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Vol 26, No 1 (2020)

Cover Page

Health care organization and public health

Effectiveness of a multidisciplinary approach in the rehabilitation treatment of post-stroke patients at the outpatient stage of medical rehabilitation

Fakhretdinov V.V., Brynza N.S., Kurmangulov A.A.


Background. Current approaches to the rehabilitation of stroke patients are based on the early start of rehabilitation measures, a certain sequence, duration, and, of course, the active participation of the patient and their environment. Recently, the scientific medical community has engaged in a serious discussion on the organization of rehabilitation from the perspective of a multidisciplinary approach.

Aim. To assess the impact of the multidisciplinary approach to the outpatient rehabilitation phase on the main health components in stroke patients.

Materials and methods. An experimental, longitudinal, open study included 60 patients with stroke in the late residual period. The studied patients were classified into groups using stratification randomization: Group 1 – 30 (50%) patients with high rehabilitation potential, as well as a high degree of personal interest in undergoing the outpatient phase of medical rehabilitation; Group 2 – 30 (50%) patients who had rehabilitation potential but were, for several reasons, forced to refrain from undergoing the outpatient phase of medical rehabilitation. The duration of the outpatient rehabilitation phase was 14 days: the course of rehabilitation treatment included 10 visits to the rehabilitation department, which operates on the principles of lean manufacturing and a quality management system; 2 days of medical leave; and 2 days of independent work by patients. The multidisciplinary team included a neurologist, physiotherapy physiologist, physical therapy instructor, speech therapist, psychologist, occupational therapist, and a social worker who received special training in medical rehabilitation. As the criteria for assessing the effectiveness of rehabilitation measures during the course of this study, we identified 11 key indicators that allowed us to assess the recovery of neurological deficit, motor functions, possible risk of patients falling, psycho-emotional state, cognitive functions, level of disability, frequency of repeated strokes, number of visits to the clinic place of residence, level of independence, and quality of life of the patient.

Results. When we compared these groups in response to the course of rehabilitation treatment, the patients who passed the outpatient stage achieved a positive result of 91% (a positive response to 10/11 criteria for evaluating effectiveness), while the percentage of response to treatment in the second group was 18% (positive answer for 2/11 criteria for evaluating effectiveness).

Conclusion. To achieve the rehabilitation goals and objectives set for the patient in the late recovery period, it is advisable to conduct the outpatient phase of medical rehabilitation.

Medical Journal of the Russian Federation. 2020;26(1):4-9
pages 4-9 views

Clinical medicine

The use of corrective Chenot corset in the treatment of idiopathic scoliosis in children and adolescents

Shavyrin I.A., Levkov V.Y., Lobov A.N.


Aim. The aim of the study is to evaluate the effectiveness of using a Chenot corset in the treatment of idiopathic scoliosis in children and adolescents.

Materials and methods. Thirty-five patients aged 7 to 17 years, suffering from idiopathic scoliosis degree II-III, under our supervision, were included. The distribution according to gender was 8 boys and 27 girls. The range of the angle of scoliotic deformation before the appointment of the corset was from 21 to 47 degrees according to Cobb on the anterior-posterior x-ray of the spine performed standing. The average angle of deformation was 32 degrees.

Results. Evaluation of the effectiveness of corset therapy was carried out after the patient had adapted to the orthosis (3 months after the appointment of the corset) and reached a wearing time of 18–21 h per day on an x-ray of the spine performed in a standing corset. The average correction was 37.5%, and the average angle of deformation was reduced from 32 to 20 degrees.

Medical Journal of the Russian Federation. 2020;26(1):10-15
pages 10-15 views

Accommodative ability in patients with strabismic amblyopia at concomitant strabismus

Usenko V.A., Berdibaeva A.I.


Aim. To study the state of the accommodative ability of amblyopia before and after treatment.

Materials and methods. One hundred patients (158 eyes) with friendly alternating and monolateral strabismus were examined. The control group consisted of 10 healthy individuals (20 eyes) with emmetropia: the average age of patients under 3 years of age was 2.4 ± 0.15 years, from 3 years to 7 years, 4.8 ± 0.07 years, and above 7 years, 8.3 ± 0.4 years. The vast majority of patients (84 people, 126 eyes) had hyperopic astigmatism, and 16 patients (32 eyes) had a high degree of hyperopia. Twenty-eight patients (40 eyes), 48 patients (84 eyes), and 20 patients (26 eyes) had amblyopia of the 1st, 2nd, and 3rd degrees, respectively. Along with generally accepted methods for examining eyes, the OAA volume and ZAA were determined as the absolute accommodation margin by the proximetric method (AKA-0.1) before and after hardware treatment to relax and stimulate the ciliary muscle.

Results. The results after treatment revealed a 1.5–2-fold increase in OAA to 14.4 ± 0.23 D; 13.5 ± 0.10 D; 13.1 ± 0.41 D; and ZAA and a significant 2-fold increase in visual acuity (P ± 0.001).

Conclusion. A criterion for the effectiveness of hardware treatment for dysbinocular amblyopia is an increase in OAA and ZAA, accompanied by a 2-fold increase in distance visual acuity (P < 0.001).

Medical Journal of the Russian Federation. 2020;26(1):16-20
pages 16-20 views

Comparative analysis of bone volume in the anterior region in patients with protrusion and normal tooth inclination based on CBCT

Kopetskiy I.S., Slabkovskaya A.B., Kabisova G.S., Meskhiya N.G.


The introduction of cone beam computed tomography (CBCT) methods allow to most accurately visualize the bone structures of the maxillofacial region, which enables the specialist to obtain a detailed 3D model of the jaws and teeth with a fairly high resolution.

This article provides the use of computed beam tomography method in orthodontic practice to analyze the initial thickness of bone tissue at various levels of the root length of the frontal group of teeth during their retrusion and protrusion. The calculation results allow us to draw conclusions about the volume of bone tissue and the possibility of orthodontic manipulations. The results of the study significantly improve the diagnosis and planning of orthodontic treatment for pathology in the frontal jaw.

Medical Journal of the Russian Federation. 2020;26(1):21-27
pages 21-27 views

Drug-induced headache in young people of reproductive age with tobacco addiction

Sadretdinova L.D., Derevyanko K.P.


Drug-induced headache (DIH) is one of the most common forms of chronic headache (CH). Management of patients with DIH remains a pressing problem of modern medicine. This condition is characterized by headache over 15 days a month for more than 3 months. On the basis of the BSMU Clinic, we assessed the health status of young people with DIH and nicotine addiction. Patients with nicotine addiction were evaluated for the degree of negative effect of smoking on respiratory function.

It was found that the majority of patients took monocomponent analgesics, and the minority of patients took combined analgesics and triptans; compared with young men, young women were less likely to seek medical advice if the episodes of headache became more frequent; however, uncontrolled use of painkillers was observed more often in males. In the absence of an analgesic effect 30 h after medication intake, young men repeated the medication in 60% of cases.

Educational programs about DIH and the development of CHs with associated nicotine addiction may play an important in preventing the development of the condition.

Medical Journal of the Russian Federation. 2020;26(1):28-32
pages 28-32 views

Clinical pharmacology and pharmaceuticals

Comparative assessment of tolerability and risk of pharmacotherapy with botulinum toxin type a drugs in children with cerebral palsy with severe spasticity syndrome

Arkhipov V.V., Goryachev D.V., Chebanenko N.V., Solovyova A.P.


This paper presents a comprehensive assessment of safety monitoring of the use of botulinum toxin type A (BTA) drugs in the WHO databases (VigiBase) and automated information system (AIS) “Roszdravnadzor-Pharmacovigilance”, as well as a comparison of the dynamics of receipt of messages.

The authors present a post-marketing study of domestic experience in the use of BTA drugs (Dysport, Botox, and Xeomin) based on a retrospective clinical and pharmacological analysis of 169 medical records of children with cerebral palsy in whom these drugs were used to treat spasticity syndrome.

Analysis of the spectrum of adverse events, which were mentioned in 10 (5.9%) medical records, showed that their nature corresponded to the data set out in the instructions for medical use. Serious adverse reactions according to the criteria of severity “death” and “threat to life”, with a high degree of reliability of cause-and-effect relationship were not revealed during the study, which confirms a sufficiently high safety profile of these drugs.

This paper focuses on improving the methodology for assessing the effectiveness and safety of BTA drugs for the treatment of spasticity syndrome in children and the need to identify and report all adverse drug reactions.

Medical Journal of the Russian Federation. 2020;26(1):33-40
pages 33-40 views

New pharmacological effects of caripazim

Kukushkin G.V., Zhuravleva M.V., Sviridkina L.P., Yurov D.E.


The effects of a proteolytic enzyme found in papaya milk juice (caripazim) on the rate of lymphatic drainage of tissues and the pharmacokinetics of cefotaxime were studied in experiments on rabbits and mice. During the study, caripazim was administered to experimental animals, and the rate of removal of Evans blue from the mesentery of mice, as well as the concentration of cefotaxime over time in the blood plasma of rabbits and the blood plasma, intestinal tissues, and livers of mice, after 1.5 and 24 h of antibiotic administration following injection of caripazim, were determined. Thus, the lymphostimulatory properties of caripazim were revealed. Its preliminary administration increased the concentration of cefotaxime in the blood plasma of rabbits in comparison with single administration of an antibiotic at all points of the study (1.5, 3, 4.5, 6, 8, 12, and 24 h). This coincides with the data from the study of the level of antibiotic in the blood plasma of mice. Administration of cefotaxime after injection of caripazim leads to an increase in its content in the intestinal tissue, after both 1.5 and 24 h, but does not affect at the accumulation of the antibiotic in the liver. The concentration ratio «liver tissue / blood» in mice in the main group was significantly lower than that in the control group, both 1.5 and 24 h into the experiment, which indirectly indicates a decrease in hepatic antibiotic extraction. The data obtained indicates that caripazim has the properties of an endolymphatic conductor.

Medical Journal of the Russian Federation. 2020;26(1):41-44
pages 41-44 views


Amyloid cardiomyopathy in the elderly: clinical options, difficulties in diagnosis and treatment

Ettinger O.A., Gendlin G.E., Stepanova E.A., Ganieva I.I., Borisovskaya S.V., Fedorov I.G., Nikitin I.G.


This article analyzes the frequency and features of cardiac amyloidosis in the elderly. The morphology and pathogenesis of amyloid cardiomyopathy are presented. The features of the clinical picture of the heart and aortic lesions in systemic and local variants of amyloidosis are analyzed. Polymorbidity in older people, which complicates the diagnosis of cardiac amyloidosis and leads to a delay in treatment, is reviewed. The diagnostic methods of various types of cardiac amyloidosis are evaluated. Modern trends in the treatment of amyloidosis are presented.

Medical Journal of the Russian Federation. 2020;26(1):45-66
pages 45-66 views

Efficacy of radiotherapy vs. The combination of radio- and immunotherapy: a systematic review and meta-analysis

Voronova V.M., Lebedeva S.A., Sekacheva M.I., Helmlinger G., Peskov K.V.


Introduction and objectives. The combination of radiotherapy and immune checkpoint inhibitors has demonstrated antitumor activity in numerous preclinical studies and is currently being investigated in the clinical setting. This study aims to compare the efficacy of radiotherapy alone (RT) vs. the combination of radio- and immunotherapy (IT-RT) and identify the treatment regimen associated with maximal efficacy by using a meta-analysis.

Materials and methods. A systematic literature search was performed using the PubMed database and materials of the key oncology congresses. Studies reporting 1-year overall survival (OS) of patients with brain metastases undergoing IT-RT treatment were included in the analysis. Information about 1-year OS, individual patients’ characteristics, and treatment regimens for both IT-RT and control RT arms was extracted. Identification of the optimal treatment regimen was performed using a mixed meta-regression modeling approach. Analysis was performed using the R statistical environment (metafoR package).

Results. In total, 30 studies were identified, of which 13 reported outcomes for the control RT groups. The analysis revealed that IT inclusion into RT is associated with a significant increase in 1-year OS; given simultaneously, IT and RT demonstrated the highest efficacy with a 1-year OS of 68% (95% confidence interval (CI): 60%–75%), followed by a sequential regimen: 1-year OS = 54% (95% CI: 47%–61%) and RT alone: 1-year OS = 32% (95% CI: 25–39%).

Conclusion. The current study demonstrates the superiority of combined IT-RT over RT alone; simultaneous IT and RT treatment is associated with the highest efficacy.

Medical Journal of the Russian Federation. 2020;26(1):67-73
pages 67-73 views

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