Social Adaptation Of Patients Research Articles

Influence of Personal Factors on Quality of Life in Patients with Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is a disease characterized by restriction of airflow in airways. Smoking is a major risk factor for disease. Other factors are air pollution from fuels, industrial dust, chemical agents and genetic causes. Main symptoms are shortness of breath, chronic cough with or without sputum and rapid fatigue. Chronic obstructive pulmonary disease /COPD/ is a source of stress and anxiety, due to severity of disease, need for long-term treatment and detachment from social life. Study cohort consisted of 124 patients with a diagnosis of COPD and a control group of 162 without lung disease. Persons studied are over 18 years of age, of different sexes, of Bulgarian ethnic origin and different family and social status. Chronic obstructive pulmonary disease is a disease of increasing social importance and, according to forecast of WHO, by 2030 it is expected to become third leading cause of death in world. Aim of pilot study was to determine influence of some personal risk factors (anxiety and type D personality in dimensions: "negative affectivity" and "social inhibition") on quality of life and social adaptation of patients with COPD.

Scalp hypothermia for the prevention of chemotherapy-induced alopecia in breast cancer

Background. Breast cancer (BC) is a socially significant disease in women all over the world, ranking 1st in the structure and 5th in the number of deaths. Polychemotherapy in the complex treatment of BC accounts for approximately 80%. The main side effect that significantly affects the quality of life is alopecia, which occurs on average in 65% of patients.
 Aim. To evaluate the efficacy and tolerability of scalp hypothermia (SHT) for the prevention of chemotherapy-induced alopecia in patients with BC.
 Materials and methods. From June 2016 to September 2023, 75 patients with a median age of 44.1 years with stage I–IV BC were observed. All patients received cytotoxic therapy at various stages of treatment. To prevent alopecia, local SHT was used using an Orbis II device (Paxman Coolers, United Kingdom).
 Results. Stage I of the disease was observed in 18 (24%) patients, stage II in 22 (29.3%), stage III in 30 (40%), and stage IV in 5 (6.7%). Patients received 5 different neo- and adjuvant regimens of polychemotherapy. Taxane-containing combined regimens prevailed. 364 SHT sessions (4–8 sessions per patient) were performed; 48 (64%) patients received the procedure in full. Complete hair preservation was achieved in 43 (57.3%) patients. Grade 1 alopecia was observed in 19 (25.4%) patients and grade 2 in 9 (12%) patients. Of the 5 patients with advanced BC, grade 2 alopecia was reported in 1 patient, grade 3 in 3, and grade 4 in 1. Side effects were reported in 16% of cases; the most common were a feeling of cold and a slight headache. Due to the intolerance of the cold helmet, 3 patients refused to use it. No scalp metastases were observed during the follow-up. During the procedure, almost all patients noted a high level of comfort.
 Conclusion. Local SHT is an effective method of preventing cytotoxic therapy-induced alopecia in patients with BC. It improves the psychological and social adaptation of patients.

Screening of patients with cerebral aneurysms: mathematical analysis and economic justification

Demonstrate the clinical and economic feasibility of screening the population (including first-line relatives) for cerebral aneurysms using an economic and mathematical model of the RF virtual population. Mathematical modeling was carried out using an algorithm that implements a discrete Markov chain. The virtual population consisted of 145 million people (the population of the Russian Federation). Magnetic resonance angiography 3DTOF was chosen as a screening method. Virtual patients underwent preventive surgical treatment in case of detection of aneurysm during screening. The number of aneurysms in the population, the number of aneurysmal subarachnoid hemorrhage (aSAH), the cost and outcomes of treatment, and the risk of disability were calculated. In the case of screening and preventive surgical treatment of aneurysms, there is a decrease in the number of aSAH by 14.3% (37.5% in first-line relatives (RPLR), which affects the reduction in mortality due to aSAH by 14.4% (24.1% in The total number of disabled people is reduced by 1.5% (5.1% for the RPHR). A shift in the structure of disability towards greater labor and social adaptation of patients was noted. An economic analysis for the entire population showed that screening saves 7.7 billion annually rubles, including in the population consisting of RPLR - 4.9 billion rubles. The created mathematical model of the virtual population demonstrated that screening and prophylactic treatment of cerebral aneurysms makes it possible to reduce the number of aSAH and associated mortality among the entire population and in the RPLR group. The number of individuals with severe disabilities is decreasing. Thus, population screening for the detection of cerebral aneurysms may be clinically effective and cost-effective in the general population, especially in RPCR.

Effects of oxytocin pathway gene polymorphisms and adverse childhood experiences on emotion recognition in schizophrenia spectrum disorders

To study a role of the interaction of oxytocin pathway gene polymorphisms and adverse childhood experiences (ACE) in facial emotion recognition (FER) deficits in schizophrenia. Patients with schizophrenia spectrum disorders (n=699) completed cognitive testing, which included a FER task. We determined patients' genotypes for common polymorphisms in three of the oxytocin pathway genes which were previously associated with face perception: OXTR (rs53576, rs7632287), CD38 (rs3796863) and ARNT2 (rs4778599). The presence of ACE in the patient's history was assessed via an analysis of medical records. In our sample, 49% of participants experienced ACE. ANCOVA adjusted for age and gender revealed a significant interaction effect of OXTR rs53576 with ACE on FER scores (F=11.51; p<0.001; η2p=0.02). The effect remained significant when accounting for cognitive functioning and negative symptoms. Carriers of the A allele without ACE recognized emotions worse than GG homozygotes without ACE (p=0.039) and carriers of the A allele with ACE (p=0.009). The results are consistent with the notion of the A (rs53576) allele's role in sensitivity to childhood experiences that influence the psychosocial development and can be used in further studies of the oxytocin treatment of social cognition and social adaptation of patients with schizophrenia.

Psychoemotional Rehabilitation and Social Adaptation of Patients with Thermal Injuries

Psychoemotional Rehabilitation and Social Adaptation of Patients with Thermal Injuries

The Role of Health Care Professionals in the Social Adaptation of Patients With Secondary Progressive Multiple Sclerosis

The Role of Health Care Professionals in the Social Adaptation of Patients With Secondary Progressive Multiple Sclerosis

Development of Post-Stroke Cognitive and Depressive Disturbances: Associations with Neurohumoral Indices.

Neuropsychiatric complications, in particular cognitive and depressive disorders, are common consequences of ischemic stroke (IS) and complicate the rehabilitation, quality of life, and social adaptation of patients. The hypothalamic-pituitary-adrenal (HPA) system, sympathoadrenal medullary system (SAMS), and inflammatory processes are believed to be involved in the pathogenesis of these disorders. This study aimed to explore these systems in IS patients, including those with post-stroke cognitive and depressive disorders, within a year after IS. Indices of the HPA axis, inflammatory system, and SAMS were measured in blood serum (cortisol, interleukin-6 (IL-6)), plasma (adrenocorticotropic hormone), and saliva (cortisol, α-amylase). During one year after mild/moderate IS (NIHSS score 5.9 ± 4.3), serum cortisol and salivary α-amylase levels remained elevated in the total cohort. In the group with further cognitive decline, serum and salivary cortisol levels were elevated during the acute period of IS. In the group with poststroke depressive disorder, salivary α-amylase was constantly elevated, while serum IL-6 was minimal during the acute period. The results suggest prolonged hyperactivation of the HPA axis and SAMS after IS. Specifically, post-stroke cognitive impairment was associated with hyperactivation of the HPA axis during the acute IS period, while post-stroke depressive disorder was associated with the chronic inflammatory process and hyperactivation of SAMS during the follow-up period.

Gender-associated role in patients with schizophrenia. Is there a connection with the resistance?

Schizophrenia is a chronic mental illness observed with equal prevalence in different cultures and ethnic groups. The clinical picture relates to behavior and social adaptation. A significant percentage of patients, despite the implementation of various therapeutic interventions, remain resistant to the ongoing treatment. Occupying a certain gender role depends both on biological belonging and on the way of self-perception characteristic of the given person. Self-perception reflects gender identification, which in social aspect is determined by the choice of social activities performed. Changes in behavior and social adaptation in patients with schizophrenia led us to conduct a study to analyze the perceived gender role in patients with schizophrenia, looking for differences between patients with treatment resistance and those in clinical remission.Materials and methodsA total of 105 patients with schizophrenia were analyzed. Of them, 45 were with resistant symptoms and 60 in clinical remission. The clinical analysis of the patients was carried out using the PANSS and BPRS scales. The evaluation of the choice of social activity related to a particular gender was done with the Bem Sex-Role Inventory (BSRI).ResultsOut of all 105 patients with schizophrenia, in 80/76.19%/we found a higher identification with the female role, 17/16.19%/made an association with the male role and in 8/7.61%/patients we found the same results, i.e., with both the male and female roles. Among the patients with treatment resistant schizophrenia (TRS)–45, 34/75.56%/identified more with the female gender role, 6/13.33/perceived the male gender role as active, and in 5/11.11%/the identification was equal both with the male and with the female roles. Among the patients in clinical remission (CR)–60, 46/76.67%/accepted the female role as active, 11/18.33/identified with the male one, and three/5%/accepted both roles equally. When assessing the relationship between biological sex and perceived gender role, it was found that among men/a total of 39/half identified with the female gender role and half with the male gender role. Among women/a total of 66/, 90% perceived the female gender role, 7%–the male and 3% equally the male and the female gender role. No relationship was found between the choice of a certain gender role and the onset of psychosis and its duration in the observed patients.ConclusionWe found a higher percentage of schizophrenic patients who showed higher identification with the female gender role. Approximately half of the males identified with the female gender role. Resistance had no influence on the choice of sex-associated social activity. Factors related to the course of the schizophrenia process such as age of onset of psychosis and duration of psychosis was not associated with an influence on identification with sex-associated social activity. Our research suggests that identification with a particular sex associative social activity is most likely established earlier in the prodromal period.

Evaluation of the effect of patient-oriented programs on functional activity in patients after cerebrovascular accident at the late stage of medical rehabilitation

The consequences of a stroke are manifested by a number of unfavorable functional disorders of the motor apparatus, which leads to a significant deterioration in the patients’ quality of life. In this regard, the prevention of the development of disability and the reduction of the severity of the patients’ condition should come to the fore when creating rehabilitation programs to ensure maximum recovery of functional activity, as well as mental, professional and social adaptation of patients. Material and methods: 120 patients after acute cerebrovascular accident with movement disorders in the form of hemiparesis with increased muscle tone of spasticity type in the late recovery period. At the control points (after treatment, 3 and 6 months after treatment), indicators of patients’ daily activity (self-care and mobility) were assessed according to the Barthel index and criteria for patients’ functional independence were evaluated in accordance with the FIM scale. All patients were divided into 3 groups comparable in terms of clinical and functional characteristics: group 1 (40 patients), who, in addition to the standard treatment complex, were prescribed massage with the pulsed low-frequency electrostatic field from the Khivamat device and broadband modulation currents, group 2 (40 patients), who, against the background of standard therapy and medical rehabilitation, were prescribed physiotherapy methods from the Alpha LED Oxy Light — Spa™ device, and group 3–40 patients who received standard drug therapy and medical rehabilitation (exercise therapy, medical massage, mechanotherapy). Results. The data obtained indicate the advantage of including the pulsed low-frequency electrostatic field and broadband modulation currents in the standard rehabilitation complex in patients with acute cerebrovascular accident, which is confirmed by the indicators of patients’ daily activity (self-care and mobility) according to the Barthel index and the criteria for patients’ functional independence in accordance with the FIM scale. Conclusion. The developed personalized medical rehabilitation complexes, including the pulsed low-frequency electrostatic field and broadband modulation currents, contribute to a significant improvement in daily activity and an increase in functional independence in patients after acute cerebrovascular accident at a late stage of medical rehabilitation.

Psychological features and social adaptation of patients with the tremor form of Parkinson’s disease

The aim of the study was to study the personality characteristics and psychological state of patients with tremulous hyperkinesis in Parkinson’s disease. We studied men and women aged 49 to 75 years with an established diagnosis of «Parkinson’s disease» of a tremulous (main group) and akinetic-rigid form (control group), stages 1-2 according to Hyun and Yar. To study the psychological state of patients, the Giessen personality questionnaire was used, which made it possible to take into account personal, intrapsychic and socio-psychological variables, as well as to investigate their corresponding characteristics; to establish relationships between intra- and interpersonal variables; to correlate personality traits with interpersonal interaction, social behavior, social attitudes and reactions of the individual. To study the level of social adaptation of patients, a questionnaire of social maladaptation associated with tremor was selected, which made it possible to assess the social consequences of existing disorders, as well as the real severity of tremor. Psychological factors play a significant role in the formation and course of Parkinson’s disease (PD). The study of social adaptation in patients with tremor in PD was first conducted. The study of the personality characteristics of patients with PD showed that, regardless of the form of the disease, all patients with PD are characterized by a decrease in the perception of their social reputation, attractiveness, popularity, respect for others, and the ability to achieve their goals; lack of long-term attachments, lack of sociability, poor ability to surrender, poor fantasy. Only patients with an akinetic-rigid form are characterized by humility, obedience, complaisance, patience, distrust, distancing from other people. Patients with combined tremor are more prone to anxiety than patients with isolated tremor. Shivering hyperkinesis causes social disadaptation and self-stigmatization of patients.

Social adaptation level and its relationship with the main clinico-dynamic and psychological characteristics in the comorbidity of affective disorders and alcohol dependence

Alcohol dependence (AD) and mood disorders are not only a serious medical and socio-economic problem for modern society, but also the cause of social adaptation disorders that form even in the early stages of each of these disorders, as well as in case of their comorbidity.Objective: to determine the relationship between the level of subjective assessment of social adaptation and the main clinical, dynamic and psychological characteristics in patients with affective disorders (AFD) with comorbid AD.Patients and methods. The study included 126 patients treated for AFD in the departments of affective or addictive conditions of the clinic of the Research Institute of Mental Health of the Tomsk National Research Medical Center (F31 – F34.1 according to ICD-10; n=83) or AFD comorbid with AD (F10. 2; n=43). The study used clinical-dynamic, psychometric, pathopsychological and statistical methods.Results and discussion. Patients with AFD without comorbidity at admission were characterized by a greater severity of subjective impairment of social adaptation and anhedonia; hypochondriacal, depressive, psychasthenic and schizoid traits predominated in the structure of their personality. At the same time, the condition of patients with AFD and AD comorbidity was objectively assessed as more severe. An inverse correlation was found between the level of subjective assessment of social adaptation and anhedonia in the group of patients with «pure» AFD, and in the group with AFD and AD comorbidity, with the severity of depressive symptoms (due to typical depressive symptoms), as well as with depressive and anxious personality traits of patients.Conclusion. Self-assessment of social adaptation of patients with “pure” AFD depends on the intensity of anhedonia manifestations, and in patients with AFD and AD comorbidity, on depressive symptoms (due to typical depressive symptoms) and on the severity of such psychological characteristics as depression and psychasthenia.

Clinical features of prosthetic treatment in edentuluos patients

BACKGROUND: Social adaptation of patients with complete absence of teeth is associated with fixation and stabilization of prostheses during chewing and speech. It is necessary to take into account the somatic status of the patient, the causes of tooth loss, pay attention to the clinical stages of orthopedic treatment.&#x0D; AIM: Of the study is to increase the efficiency of the orthopedic dentist with full removable prosthetics.&#x0D; MATERIAL AND METHODS: The conditions for obtaining a compression impression are a rigid spoon, silicone impression material of medium viscosity, constant pressure at the time of impression removal. The indication for removing the compression impression is the mucous membrane of the 1st type according to the Supple. The conditions for removing decompression impressions are a perforated individual spoon, liquid-flowing impression material, no pressure on the oral mucosa. The indication for the use of decompression impressions is a thin, atrophied mucous membrane of the oral cavity of the 2nd type according to Supple. It is necessary to use functional impressions combined according to the degree of pressure on the oral mucosa. This implies the peculiarities of manufacturing a rigid base with wax rollers. After determining the central ratio of the jaws and packing the template basis with bite rollers, the doctor applies the impression material differentially to its inner surface. Both templates with bite rollers are inserted into the oral cavity, the doctor controls the central position of the lower jaw, while functional impressions are taken from the upper and lower jaws, taking into account the functional pressure of the patients chewing muscles. This will allow you to evenly distribute the chewing pressure on the oral mucosa. The value of functional rest is determined by measuring two marked points at the base of the nose and on the chin and always exceeds the amount of separation in the state of the central ratio of the jaws by the amount of the interclusal space. Having determined the amount of functional rest, they begin to design the maxillary occlusion pattern, then note the anatomical landmarks. Often, the removal of impressions with a corrective silicone mass is performed in the position of the central ratio.&#x0D; The value of functional rest is determined by a set of anatomical landmarks in a state of maximum possible muscle relaxation in combination with phonetic tests when closing the lips without tension.&#x0D; RESULTS: The determination of the central ratio on rigid bases makes it possible to accurately fix the interalveolar distance. Patients adapt to prosthetic structures faster.&#x0D; The use of a facial arch with an articulator significantly improves the quality of the prosthetic structure, allows you to individualize the anatomical parameters of the patient.&#x0D; When determining the central ratio of the jaws, checking the design of the future prosthesis, cone-beam computed tomography of the temporomandibular joint was used to control the position of the heads of the lower jaw, confirming the correctness of the actions. At the stage of checking the design of the removable prosthesis, phonetic tests were used.&#x0D; CONCLUSION: The use of combined impressions with simultaneous determination of the central ratio of the jaws and control of the position of the heads of the lower jaw can accelerate the process of orthopedic treatment (combining two stages) and adaptation to removable prostheses. To improve speech during treatment, it is necessary to use special phonetic tests that allow you to restore the correct ratio between the jaws, find the optimal position of artificial teeth, determine the boundaries and shape of the basis of the prosthesis and design the optimal prosthesis for each patient.

Predictors of the Effectiveness of Medical Rehabilitation of Patients with Cerebral Palsy

INTRODUCTION: Cerebral palsy (CP) is one of the most common causes of disability in children. The use of clinical tools that will allow the prediction of results is necessary for the medical rehabilitation of children with CP. Although clinical and socio-economic factors that determine the prognosis of rehabilitation and further social adaptation of patients with CP are being actively investigated, predictors that help predict the effectiveness of medical rehabilitation measures are not yet identified.&#x0D; AIM: To determine the predictors of the effectiveness of medical rehabilitation in children with CP using anamnesis, scales, and questionnaire data.&#x0D; MATERIALS AND METHODS: The study involved 29 children (average age, 5.4 1.1 years) with various forms of CP who underwent medical rehabilitation in inpatient and outpatient conditions within 12 months. Before and after rehabilitation courses, all patients, apart from general somatic-clinical and neurological examinations, underwent tests that use specialized questionnaires and scales and evaluation using the International Classification of Functioning, Disability and Health (ICF) Core Sets for children and adolescence with cerebral palsy. The patients were arranged into groups depending on the presence of improvement determined using the author-developed criterion: reduction of the determinant level relative to function and activity and participation components of ICF by a minimum of at least one point in three domains. Various uni- and multivariate logistic regression models were used to evaluate the prognostic significance of history, scales, and questionnaire data. Receiver operating characteristic curves were constructed to determine the threshold values of quantitative parameters optimal for predicting a certain treatment outcome.&#x0D; RESULTS: The Gross Motor Function Measure 88 score of 82.1% before the rehabilitation measures indicated a positive rehabilitation prognosis. ICF domains b760 control of voluntary movement functions, d415 maintaining a body position, and d710 basic interpersonal relations are predictors of the effectiveness of rehabilitation in patients with a CP with determinant level 1.&#x0D; CONCLUSION: The results demonstrated that higher parameters of motor and coordination functions and higher levels of interpersonal interactions of children with ICP are significant predictors of the effectiveness of rehabilitation.

Growth hormone deficiency in childhood brain tumors and acute lymphoblastic leukemia survivors

Thanks to modern treatment protocols, childhood cancer survivors (CCS) are a very fast-growing population nowadays. Cancer therapy inevitably leads to different late adverse effects, where endocrine disorders are highly prevalent, including growth hormone deficiency (GHD) which is the most common endocrine outcome after cancer treatment in childhood and contributes to impaired growth. Short stature is a big issue, which leads to problems in psychological and social adaptation of patients and reduces their quality of life. Impact of GH treatment on various physiological processes and global outcome of CCS is of great interest. Several studies have demonstrated an influence of GH and IGF-1 on the development/tumour growth, cell proliferation. In this regard, the issue of increasing the risk of cancer recurrence and/or the development of secondary neoplasms in CCS, causes a lot of controversy and is the subject of continuous evaluation. In this review, we went through the available data on the prevalence and pathogenesis of GHD following chemo- and radiotherapy, in particular after treatment of brain tumors and acute lymphoblastic leukaemia in childhood. In addition, here we discuss the existing problems in the diagnosis of GHD, the safety of GH replacement therapy, as well as the treatment algorithm of the GHD in adults.

Surgical treatment of acetabular fractures

Background. Acetabular fractures are severe intra-articular injuries that require anatomical reposition and early function, but they are often complicated by degenerative changes in both the acetabulum and the femoral head, leading to the development of post-traumatic coxarthrosis. The purpose was to study the clinical effectiveness of surgical treatment and postoperative management of patients using autologous platelet-rich plasma in patients with fractures of the acetabulum. Materials and methods. Twenty-eight patients with acetabular fractures of various degrees were operated at the City Emergency Hospital of Zaporizhzhia and the Municipal Clinical Hospital No 9 from 2017 to 2019. Gender composition: 22 men (78.57 %), 6 women (21.43 %), average age 46.64 ± 2.21 years, with a 95% confidence interval 42.31–50.96. Nineteen victims (67.86 %) had road traffic injuries, 7 (25 %) domestic injuries, and 2 (7.14 %) had industrial injuries. Results. In the main group of patients treated with platelet-rich plasma, radiologically visible adhesion of the injured area after 8 weeks occurred in 10 people (83.4 %). In one person (8.3 %), the adhesion occurred after 12, and in another (8.3 %) — 16 weeks after surgery. In the control group, adhesions at 8th week were registered in 14 patients (60.87 %), in 8 (34.78 %) — at 16th week. Given the general recovery of the body in the main group, the activation and social adaptation of patients occurred 2–3 weeks earlier. The assessment was performed radiologically and by the criteria of functional recovery.

Olfactory disorders as a multidisciplinary problem

Olfactory dysfunction is a serious symptom that requires careful differential diagnosis. The article presents convincing evidence that dysosmia is not only a symptom of rinological pathology, but also a manifestation of various neurodegenerative diseases. Some patients with SARS-CoV-2 have neurological symptoms. Modern studies show that olfactory and gustatory dysfunctions are significant symptoms in the clinical presentation of the COVID-19 infection. The importance of olfactory diagnostics in relatives of patients with hereditary neurodegenerative diseases for the purpose of early detection of pathology is noted. We consider the possibility of introducing new methods for the diagnosis of olfactory dysfunction, which is a promising task both in the field of neurology and otorhinolaryngology, in order to prevent the development of neurodegenerative diseases at an early stage, improve the quality of life and social adaptation of patients.

Clinical and Therapeutic Factors Affecting the Social Adaptation of Patients with Schizophrenia

Background: сurrently, the question remains open about the factors that affect the social functioning of patients with schizophrenia, including the role of negative symptoms and neurocognitive deficits. The aim: to study factors that affect the social functioning of patients with schizophrenia. Patients and methods: 64 in-patient with schizophrenia (mean age 35.9 ± 10.9 years) were examined at the stage of remission. The disease duration was 9.71 ± 6.0 years. The majority of patients suffered from paranoid and hallucinatory-paranoid attacs (43 and 23%, respectively). The study used follow-up, clinical and psychopathological methods as well as psychometric scales: PANSS, SANS, ВАСS, Calgary scales and UKU scales. An integrative indicator was introduced to assess the social adaptation of patients. Results: it is shown that as the duration of the disease increases, the indicator of social adaptation decreases. The presence of side effects of antipsychotic therapy is associated with restrictions on the social functioning of patients, but the use of second-generation antipsychotics contributes to an increase in the level of social functioning of patients. Patients with more pronounced apathetic-abulic disorders, flattened affect, anhedonia-asociality and social isolation are characterized by a lower level of social functioning. Adapted patients differ from maladapted patients by better indicators of auditory-speech memory, motor skills, information processing speed, ability to plan and problem solving behavior. Conclusion: the integrative indicator of social adaptation of patients with schizophrenia is associated with a number of cognitive and negative symptoms, features of antipsychotic therapy and the duration of the disease.

Наш опыт применения пульсовой радиочастотной абляции ганглиев задних спинальных корешков (PRF DRG) в лечении поясничных радикулопатий

Актуальность. Дегенеративные поражения поясничного отдела позвоночника и связанные с ними клинико-неврологические проявления — одна из наиболее важных проблем современной ортопедии. Консервативное лечение данной патологии эффективно у 60 % пациентов. В остальных случаях боль становится хронической, что приводит к инвалидизации. Эти факты стимулировали разработку малоинвазивных процедур, обладающих достаточной эффективностью при низком риске потенциальных осложнений. Наибольшую распространенность из них получило интервенционное радиочастотное лечение. Цель исследования: изучить динамику болевого синдрома и социальной адаптации у пациентов, страдающих хроническими поясничными радикулопатиями, при использовании в их лечении пульсовой радиочастотной абляции ганглиев задних спинальных корешков (pulsed radiofrequency of dorsal root ganglion — PRF DRG). Материалы и методы. В ретроспективное исследование включены 42 пациента в возрасте от 27 до 78 лет (49,7 ± 14,8 года), пролеченных в 2016–2018 годах в клинике «Нейромед» г. Киева и Институте травматологии и ортопедии НАМН Украины. В обследование были включены пациенты, страдающие реактивными пояснично-крестцовыми радикулопатиями вследствие дегенеративно-дистрофического поражения позвоночника. Болевой синдром оценивался по 10-балльной визуально-аналоговой шкале (ВАШ) перед манипуляцией, непосредственно после нее и через 6 месяцев после ее проведения. Социальную адаптацию в повседневной жизни объективизировали при помощи Oswestry Low Back Pain Disability Questionnaire (ODI). Результаты. Осложнений не зарегистрировано. Абсолютно все пациенты отмечали снижение болевого синдрома. Большинство пациентов до манипуляции характеризовали свою боль как очень сильную (ВАШ — 7,14 ± 0,68), а после процедуры такое же количество больных уже говорили о своей боли как о средней (ВАШ — 4,02 ± 0,81). Подобная же тенденция сохранялась и через полгода после лечения (ВАШ — 1,85 ± 0,78). До манипуляции индекс нарушения жизнедеятельности из-за болевого синдрома составлял 71,42 ± 6,83 балла. А спустя полгода после проведения процедуры индекс ODI уже составлял 18,57 ± 7,83 балла. Выводы. Радиочастотное пульсовое воздействие на ганглии заднего спинального корешка (PRF DRG) является безопасным и эффективным методом лечения хронических поясничных радикулопатий.

Two-stage fixation in the treatment of diabetic arthropathy of the ankle

Aim — to improve the results of treatment of diabetic anklearthropathies by using the final method of fixation by semi-rigid systems after arthrodesis and the use of extrafocal ring fixators (RF). Materials and methods. The authors presented own experience of treatment of 12 patients with diabeticankle osteoarthropathy. After arthrodesis and fixation with RF, the alternating osteosynthesis was performed with Scotchcast/Softcast bandages. The use of extrafocal RF of the needle-rod type in the first stage with low trauma wasadvantageous, however the time of fixation before the appearance of the fusion between the tibia and talus was significant, which led to a decrease in the rigidity of the fixation of the bone-needle system and development of inflammation at the exit of the spokes. This required the transition to other means of fixation, which would provide the possibility of functional use of the limb. The authors used Scotchcast/Softcast functional bandages, applied circularly, with stiffeners on the lateral surfaces, which allowed to carry out the supporting function of the limb. Interventions (arthrodesis of the ankle joint) were performed under multimodal analgesia. Vascular disorders required hematopoietic therapy (use of a tourniquet and administration of tranexamic acid solution) and bemiparin administrationfor microthrombosisprevention. Treatment of diabetic neuropathy and metabolic disorders was carried out by prescribing vitamin B and C, drugs Ca and vitamin D3, antioxidants. Results. The dynamics of the most examined indicators of the coagulation — anticoagulation system did not differ significantly (activated partial thromboplastic time, prothrombin time, international normalized ratio, platelet quantity). There was a tendency to shift the indicators to the recommended safe zone and even a significant decrease in the level of soluble fibrin monomer complexes (R2= 0.9494). Conclusions. The use of Scotchcast/Softcast immobilizing bandages in patients with diabetic arthropathy was safe after arthrodesis and RF fixation.This strategy allowed to restore limb capacity in the early stages of treatment, which improved the social adaptation of patients.&#x0D;

Results of Colostomy Use in Children with Anorectal Malformation

Introduction. Anorectal malformations in children are still one of the most challenging problems in pediatric coloproctology. The incidence of anorectal malformations in recent years has no tendency to decrease and, according to various authors, ranges from 1 in 4000-5000 live births. Most pediatric surgeons continue to adhere to the opinion about the advisability of preliminary colostomy and delayed proctoplasty at the age of 6-18 months or when the child reaches a certain body weight (8-10 kg.). They are motivating this tactic with the possibility of creating an optimal condition for performing a complex intervention, reducing anesthetic risk, avoiding technical errors. Objective is to improve treatment outcomes for anorectal malformations in children with prior colostomy. Materials and methods. The work is based on the results of treatment of 154 children with anorectal malformation, with preliminary colostomy in the clinic of the Tashkent Pediatric Medical Institute for the period from 2000 to 2020. Along with routine and general clinical examination methods, all children underwent: X-ray of the abdominal cavity, colostography, fistuloirrigography, excretory urography, cystography, ultrasound of the perineum (small pelvis), neurosonography (NSG) screening tests. Results. 154 (10*0%) children had colostomy as a palliative stage of treatment. Of these 117 (76%) children developed colostomy on the first day of life, with the development of intestinal obstruction. In 37 (24%) children, the formation of a colostomy was performed directly by us. 9 (5.8%) children as the first stage before primary radical correction with a high form of the defect and 10 (6.5%) children previously operated on and requiring re-corrective operations, 5 (3.2%) patients underwent colostomy after the development of complications in the early postoperative period. In 13 (8.5%) cases, colostomies were formed with identified concomitant anomalies and defects that clinically "dominated" over anorectal malformation. In 2 (5.4%), a double sigmastoma was imposed, in 2 (5.4%) a distal single-barreled sigmastoma, in 5 (13.5%) the Hartmann type terminal sigmastoma. Conclusion. The use of colostomy in children with anorectal malformation made it possible to carry out the necessary surgical tactics in a timely and differentiated manner. To reduce the frequency, nature of complications and early disability, to improve the quality of life and social adaptation of patients.