Social Rehabilitation Of Patients Research Articles

DENTAL IMPLANTATION AFTER RECONSTRUCTION OF TOTAL AND SUBTOTAL DEFECTS OF THE UPPER AND LOWER JAWS

Medical and social rehabilitation of patients with total jaw defects is an urgent surgical problem for maxillofacial surgeons. Cicatricial deformities, functional disorders of anatomical structures after resection are a difficult task for reconstructive surgery. It is impossible to achieve positive results without the use of digital technologies, a review of the methods of «digital dentistry» (CAD-CAM modeling and 3D printing) on clinical examples.The aim of the study was to investigate the necessity of using digital technology in prosthetic patients with subtotal and total jawbone defects.Materials and methods. The review provides examples of complex dental rehabilitation of patients with a detailed description of clinical and laboratory procedures, photographs and X-ray studies.Results. An illustrative clinical example confirms the high value and significant role of computer simulation in complex clinical cases and situations. The presented technique made it possible to restore the former quality of life of patients, which indicates its high development today.Conclusions. Clinical examples confirm the effectiveness of the use of digital dental technologies, prosthetics on implants in maxillofacial surgical dentistry. In the future, these methods will be improved through the introduction of new materials, workflow optimization and improved design accuracy using CAD-CAM and 3D modeling technologies.

Клинический случай комплексного лечения пациентки с паралитическим лагофтальмом, ассоциированным с нейротрофической кератопатией

Introduction. Combined leisure of facial and trigeminal nerves causes paralytic lagophthalmos and severe neurotrophic keratopathy that can lead to significant loss of vision. Material and methods. This article describes a clinical case of step-by-step complex surgical treatment in paralytic lagophthalmos accompanied by neuropathic keratopathy complicated by fistula of corneal graft. Results. The performed three stepped surgeries to improve lagophthalmos and corneal nerve supply resulted in subcompensation of lagophthalmos and restoration of corneal sensitivity up to the low limit. This was accompanied by heeling of long lasting corneal fistula. Conclusion. Pathogenetic treatment of combined paralytic changes, that includes correction of eyelid position and direct corneal neurotization, provides medical and social rehabilitation of patients with paralytic lagophthalmos complicated by neurotrophic keratopathy. Keywords: facial nerve, trigeminal nerve, neuropathic keratopathy, corneal neurotization, corneal fistula

Первичная отсроченная хирургическая помощь пациенту с боевым ранением глаза

Currently, injuries to the visual organ are one of the most important causes of blindness and disability due to the complicated course of the post-traumatic process and an unfavorable functional outcome, in the vast majority of cases of the able-bodied population. The timeliness of providing highly specialized ophthalmic surgical care is a fundamental factor that allows for the medical and social rehabilitation of patients with various visual organ injuries in the shortest possible time. In turn, the prolongation of the terms of primary surgical treatment dictates slightly different approaches to the conservative and surgical treatment of such patients. Objective. To evaluate the effectiveness of primary delayed simultaneous surgical care for a patient with a penetrating comminuted battle wound of the eye. Material and metods. Patient K., 35 years old, was admitted to the ophthalmological department of the State Medical Institution «OOKB» of Orenburg with complaints of decreased visual acuity of the left eye with the diagnosis: OS – Multiple military trauma. Consequences of penetrating eye injury. Corneal scar. Traumatic cataract. Partial hemophthalmos. Local retinal detachment. Intraocular foreign bodies. From anamnesis: a month ago, during military operations, he received a shrapnel wound to the head. An open penetrating comminuted fracture of the left temporal bone was performed in a military hospital. I did not receive surgical ophthalmological care. Ophthalmological status: Vis OD = 1,0: OS = movement of the shadow at the face. The IOP of both eyes is normal. OS – conjunctiva is injected, a metallic foreign body is embedded in the sclera at the meridian of 7 hours, 5 mm from the limb, the cornea is transparent, the corneal scar, the anterior chamber is shallow, the moisture is transparent, the iris is edematous, the pupil in the center is deformed, tightened for 7 hours, the pupil reaction is slowed down, inhomogeneous opacities in the lens. The reflex is dim, the details of the fundus and vitreous are not ophthalmoscoped. Preparatory measures were carried out before the surgical intervention: antibacterial and anti-inflammatory therapy. At the first stage, phacoemulsification of traumatic cataract with posterior continuous capsulorexis was performed in the conditions of medical mydriasis. The second stage was a standard three-port vitrectomy of 25 G with the removal of organized vitreous blood clots and the removal of the posterior hyaloid membrane. During the revision, a parietal foreign body with local retinal detachment is visualized in the middle outer part. A 23 G tweezers were used to remove the foreign body, which required the replacement of one of the ports. Delimitative endolasercoagulation was performed. The foreign body was removed through the posterior capsulorexis: brought to the iris in the anterior chamber of the eye, then evacuated through a tunnel incision of 2.75 mm. Then a perfluoroorganic compound (PFOS) was introduced, the retina was attached, additional retinal endolasercoagulation was performed. At the third stage, a simultaneous replacement of PFOS with silicone oil was carried out. The Miol-soft intraocular lens was implanted. At the last stage, the embedded foreign body of the sclera was removed, the conjunctival wound was sutured. On the fifth day after surgical treatment, the patient was discharged for outpatient follow-up with the functions of vis OS = 0.2 sph (+) 4.0 = 0.4 with recommendations. Conclusions. As a result of simultaneous high-tech vitreoretinal surgical treatment against the background of anti-inflammatory and antibacterial therapy, high functional results were achieved. Keywords: injury, penetrating wound of the eye, foreign body of the eye, local retinal detachment

THROMBECTOMY IN PATIENTS WITH THROMBOSIS OF ARTERIO-VENOUS FISTULA: CASE SERIES

Introduction. Thanks to the use of renal replacement therapy at the current stage of medical development, complete medical and social rehabilitation of patients with end-stage chronic renal failure is possible. The key to effective programmed hemodialysis is the formation of adequate permanent vascular access. Ensuring the optimal use and functioning of permanent vascular access is a multidisciplinary challenge. Currently, none of the known options for permanent vascular access is ideal, but a native arteriovenous fistula meets the requirements to a greater extent. Complications from vascular access for hemodialysis remain relevant for their solution today. The most common complication of vascular access is thrombosis of an arteriovenous fistula. For patients with chronic renal failure who are on programmed hemodialysis, thrombosis of vascular access is a great danger, which ultimately can lead to the impossibility of further hemodialysis and is the main reason for hospitalization and high mortality of this contingent of patients and needs an urgent solution.
 Clinical cases. 17 patients underwent thrombectomy from the subcutaneous "fistula". vein of the upper extremity. The age of the patients was 49.0 (44.0-61.0) years. By gender, the studied patients were distributed as follows: women - 9 (53%), men - 8 (47%). Among 17 (100%) operated patients, 12 (71%) had late thrombosis, 5 (29%) had early thrombosis of arteriovenous fistula,. Of 5 (100%) patients with early thrombosis of arteriovenous fistula, thrombectomy was effective in 2 (40%) patients (p=0.038). On the other hand, in 12 (100%) patients with late thrombosis of arteriovenous fistula, thrombectomy was successful in only 4 (33%) cases.
 Discussion. The cause of thrombosis of any vascular anastomosis is primarily hyperplasia of the neointima due to the proliferation of smooth muscle cells of the vascular wall. This circumstance leads to the formation of stenosis of the anastomosis, and as soon as the stenosis values become hemodynamically significant (> 50% of the lumen of the vessel), the risk of developing thrombosis increases by more than 50%. Thrombectomy alone is insufficient to restore patency of the permanent vascular access in the long term, as flow-limiting stenosis is present in more than 85% of cases.
 Conclusions. Neointimal hyperplasia is the main cause of progressive stenosis of arteriovenous fistula and subsequent thrombosis. Thrombectomy is indicated for thrombosis of arteriovenous fistula in the early postoperative period (up to 30 days after arteriovenous fistula formation). Thrombectomy alone is not enough to restore the patency of the permanent vascular access in the long term, and the final treatment requires its reconstruction at an early stage or the creation of a new arteriovenous fistula.

The main provisions of programs of medical and social rehabilitation of patients with occupational diseases of ent organs

The article discusses the main, modern provisions of the programs of medical and social rehabilitation of patients with occupational diseases of the ENT organs. The criteria of the degree of loss of professional ability to work in hearing loss and malignant neoplasms of the upper respiratory tract are presented. Rehabilitation programs and forms are developed taking into account the needs of the victim in medical, social and vocational rehabilitation, taking into account the potential capabilities and abilities of the victim to carry out professional, domestic and social activities.

Функциональное состояние единственной почки после нефрэктомии по поводу рака

The outcome of surgical treatment of renal cancer depends not only on cancer-specific survival, but also on the degree of loss of renal function, which often develops after surgery, especially radical nephrectomy.To study the features of functional changes in a solitary kidney as a compensation mechanism after radical nephrectomy for renal cancer.The functional state of a solitary kidney in 36 patients with renal cancer who undergone to radical nephrectomy was evaluated. There were 20 and 16 women. The mean age was 59.0+/-10.8 years (from 39 to 76 years). The size of the tumor was in the range of 7.0-12.0 cm. All patients with a solitary kidney underwent a follow-up examination 3 months after surgery, including measurement of peripheral blood pressure with calculation of mean dynamic pressure, renal ultrasound, calculation of glomerular filtration rate (GFR), renal doppler ultrasound, determination of serum fibrinogen and fibrin monomers, and microscopy of the bulbar conjunctiva. Patients who had pathological abnormalities during the examination were prescribed reno-cardioprotective drugs, including perindopril in a titrated dose, apixaban 5 mg a day as thromboprophylaxis and for improvement of the flow properties of blood for a period of 3 months with re-evaluation of the above parameters.In 61.1% of patients after radical nephrectomy, on 2-4 postoperative days, there was a tendency to increase blood pressure compared to baseline values (p<0.05). By the seventh day after the procedure, the volume of the contralateral kidney increased on average by 16% (from 110.4+/-11.2 cm3 to 132.4+/-4.8 cm3, p<0.05). After radical nephrectomy, a decrease in GFR was detected in 33 cases (91.7%; p<0.05). Renal doppler ultrasound showed a moderate increase in linear blood flow, the resistance index in the main renal artery, and a decrease in the pulse index in the segmental and arcuate arteries. The microscopy of the bulbar conjunctiva in 83.3% of patients revealed changes in the microcirculatory bed, including narrowing of arterioles, dilation of venules, a decrease in venular and capillary blood flow. After 3 months of reno-cardioprotective therapy, it was revealed that the target values of blood pressure (<130/85 mm Hg) were achieved with an average dynamic blood pressure of 93.4+/-2.6 mm Hg. In addition, a decrease in creatinine to an average of 106.2+/-6.4, fibrinogen and fibrin monomers to subnormal values of 3.2+/-0.2 g/l and up to 8.1+/-0.5x10-2 g/l, respectively were seen. Renal hypertrophy according to ultrasound examination was preserved with a mean kidney volume 119.7+/-3.6 cm3. Disturbances in peripheral microcirculation according to the microscopy of the bulbar conjunctiva was assessed as moderate.The development of CKD in patients with a solitary kidney is accompanied by a structural reorganization of the organ with an increase in blood pressure, an increase in its volume, a decrease in function, microcirculatory disorders and hypertensive nephropathy. Considering the prognostic significance of changes in the solitary kidney, it is important not only to control the functional parameters, but also to include reno- cardioprotective therapy as a standard, since it contributes to the preservation of the renal function and prevents the rapid progression of CKD. Thus, medical and social rehabilitation of patients with a solitary kidney is required. However, it is currently cannot be considered comprehensive.

Video and social rehabilitation of persons with mental illness helps to structure everyday life: a qualitative study.

Living with a mental disorder has a significant impact on everyday life. In 2018, one out of every six adults, equivalent to 17.3% of the adult population of the European Union, had symptoms of mental disorders. This paper focus on social rehabilitation of patients with mental illness who have been discharged from hospital and who use video communication technologies in their rehabilitation in collaboration with their social worker. The aim of this study has been to explore the experiences of persons with mental illnesses who participated in a long-term video-based tele-social rehabilitation program, the Video Assist. The overall research strategy is the case study method. Data collection techniques are based on triangulation. Document analysis has been performed. Participant observation in homes of persons with mental using video with social workers (168 hours). Semi structured qualitative interviews with persons with mental illness (n=13) has been conducted lasting between 30 and 60 minutes. Data were analyzed using NVivo 10.0. Experiences of persons with mental illness participating in the tele-social rehabilitation program are in themes: user friendly video technology, video created a new means of communication between citizen and social worker, feeling of surveillance by having the technology in the home, development of new coping strategies in everyday life and need for psychosocial support and training via the video technology. Persons with mental illness who are in a recovery process find that participating in a tele-social-rehabilitation program gives them a sense of mobility, security, surveillance but the ability to develop new coping strategies in their everyday lives. Future research is needed on long-term effects of tele-social rehabilitation for persons with mental illness.

Priorities of medical rehabilitation of patients with recent experience of transient ischemic attack

Introduction.Transient ischemic attacks can be a predictor of a more severe cardiovascular event, the risk of which depends on many factors that requires a personalized approach. Neuropsychological disorders (cognitive, emotional) have a significant impact on quality of life and social activity and are often underestimated in patients with TIA. Comprehensive medical rehabilitation with the inclusion of antithrombotic therapy and psychocorrection measures may reduce the risk of recurrent cardiovascular events in patients with TIA.Purpose of the study: to substantiate the efficiency of complex medical and non-pharmacological rehabilitation in patients who underwent TIA by analyzing the characteristics of the main and leading concomitant diseases.Materials and methods. The morbidity of 351 TIA patients was studied and analyzed. The average age of the examined patients was 58.6 ± 2.2 years, there were 64.9% of women and 35.1% of men. All patients received an individualized medical rehabilitation program for 12 months with correction of identified neuropsychological disorders. Depending on background and concomitant diseases the antiplatelet or anticoagulants therapy was differently administrated.Results and dicussion. Psychological, cognitive, and physical disorders (based on subjective complaints) are common in patients with TIA. The prevalence of mental disorders in patients with TIA was 138.2 cases per 100 patients. The correction of cognitive impairment, depressive symptoms is associated with improved quality of life (p &lt; 0.05). Repeated acute cerebrovascular events (TIA, ischemic stroke) were recorded during the first 6 months after TIA in 29 patients (10.4%) with severe stenosis of the brachiocephalic arteries, severe arterial hypertension and paroxysmal atrial fibrillation.Conclusion.The importance of comprehensive medical and social rehabilitation of patients with TIA is determined. The participation of a psychotherapist as a member of a multidisciplinary team is necessary. A significant role of the secondary prevention of acute cerebrovascular events is assigned to rational antithrombotic therapy.

Features of the organization of complex medical and social rehabilitation of patients with diabetes in the rehabilitation center

The prevalence of diabetes is high and continues to grow. Patients with diabetes make up 3.12% of the population of Russian Federation. Economic losses from diabetes accounted for 1.8% of the worlds gross domestic product. There are no effective treatments for diabetes. The goals of patient care are control homeostasis indicators and prevent complications. The Russian Federation has created a multi-level system of care for patients with diabetes. Social protection institutions take part in comprehensive rehabilitation of patients with diabetes. In 20152019 years the state budgetary institution of the city of Moscow Scientific and practical rehabilitation center conducted inpatient rehabilitation of 10.4 thousand disabled people. The prevalence of diabetes among them was 19.5%. Rehabilitation of patients with diabetes in the rehabilitation center has a number of features: planned nature, the possibility of individual and group work of doctors with patients, the state of physical and psychological comfort of patients, the use of climate therapy.

Features of obsessive autoerotic behavior in men

The study objective is to investigate clinical features of obsessive autoerotic behavior in men and to develop a complex of therapeutic interventions. Materials and methods Comparison and analysis of psychopathic characteristics of 60 patients were performed. The group 1 included 28 patients with schizoid personality disorder, the group 2 included 14 patients with obsessive compulsive disorder, the group 3 included 18patients with schizotypal disorder. Results. Presence of obsessive autoerotic behavior and its clinical and psychopathological features are considered an important criterion of mental pathology diagnosis. A program of effective therapy and rehabilitation for these disorders is proposed: in patients with schizoid personality disorder — serotoninergic antidepressants and low doses of antipsychotics; in patients with obsessive compulsive disorder — anxiolytics (for several subsequent weeks), selective serotonin reuptake inhibitors and low doses of antipsychotics; in patients with schizotypal disorder — atypical antipsychotics predominantly in combination with selective serotonin reuptake inhibitors. Social rehabilitation of patients is also necessary for all groups. It is directed towards learning social skills of appropriate interactions with the partner considering their needs, capabilities, personal preferences both in intimate relations and everyday life. Conclusion. Features of obsessive autoerotic behavior (pretentiousness, preferring these sexual activities to real sexual contacts with an available partner, persistent character et al.) can serve as a criterion for diagnosis of mental pathology and basis for therapy selection. In selection of medications, clinical manifestations of mental disorders are considered.

Разработка и анализ эффективности клинико-математической системы прогнозирования развития ятрогенного синдрома «сухого глаза» после факоэмульсификации возрастной катаракты

Purpose . Development and analysis of effectiveness of predictive clinical-mathematical system of development of dry eye syndrome (DES) after phacoemulsification (PE) of senile cataract (SC). Material and methods . 120 patients (120 eyes) after SC surgery: 52 men and 68 women. Age: from 62 to 83 years (average 69.3±6.4 years). The main selection criteria for study were the absence of objective and subjective signs of DES, the presence of initial or immature SC and optimal conditions for surgery – absence of corneal pathology and mydriasis of 6 mm or more. Standard preoperative examination; 3 months after PE – Schirmer 1 test, tear break-up time, OCT mapping (Avanti RTVue XR, Optovue, USA). The above indicators were selected as potential predictors for development of algorithms for predicting of development of DES after PE of SC. Patients were divided into groups: 1st group consisted of 31 patients (31 eyes) with DES developed after PE, 2nd group consisted of 89 patients (89 eyes) without signs of DES. Results . Based on peculiarities of induced damage to structures of ocular surface in treatment of SC, two algorithms were developed to predict DES after FE of SC, which shown high prognostic characteristics: sensitivity – 80–90% and specificity – 80–87%, allowing to consider them reasonable and informative. Conclusion . The analysis of the developed clinical and mathematical system for predicting the development of DES after PE of SC showed its high efficiency. Application of developed technique in ophthalmic practice is advisable to ensure maximum medical and social rehabilitation of patients with SC.

P0910CLINICAL-LABORATORY AND CYTOMORPHOLOGICAL CHARACTERISTICS OF HYPERPARATHYROIDISM IN PATIENTS WITH CRONIC KIDNEY DISEASE

Abstract Background and Aims Secondary hyperparathyroidism (HPT) is a serious complication of chronic kidney disease (CKD), which decrease the medical and social rehabilitation of patients, increases cardiovascular morbidity and mortality. The aim of the study is analysis the clinical and laboratory manifestations of secondary HPT and cytomorphological signs of parathyroid glands (PG) tissue in patients with CKD. Method 51 patients (age 24-66 years) with CKD G5D (on hemodialysis – 30 patients and peritoneal dialysis – 21 patients) and HPT were examined. Clinical and laboratory examination included determination of laboratory parameters of mineral and bone metabolism, an ultrasound study of the PG, a fine needle aspiration biopsy of the visualized lesions in the projection of the PG, and light microscopy of the material obtained (х400). The method of logical-semantic analysis (program “Consilium”) is used. Results All patients had severe HPT with high turnover bone disease: bone pain and deformity, increase of serum PTH to 2200±817 pg/ml, calcium and phosphorus of blood, respectively 2.4±0.2 and 2.2±0.4 mmol/l, alkaline phosphatase activity 489±205 u/l (norm 30-117), a decrease in bone mineral density according to dual energy X-ray absorptiometry in the distal forearm – 100% patients, proximal femur and lumbar spine – 50% patient. An ultrasound procedure visualized from two to four enlarged PG with a diameter of more than 1 cm and a heterogeneous ultrasound structure. A large number of epithelial elements were determined in the puncture material of the PG tissue, multicellular clusters of major dark parathyrocytes in combination with groups of major light parathyrocytes, the presence of pronounced intercellular contacts and the absence of macrophages and fat cells (fig). Conclusion Severe HPT in patients with CKD is characterized by an increase in PG by more than 1 cm with a heterogeneous ultrasound structure and pronounced proliferative activity in the parenchyma of glands tissue.

Quality of life of patients with terminal stage of chronic kidney disease

WHO defines quality of life (QL) as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns". Health related QL is an evaluation of QL and its relationship with health. The aim. To analyse quality of life components in patients with chronic kidney disease (CKD), stage V. For this 68 CKD (stage V) patients have been under examination. By assessing physical activity, performance, clinical and laboratory data, an objective assessment of QL have been made. The patient's subjective perception of his illness and social adaptation makes it possible to determine with great accuracy the measures necessary for the medical and social rehabilitation of patients on program and peritoneal dialysis. Conclusion. In the terminal stage of CKD, the patients’ QL and its individual components deteriorate significantly. According to general health, physical, mental well-being, social functioning, the lowest assessment of QL was found in patients of the hemodialysis group.

Features of postoperative period in patients with chronic venous insufficiency: phlebectomy versus thermal ablation

The purpose of the study was to conduct a comparative assessment of the course of the postoperative period after phlebectomy and thermal ablation in patients with varicose veins of the lower extremities in the system of the great saphenous vein (GSV) with class C2 of chronic venous insufficiency (CVI) — CEAP class C2. Materials and methods: 455 patients (455 limbs) with CEAP class C2. Group 1 (n = 154) received stripping + minimally invasive phlebectomy; Group 2 — endovenous laser ablation (EVLA) of GSV trunk + sclerotherapy of varicose veins; 3 group (n = 150) — radiofrequency ablation (RFA) of the GSV + sclerotherapy. All patients were united by a single tactical solution — the elimination of pathological vertical reflux in GSV. In each group, patients were with similar hemodynamic profile were selected (Group 1 = 63; Group 2 = 61; Group 3 = 61). The course of the postoperative period (from 2 days to 2 months) was compared for pain (visual analog scale — VAS), clinical symptoms of chronic venous insufficiency, degree of satisfaction (Darvall questionnaire), and duration of disability. Statistical processing was carried out using Excel programs for Windows XP, MedCalc® (version 11.4.2.0., Mariakerke, Belgium). Results: Postoperative pain is more pronounced (during day 1 for Group 1–4.0, Group 2–3.0, Group 3–2.0) and more prolonged (up to 4 days) after open surgeries (p &lt; 0.05). The dynamics of the clinical symptoms of CVI (including varicose syndrome and use of compression therapy) could not be fully evaluated in connection with the ongoing sclerotherapy procedures for patients of Groups 2 and 3. Satisfaction of patients with aesthetic aspects was higher than expected in all groups. Reliable statistical differences proved decrease in days of disability (Group 1–14; Group 2–4; Group 3–3) and earlier return to physical activities and work in patients after thermal ablation in comparison with phlebectomy. Conclusion: The study shows that all three methods for eliminating vertical reflux in the GSV can be proposed for a large category of patients with CEAP of class C3 and C2. Medical and social rehabilitation of patients using endovascular thermal ablation technologies proceeds faster, which is beneficial both for the patients and for society.

Characteristics of personality in patients with endogenous psychoses with an episodicаl course in the context of post-manifest pathopersonаlogical transformations (comparative analysis)

Solution of the problems of differential diagnosis, treatment and social rehabilitation of patients with endogenous psychoses with episodic course is one of the most complex and urgent problems of clinical psychiatry, which is caused by polymorphism and variability of symptoms, decrease or loss of critical attitude toward the disease, with grave social and economic consequences. The aim of the study is to establish, on the basis of the results of the comparative analysis of the characteristics of the personal profile, the features and nosospecific differences of post-manifest pathopersonаlogical transformations in patients with schizophrenia, schizoaffective disorder and affective disorders in remission / intermissions. The study examined the personality characteristics of endogenous psychoses with an episodic course in remission / intermission conditions and established signs and nosospecific differences in post-manifest pathological transformations in patients with schizophrenia, schizoaffective disorder, and affective disorders. Existing pathopersonalogical transformations are characterized by signs of multidirectional tendencies of compensatory tension of personal resources, which is confirmed by the presence of several moderately elevated (65-75 T-points) indicators of individual scales and a simultaneous increase in indicators of both hyposthenic (2nd and 7th scales) and hypersthenic ( 4th and 9th scales) registers. In schizoaffective disorder, such scales are the 2nd (65.36±12.28 T-points), 4th (73.23±11.83 T-points), 8th (68.40±12.33 T-points) and 9th (66.05±12.02 T-points); in affective disorders, these are the 2nd, 4th and 8th scales (67.72±13.96, 67.08±9.53 and 65.90±10.08 T-points, respectively); for schizophrenia, such scales are the 2nd (72.37 ± 16.80 T-points), 4th (69.47±12.48 T-points), 7th (66.59±15.69 T-points) ) and 8th (71.73±19.95 T-points). The obtained data can be used as a component of the differential diagnosis system and personified psychotherapeutic support.

TYPOLOGY OF PATHOPERSONOLOGICAL TRANSFORMATIONS IN PATIENTS WITH SCHIZOAFFECTIVE DISORDER

The issue of diagnostics, treatment and social rehabilitation of patients with endogenous psychoses with episodic course remains one of the most urgent problems of psychiatry, which, despite the considerable advances of science and practice, has not found a definitive solution. Significant difficulties of nosological separation in the group of endogenous psychoses with episodic course and evaluation of the pathopersonological aspect of the clinic are related to schizoaffective disorder. The aim of the study was to establish a typology of pathopersonological transformations in patients with schizoaffective disorder based on the analysis of clinical-psychopathological, medical-psychological, clinical-ethological characteristics of remission. On the basis of “Regional Clinical Psychiatric Hospital” (Zaporizhzhіa) 102 persons with the established diagnosis of schizoaffective disorder were examined. The main methods of the study were clinical psycho-pathological, psychodiagnostic, patho-psychological, clinical-anamnestic, clinical-medical, social-medical and statistical analysis. As a result of the conducted research, on the basis of the analysis of clinical-psychopathological, medical-psychological, clinical-ethological characteristics of remission, the typology of pathopersonological transformations was established. The presence and prevalence of 4 main types of pathopersonological transformations in schizoaffective disorder (“affective-labile” (20.1 % of the contingent), “paranoid-dysthymic” (17.3 %), “hysteroid-agonistic” (25.9 %), “Neurocognitive-deficient” (16.9 %) and “mixed” (19.8 % of the contingent)), which differ in clinical-anamnestic, clinical-psychopathological, medical-psychological, neuropsychological and clinical-ethological characteristics and cause social (labor and family) maladjustment of varying degrees. The clinical-anamnestic, clinical-psychopathological, medical-psychological, neuropsychological and clinical-ethological features identified in the study can be used to determine the type of pathopersonological transformations and its severity in patients with schizoaffective disorder and, accordingly, quantitative characteristics of individually needed psychopharmacological, psychotherapeutic and social rehabilitation activities and evaluation of their effectiveness in dynamics.

CT-PLANNING ACCESS FOR ADRENALECTOMY

Aim: to determine the possibilities of modern multislice computed tomography in the preoperative planning of a rational variant of surgical access to the adrenal gland with a tumor. Materials and methods: the results of the examination and treatment of 1196 patients with surgical diseases of the adrenal glands (AG) were studied. The virtual-figurative design of a rational variant of surgical access to AG with a tumor was carried out in 362 patients after evaluating the features of their topographic-anatomical location according to CT-scan. The criterion for the inclusion of patients in the study was the ability to perform after 2013 multislice computed tomography (MSCT) with intravenous contrast on the modern installation Aquillion 64 (Toshiba, Japan) and subsequent post-processing of images with the construction of multiplane and 3D reconstructions. Results: studying the features of the topographic-anatomical location of AGs with a tumor using MSCT allowed us to form a virtual-figurative perception of their syntopy in 362 patients and to design options for access to perform adrenalectomy (AE): retroperitoneoscopic (n = 303), laparoscopic (n = 25), thoracophrenotomy ( n = 30), thoracophrenolaparotomic (n = 5). 363 surgical interventions were performed for 362 patients. A single-sided retroperitoneoscopic AE for pheochromocytoma was performed in 1 patient. Reliable CT criteria were determined that affect the duration and safety of the above-mentioned accesses performed by AEs. It has been established that when designing access to the right AG, it is necessary to consider: the diameter of the neoplasm; the location of the AG with a tumor relative to the inferior vena cava and the lower right hepatic vein; contact with vessels in the gate of the kidney, as well as the presence of additional central veins AG. The determining factors in planning access to the left AG are: neoplasm diameter, contact with vessels in the gate of the kidney and splenic vessels, location in the aorto-renal vascular triangle. It was established that retroperitoneoscopic AE, performed in 83.7% of patients with AG tumors with a diameter of ≤ 8 cm, is an operation of choice. Laparoscopic access remains relevant only when the right-sided localization of an AG tumor with a diameter of up to 8 cm and planning simultaneous surgical interventions on the abdominal organs in individuals of a brachymorphic physique (8.3%). Open approaches are shown in benign lesions of the AG more than 8 cm in diameter, generalized forms of adrenocortical cancer (ACC) (T3-4N0-2M0-1), malignant paragangliomas with signs of invasion or distant metastasis (n = 9.7%). Conclusions: multispiral computed tomography allows, before the operation, to carry out adequate planning of the safest surgical access for adrenalectomy, avoiding the development of intra- and postoperative complications, minimizing operative trauma, shortening the operating time, and speeding up the medical and social rehabilitation of patients.

The impact of cognitive behavioral therapy with program (Self- Instructions)

The research aims to identify the effect of behavioral cognitive therapy on with(self–instruction by Meichenbaum)in psychologic and social rehabilitation of patients with residual schizophrenia at(Ibn-Rush Hospital for psychologic diseases)Baghdad, in order to achieve the aim of research, also the static analysis sample has been used that consist of(120)patients with residual schizophrenia, one case has been diagnosed which get lowest degrees for applying the program on it, also build a therapy program according to the presented problem on the scale. after the therapy program has finished with individual therapy method on sample, the results show that program is effective in psychologic and social rehabilitation.

Investigating the effect of a passive exoskeleton on the activity of low back muscles during different phases of repetitive dynamic task

In literature, there are multiple lines of work aimed to develop human-centered robotic devices, and among them there is a promising one named robotic exoskeleton. Exoskeletons are biomechatronic devices coupled to the person's body (a “wearable” robot) (Pons, 2008). In general, exoskeletons are composed of a structural mechanism with joints and links, which is worn by the human user. Hence, the whole kinematic structure usually performs several motions similar to those of the human body. Exoskeletons are devices designed to enhance the human strength by the external framework, thus those devices are currently under development for the enhancement of human motor performance in the military (Zoss et al., 2006), in industry (de Looze et al., 2015), and for medical applications (Colombo, 2001; Veneman, 2007; Gijbels et al., 2011).Technological developments on exoskeletons started in the early 1960s. The US Department of Defense became interested in developing the concept of a powered “suit of armor.” In parallel, researchers at Cornell Aeronautical Laboratories started to develop the concept of man amplifiers such as a manipulator to increase the strength of a human operator (Kazerooni, 1990). In 1962, the technological limitations at that time to develop the concept became apparent: there were limitations in terms of actuators, sensors, and energy storage. Currently, most of those technological limitations have been overcome and applications of exoskeletons have been spreading in multiple fields, including teleoperation with force feedback, power amplifier, entertainment as well as the physical rehabilitation. The rehabilitation field is a key application domain for the development of exoskeletons, to help disabled people with difficulties in moving (Kiguchi et al., 2004; Colombo, 2001). For instance, these devices enable people with paralysis of the lower part of the body (paraplegia) to walk (Esquenazi et al., 2012). Their task is the compensation for the lost functions and physical and social rehabilitation of patients. Nowadays, the exoskeleton systems are forging ahead with high integration using other emerging technologies including virtual reality, haptics, videogames, and soft robotics, among others.

A bionic eye: performance of the Argus II retinal prosthesis in low-vision and social rehabilitation of patients with end-stage retinitis pigmentosa

The death of outer retinal layers occurring in retinitis pigmentosa causes severe visual impairment and often leads to total blindness. Inner retinal layers are spared, though, which provides a possibility of inducing visual perception by direct electrical stimulation of intact retinal cells. This article presents clinical outcomes of two patients who were the first in Russia to have received the Argus II Retinal Prosthesis System. Both implantations were successful. No complications were reported throughout the entire follow-up period. Upon completing 3 rehabilitation sessions, the patients were able to navigate indoors and outdoors, locate small high-contrast objects, discern contours of large objects and people’s silhouettes.