Clinical Hospital in 2022–2023. The sample consisted of the main group (MG, n = 74) — patients who underwent removal of the hernia of the intervertebral disc used UBED and complex rehabilitation and control group (CG, n = 68) — UBED was performed without a rehabilitation course. Study methods: we used visual-analogue scale (VAS) and Oswestry questionnaire before surgery and after it (in 1 day and 1, 6 and 12 months). Results. In the preoperative period, the back pain index was 5.3 ± 1.4 and 5.6 ± 1.1 cm in MG and CG, respectively. In the postoperative period the back pain index according to the VAS decreased to 1.5 ± 0.4 cm in one day after surgery in the MG with its positive dynamics during the year of observation. In CG this index also decreased to 1.4 ± 0.9 cm with a gradual improvement to 0.3 ± 0.1 cm in 12 months. At the 12 months after the surgery the Oswestry index demonstrated that quality of life was better in the subjects of MG compared to the CG (5.4 ± 3.2 and 17.4 ± 3.3 %, respectively). Conclusions. The use of physical ­exercises in combination with massage and hardware physiotherapy in patients who have UBED improved the quality of life of the patients in the long-term observation period, but did not affect the reduction of pain after the surgery in both short-term and long-term observation

Possibilities of comprehensive rehabilitation in combination with vitamin and mineral preparations for patients who have undergone hospitalization COVID-19 form

Relevance. Rehabilitation of patients who have suffered severe and moderate COVID-19 is an urgent task of modern medicine. Today, the most important are rehabilitation measures for people who have undergone hospitalization. The goal is to study. The possibility of comprehensive rehabilitation of patients who have suffered hospital-acquired COVID-19, incl. using vitamin and mineral preparations. Materials and methods. A total of 195 consecutively recruited patients were examined. There were 2 groups of patients: with moderate severity (111 (56.92 %)) and severe severity (84 (43.0 %)). After discharge from the hospital, patients were randomly divided into 4 groups: Group A — 47 patients who received a rehabilitation complex, including therapeutic physical education (therapeutic and breathing exercises), physiotherapeutic treatment (inhalation and respiratory support) in accordance with the recommendations of the Ministry of Health Russian Federation, drug therapy in accordance with the recommendations of the Ministry of Health of the Russian Federation (anticoagulant therapy, if indicated — HMG-CoA reductase inhibitors, oral hypoglycemic therapy, ACE inhibitors and sartans); Group B — 49 patients who, in addition to the above methods, received vitamin preparations (vitamin D 1500 IU/day and vitamin C 30 mg/day); Group B — 48 patients who, in addition to the above methods, received mineral preparations (zinc 15 mg/day and selenium 70 mcg/day); Group D — 51 patients who, in addition to the above methods, received vitamins and mineral preparations in the previously indicated doses for groups B and C. The dynamics of mineral metabolism parameters were assessed. Results. During the examination of patients upon discharge from the hospital, a change in the content of macroelements was established: an increase in the level of potassium, sodium, sulfur and a decrease in calcium, as well as microelements: an increase in antimony and barium and a decrease in zinc, selenium and silicon. The most pronounced positive effect in terms of increasing the levels of essential macro- and microelements in the body (zinc, selenium and iron) in patients who had hospitalized COVID-19 was observed when using rehabilitation complexes in combination with vitamin and mineral preparations.

The influence of magnetic fields and fluctuating currents in the complex of medical rehabilitation on the state of peripheral blood flow in the early postoperative period of breast cancer

Abstract. Taking into account the high prevalence of complications after radical surgical treatment of breast cancer, medical rehabilitation courses were developed and conducted in the early postoperative period (2–4 days after surgery) with the inclusion of physical factors: fluctuating currents, extended local magnetic therapy, general magnetic therapy, as well as physical therapy, training with biofeedback on the support reaction (balance therapy) and individual sessions with a medical psychologist. Purpose. In a comparative aspect, study the indicators of peripheral microcirculation to assess the effectiveness of various methods of magnetic therapy and fluctuarization in patients operated on for breast cancer in the early postoperative period. Material and methods. The study included 107 women operated on for breast cancer 2–4 days after surgery. Using simple randomization, the patients were divided into 3 groups, comparable in age, clinical and functional indicators; at all stages of the study, the patients underwent clinical, functional and laboratory examinations, and questionnaires. In the 1st group (n=35), in the early postoperative period, in the complex of medical rehabilitation, 10 fluctuarization procedures were carried out using an expanded technique; in the 2nd group (n=35), patients received 10 procedures of expanded magnetic therapy; in the 3rd group (n =37) patients received 10 procedures of general magnetic therapy. In addition to physiotherapy, all patients received a complex of physical therapy, balance therapy and classes with a medical psychologist. Results. In the early stages, fluctuating currents seemed more effective, which, due to chaotic changes in the frequency and amplitude of current pulses, help restore conduction along peripheral nerves and activate muscle fiber contractility, improving hemodynamics. It should be noted the effect of extended and general magnetic therapy on improving the contractility of the muscles of the upper limb and the conductivity of peripheral nerve fibers, as well as on the restoration of capillary blood flow. Early signs of the regeneration process are a restructuring of microvascular regulation, namely an increase in the contribution of nutritional blood flow, the activity of myogenic and neurogenic oscillations in hemodynamics, and an increase in blood flow activity.

Complex rehabilitation of erosive tooth wear with digital workflows

Complex rehabilitation of erosive tooth wear with digital workflows

Use of orthoses in complex rehabilitation of children that have underwent oncological arthroplasty

Background: The urgency of medical rehabilitation for children with bone sarcoma is extremely high due to the significant impact on a socially important population and the increasing life expectancy of patients with bone sarcomas, leading to long-term orthopedic complications. This necessitates the development of highly effective, comprehensive programs not only for treatment but also for rehabilitation. AIM: Maximizing the recovery of residual quality of life abilities in children with bone sarcomas through the use of orthoses during various perioperative periods. MATERIALS AND METHODS: The study included 61 patients with bone tumors who underwent anti-tumor treatment and surgical intervention involving tumor removal with endoprosthesis implantation. Medical rehabilitation began from the moment of diagnosis and was conducted throughout all periods of anti-tumor therapy to help patients adapt to the treatment, restore functions in the postoperative period, and during remission, as well as to minimize the effects of aggressive specialized treatment. RESULTS: The functional outcome was assessed using the international MSTS scale. Limb function according to the MSTS scale was evaluated 12 and 24 months after surgery. No unsatisfactory results were observed. Functional outcomes improved over the course of 24 months. CONCLUSION: A dynamically evolving individualized rehabilitation program for children with bone sarcomas is necessary, tailored to the patient's condition and needs at the time of observation, along with personalized selection of orthoses and timely surgical correction of orthopedic consequences, which should be performed in orthopedic specialized hospitals.

Following hip fracture, hospital organisational factors associated with prescription of anti-osteoporosis medication on discharge, to address imminent refracture risk: a record-linkage study.

Patients who sustain a hip fracture are known to be at imminent refracture risk. Their complex multidisciplinary rehabilitation needs to include falls prevention and anti-osteoporosis medication (AOM) to prevent such fractures. This study aimed to determine which hospital-level organisational factors predict prescription of post-hip fracture AOM, and refracture risk. A cohort of 178 757 patients aged ≥60years who sustained a hip fracture in England and Wales (2016-19) was examined and followed for 1year. Patient-level hospital admission datasets from 172 hospitals, the National Hip Fracture Database, and mortality data were linked to 71 metrics extracted from 18 hospital-level organisational reports. Multilevel models determined organisational factors, independent of patient case-mix, associated with (i) AOM prescription, (ii) refracture (by ICD10 coding). Patients were mean (SD) 82.7 (8.6) years old, 71% female, with 18% admitted from care homes. Overall, 101 735 (57%) were prescribed AOM during admission; while 50 354 (28%) died during 1-year follow-up, 12 240 (7%) refractured. Twelve organisational factors were associated with AOM prescription, e.g., orthogeriatrician-led care compared to traditional care models (OR 4.65 [95%CI: 2.25-9.59]); AOM was 9% (95%CI: 6%-13%) more likely to be prescribed in hospitals providing routine bone health assessment to all patients. Refracture occurred at median 126days (IQR 59-234). Eight organisational factors were associated with refracture risk; hospitals providing orthogeriatrician assessment to all patients within 72-hours of admission had an 18% (95%CI: 2-31%) lower refracture risk, weekend physiotherapy provision an 8% (95%CI: 3-14%) lower risk, and where occupational therapists attended clinical governance meetings, a 7% (95%CI: 2-12%) lower risk. Delays initiating post-discharge community rehabilitation were associated with a 15% (95%CI: 3-29%) greater refracture risk. These novel, national findings highlight the importance of orthogeriatrician, physiotherapist and occupational therapist involvement in secondary fracture prevention post hip fracture; notably fracture risk reductions were seen within 12months of hip fracture.

A Post-Implanto-Prosthetic Rehabilitation Study Regarding the Degree of Improvement in Patients' Quality of Life: A Before-After Study.

Implant-prosthetic rehabilitation has the ability to improve the quality of life of patients, because, in addition to the role of restoring masticatory function, they also have many other benefits, such as restoring aesthetics or improving speech. This study aimed to analyze whether patients' quality of life was improved by implanto-prosthetic rehabilitation and which were the most important aspects. In this before-after study, we applied the Oral Health Impact Profile (OHIP-14) questionnaire to analyze the degree to which complex implanto-prosthetic rehabilitation led or not to an increase in patients' quality of life. The present study was carried out at the level of a private medical center in a city in the central region of Romania and included patients who visited this medical center between January and June 2022 and who benefited from a complex implanto-prosthetic rehabilitation, with the total number of patients eligible for inclusion in the study being 116. Overall, an improvement in quality of life after implant-prosthetic rehabilitation was found. Patients' gender, age, or educational level did not significantly influence their responses. The network analysis offered an overview (intuitive visual representation) of the similarities but also the differences in the OHIP-14 item relationships in both situations: before and after oral rehabilitation. A better understanding of how patients perceive implanto-prosthetic rehabilitation and the aspects that influence this perception can lead to an improvement in their quality of life, increasing the addressability of this type of medical procedure.

Features of correction of disorders of the digestive system in children with reactive asthenic syndrome

Objective: to study the features of the digestive system in children with reactive asthenic syndrome and correction of disorders using a comprehensive integration program.Materials and methods: a prospective cohort non-randomized study of 419 children of primary school age was conducted. The main group consists of 128 children living in the territory of active hostilities. Control group — 291 children outside the zone of active hostilities. A full examination was carried out before and 6 months after the start of the comprehensive integration rehabilitation program. All children were collected complaints, anamnesis, analysis of outpatient records, objective examination, examination of the motor-evacuation function of the gastrointestinal tract.Results: all children of the main group had complaints from the digestive system. 97 (75.78%) children were concerned about decreased appetite; 79 (61.72%) — stool disorders. Functional disorders were registered in 80 (62.50%) children of the main group, organic pathology — in 62 (48.44%). Among functional abnormalities, functional disorders of the biliary tract were in the first place (in 65 (50.78%) people). Among the organic pathology — diseases of the stomach and 12-duodenum (in 59 (46.09%) children). Peripheral electrogastroenterography revealed in most children of the main group non-impulsive contractions and discoordination of motor skills of varying degrees of severity in all parts of the gastrointestinal tract.Conclusions: the implementation of complex rehabilitation measures optimized the studied indicators with more pronounced effectiveness in children evacuated from active combat zones.

Is the Rehabilitation Complexity Scale Useful in Individuals Undergoing In-Hospital Pulmonary Rehabilitation?

ObjectiveTo assess validity and responsiveness of the Extended Rehabilitation Complexity Scale (RCS-E v13) to in-hospital pulmonary rehabilitation (PR) in individuals with chronic respiratory diseases (CRD). DesignCross-sectional, multicentric study. Assessments in individuals attending units on 2 nonconsecutive days. SettingFourteen in-hospital PR units. ParticipantsFive hundred forty-seven individuals (59.2% male, age 72y [range, 65-78y]): 317 with chronic respiratory failure because of various causes (CRF); 96 with chronic obstructive pulmonary disease without CRF (COPD), 39 tracheostomized and ventilated (TX/V), and 95 with other diseases (Miscellaneous). InterventionAssessment of RCS-E v13 before and after the PR program. Main Outcome MeasuresRCS-E v13 and outcome measures: Barthel Index (BI), Barthel Index Dyspnea (BiD), Medical Research Council scale for dyspnea (MRC), COPD Assessment Test (CAT), Short Physical Performance Battery (SPPB), and 6-minute walk test (6MWT). ResultsThe highest RCS-E v13 admission values (median [interquartile range]) were found in TX/V (17 [15-18]) as compared with other groups (8 [7-10], 10 [9-12], and 8 [8-10] in COPD, CRF, and Miscellaneous, respectively, P<.001). At admission and discharge, RCS-E v13 correlated strongly with BI, 6MWT, and SPPB and moderately with MRC and BiD (r=.43-.60). After the program, RCS-E v13 as well as all outcome measures improved significantly in all groups (P<.001 for all). The size of improvement was different among groups according to the different variables. In the overall group, the effect size was high for changes in RCS-E v13 (Cohen's d=−2.0984), CAT (d=−1.1937), MRC (d=−1.0505), BiD (d=−.9364), and SPPB (d=.9231) whereas it was moderate for 6MWT (d=.7670) and BI (d=.6574). ConclusionsRCS-E v13 varies according to different CRD, is responsive to PR, has good construct and concurrent validity, and correlates with most of the accepted outcome measures of PR. Its scoring may provide useful information on the care burden of individuals undergoing PR.

Unmet rehabilitation needs in the first 6 months post-injury in a trauma centre population with moderate-to-severe traumatic injuries.

To describe the needs for subacute inpatient rehabilitation and community-based healthcare services, rehabilitation, and social support in patients with moderate-to-severe traumatic injury in the first 6 months post-injury. Further, to explore associations between sociodemographic and clinical characteristics and unmet needs. Multicentre prospective cohort study. Of 601 persons (75% males), mean (standard deviation) age 47 (21) years, admitted to trauma centres in 2020 with moderate-to-severe injury, 501 patients responded at the 6-month follow-up and thus were included in the analyses. Sociodemographic and injury-related characteristics were recorded at inclusion. Estimation of needs was assessed with the Rehabilitation Complexity Scale Extended-Trauma and the Needs and Provision Complexity Scale on hospital discharge. Provision of services was recorded 6months post-injury. Multivariable logistic regressions explored associations between baseline variables and unmet inpatient rehabilitation and community-based service needs. In total, 20% exhibited unmet needs for subacute inpatient rehabilitation, compared with 60% for community-based services. Predictors for unmet community-based service needs included residing in less central areas, profound injury severity, severe head injury, and rehabilitation referral before returning home. Inadequate provision of healthcare and rehabilitation services, particularly in the municipalities, resulted in substantial unmet needs in the first 6 months following injury.

Clinical case of complex rehabilitation for post-traumatic myelopathy using Taraskul lake sapropels

BACKGROUND. Post-traumatic myelopathy (combat injury) is a serious condition that leads to severe functional impairment requiring complex rehabilitation based on assessment of functional impairment. The use of sulfide-silt mud is used in sanatoriums of the eastern military district for the rehabilitation of patients with pathology of the musculoskeletal system according to generally accepted methods. Lake Bolshoi Taraskul in the Tyumen region is a natural reservoir of sapropels with unique biological properties. AIM. Show on the example of a clinical case the results of an integrated approach in the rehabilitation of a patient with post-traumatic myelopathy as a result of combat trauma, implemented on the basis of an individual. CASE DESCRIPTION. Patient, 32 years old, with post-traumatic myelopathy due to spinal injury. Upon admission, the indicators: rehabilitation routing scale — 5 points, Revermid mobility index — 4 points, Ashforth spasticity scale — 3 points, ASIA scale — B, FIM functional independence scale 99 points. Initially, the patient is transferred from the chair to the couch with minimal support, sits without additional support for more than 5 minutes, verticalization of the patient only using high support (high walkers). The comprehensive rehabilitation program included physiotherapy, hydrokinesotherapy and peloidotherapy with Lake Taraskul sapropels. As a result of treatment, the patient walks with a support on a walker on a flat surface with rest, walks along the wall with a support on handrails. A patient supported by canes climbs a ladder. CONCLUSION. This clinical case discloses the effectiveness of comprehensive rehabilitation of a patient with post-traumatic myelopathy (combat trauma) with the inclusion of Lake Taraskul in the rehabilitation program for hydrokinesiotherapy and peloidotherapy with sapropels.

Prenatal ultrasound diagnostics and sociopsychological support as rehabilitation measures in patients with congenital cleft palate complicated by anomalies of other organs and systems

BACKGROUND: Prenatal ultrasound diagnostics and sociopsychological support in the early rehabilitation of children with congenital cleft palate combined with malformations of other organs and systems complement the unified algorithm of dynamic monitoring and rehabilitation treatment of these patients. Thus, predicting the choice of techniques and the system of rehabilitation prescriptions became possible. AIM: To present the experience of prenatal ultrasound diagnostics and sociopsychological support during pregnancy for the early rehabilitation of a patient with cleft palate combined with malformations of other organs and systems. MATERIALS AND METHODS: The study was conducted in the Multiprofile Clinical Medical Center “Bonum” in Yekaterinburg. For 24 years, from the analysis of medical records of the organizational and rehabilitation process of 2,475 patients with congenital cleft lip and/or palate receiving comprehensive care (1998–2022), 823 (33.25%) patients who had with cleft palate and malformations of other organs and systems were enrolled in this study. The discharge epicrises of the pregnancy and the timing of intrauterine ultrasound diagnostics of the fetus were studied, and the history of childbirth and anamnesis of newborns and timing of their routing and registration in the specialized “Bonum” Center were analyzed. At the time of the initial outpatient appointment at the center, parents’ responses to a survey on the nature of emotional and psychological experiences during the prenatal ultrasound examination of the fetus, period of “bearing” pregnancy, and birth of a baby with a complex anatomical and physiological pathology were analyzed. RESULTS: Ultrasound examination of the fetus during uterine development registered 292 (35.48%) of 823 cases of a combination of congenital cleft palate and anomalies of other organs and systems. The main forms of malformations in the fetus were established in the second (n=99, 33.90%) and third (n=185, 63.36%) trimester pregnancy screening. Mothers who were told about the results of ultrasound diagnostics of the fetus showed anxiety and emotional lability. The use of psychocorrectional and socially significant measures during the diagnosis of fetal pathologies and at the time deciding whether to continue pregnancy, as well as the newborn period, which relieved the psycho-emotional tension of parents, was proposed. CONCLUSION: Early rehabilitation of patients with congenital cleft palate combined with malformations of other organs and systems should be provided as an integral part of the complex rehabilitation therapy. Sociopsychological support of the family from the period of prenatal diagnosis of the fetus who had multiple malformations is necessary at all stages of pregnancy and rehabilitation treatment of the child.

Application of haloinhalations at the sanatorium-resort stage of rehabilitation of patients after COVID-19.

After suffering from COVID-19, a large number of patients need respiratory rehabilitation. One of the methods of rehabilitation is inhalation with salt aerosols. Our work aimed to study the effectiveness of inhalations of a dry aerosol of salt precipitated from the mineral water of the "Teplitsa multidisciplinary sanatorium", Transcarpathian region of Ukraine. 30 male patients were examined after suffering from COVID-19. We formed two groups of patients, control and main, 15 people each. Patients in the control group received inhalation with a dry aerosol of table salt of the "Aero-M-sol". In contrast, patients in the main group received a course of inhalations with a dry aerosol of salt precipitated from the mineral water. Under the influence of the rehabilitation complex in both groups, there is a performance improvement but significant changes are observed only in patients of the main group. The indicator Forced Vital Сapacity1 increased to the greatest extent, which after rehabilitation is significantly higher than in the control group (p<0.05). As a result, the Tiffeneau index significantly increases in the main group compared to the control group, reaching normal values. The main effect is associated with a decrease in obstructive complications of the respiratory tract as a result of a decrease in inflammation. The use of iodine-bromine brines (as in our case) for inhalation in the treatment of respiratory diseases has been proven to be effective, with systemic effects in the form of decreased IgE and increased IgA in the blood serum having been noticed. The use of haloinhalations with MW salts in the rehabilitation of patients after suffering from COVID-19 disease significantly improves the clinical condition of convalescents.

The use of an innovative technique for perforations of the mucous membrane of the maxillary sinus during the sinus lift operation

Introduction. To date, according to WHO, the number of people with a complete absence of teeth is greater than 8% of all the people worldwide. Loss of teeth due to complications of caries treatment, chronic periodontitis and trauma leads to atrophy of the alveolar ridge and that of soft tissues in this area, which in turn complicates the rehabilitation of the patients. According to the literature, in the first year after tooth extraction, the volume of the bone tissue of the alveolar ridge decreases by 40–60%, which greatly complicates the subsequent orthopedic rehabilitation of the patients. Currently, the «gold standard» for increasing the volume of the bone tissue of the alveolar ridge of the upper jaw in the distal section is the sinus lift operation. However, according to the literature, when sinus lift operation is performed, Schneider’s membrane perforation occurs in 7–23% of cases, which in terms, leads to the inability to complete the operation and complications in cases with total perforations of membrane.Purpose of the study. To evaluate the complex rehabilitation of patients with partial secondary absence of teeth and severe atrophy in the lateral sections of upper jaw using the «envelope technique» during open sinus lifting.Materials and methods. In 2020–2022, during a clinical study at the clinic of the Department of maxillofacial and plastic surgery of the Moscow State Medical University named after A.I. Evdokimov, 54 patients who had a history of PPI interventions in the ENT department were treated. All patients underwent bilateral open sinus lifting using enamel matrix proteins or the «envelope technique» for perforation of the Schneider membrane. After 9–12 months, a comprehensive rehabilitation of patients based on dental implants was carried out.Results. The number of extensive (total) perforations of the Schneider membrane in the study group of patients was 50%. As a result of the use of the patented «envelope technique» with the use of enamel matrix proteins, no postoperative complications were observed in patients with total perforation of the Schneider membrane. Taking into account the planned orthopedic design, 292 dental implants were installed in all patients.Conclusion. The method is effective and safe, allowing to rehabilitate patients with missing teeth and severe atrophy in the lateral part of the upper jaw, in case of intraoperative total perforation of the Schneiderian membrane.

The effectiveness of medical and psychological rehabilitation of patients with nervous tension

Abstract. The prevalence of anxiety disorders during life among residents of developed countries reaches 34 %. The low effectiveness of pharmacotherapy and psychotherapy determines the search for comprehensive technologies for the treatment of patients with nervous tension. The purpose of the study: to determine the prognosis of the effectiveness of medical and psychological rehabilitation (MPR) in patients with nervous tension and to identify its determinants. Methods: 254 patients aged 32 (19–50) years with nervous tension (ICD–X code R45.0) were studied. The complex of medical and psychological rehabilitation included physical exercises, courses of audiovisual polysensory relaxation, transcranial magnetic therapy, alpha massage, sodium chloride baths, climatotherapy, cognitive behavioral psychotherapy and therapeutic nutrition. The total duration of the MPR course is 10–20 days. To determine the relationship between integral health parameters and individual clinical and functional signs of nervous tension, correlation analysis was performed, canonical correlation analysis was used to select the most informative signs, and discriminant analysis was used to determine the prognosis of MPR and the dominants of its effectiveness. Results: A significant improvement in clinical and psychological status, physical health, increased physical performance, increased adaptive potential and autonomic regulation in patients was revealed. Significant high correlations of improvement of adaptive potential and physical performance with SAD (0.77), double product (0.81), Martin — Kushelevsky breakdown (0.74), average — with heart rate (0.58), DBP (0.69), level of physical health (0.54), weak — with BMI (0.47) were established. The effectiveness of MPR in patients with FA is 90 %. The determinants of effectiveness are indicators characterizing the heart rate, SAD, double product, BMI, age, Kerdo vegetative index, DAD, indicators of the Martinet — Kushelevsky test and physical performance PWC170–1. Conclusion: Various components of the pathogenesis of nervous tension determine the choice of rehabilitation technologies, the combination of mechanisms of therapeutic action of which determine the high effectiveness of MPR in patients with nervous tension.

Dynamics of clinical and laboratory indicators in patients with diabetic nephropathy caused by arterial hypertension after complex recovery treatment

Abstract. The purpose of the study is to evaluate the dynamics of clinical and laboratory parameters with patients suffering from diabetic nephropathy (DN) caused by arterial hypertension (AH) after using complex rehabilitation treatment. Materials and methods. Open-label, prospective, randomized controlled trial was conducted on 148 patients with DN caused by hypertension, whose average age was 62.4 [52.4; 69.9] years old, the duration of AH — 24.5 [14.3; 36.4], diabetes mellitus (DM) type 2–16.8 [14.7; 19.3] and DN — 6.0 [4.0; 8.7] years. We studied clinical symptoms and laboratory parameters in dynamics (glucose, glycated hemoglobin, albumin, creatinine, their ratio, proteinuria and glomerular filtration rate) with this category of patients which included a control group (49 people) who was prescribed standard medication, a comparison group (48 people) who additionally had Nordic walking (NW), and a main group (51 people) that, in addition, was prescribed magnetic laser therapy (MLT) as part of the complex. Research results. The patients suffering from DN caused by AH showed some data indicating the positive effect of complex restorative therapy (medical standard with the additional use of NW and MLT) on the clinical manifestations of pathology and renal function including the condition of the glomerular filter and the endothelium of renal capillaries. Conclusions. The results of the conducted study allow us to recommend the prescription of complex restorative treatment for patients suffering from DN caused by AH taking into account contraindications to the use of physical methods of therapy.

Nutritional support in the complex of medical rehabilitation at the stage of adjuvant radiation therapy of breast cancer

BACKGROUND: Currently it is known that there exists the need for complex medical rehabilitation at the stage of adjuvant radiation treatment of breast cancer. However, data on the combined use of nutritional support and physical factors at this stage of oncological treatment are not available. AIM: Evaluation of the effectiveness of specialized therapeutic and preventive nutrition in patients with malignant breast diseases and a history of polychemotherapy at the stage of adjuvant radiation therapy in complex medical rehabilitation using low-temperature plasma and general magnetic therapy. MATERIALS AND METHODS: A prospective simple randomized study was conducted, which involved 60 patients at the stage of adjuvant radiation therapy for breast cancer. The main group (n=30) received a course of medical rehabilitation with the inclusion of nutritional support using specialized therapeutic and preventive nutrition LEOVIT ONCO®, as well as exposure to low-temperature plasma and general magnetotherapy. In the comparison group (n=30), the rehabilitation course included general magnetic therapy without therapeutic and preventive nutrition. All patients underwent individual physiotherapy exercises, and sessions with a medical psychologist. The results obtained were recorded using clinical and functional, laboratory, instrumental studies. RESULTS: It has been established that the use of specialized dietary products LEOVIT ONCO and physical factors is an effective method of rehabilitation. The use of nutritional support demonstrates the maintenance of the patient’s protein status, reduces intoxication, and reduces the negative impact of oxidative stress factors in the body at the stage of adjuvant radiation treatment. The inclusion of low-temperature plasma and general magnetic therapy in the rehabilitation program has a beneficial effect on hemomicrocirculation in the area of ionizing radiation exposure. CONCLUSION: The use of nutritional support and physical factors, as a component of complex medical rehabilitation, helps to maintain the optimal nutritional status of the patient, reduces the manifestations of skin radiation reactions, improves the psycho-emotional state of patients and the quality of life of patient.