Russian Journal of Physiotherapy, Balneology and Rehabilitation

BACKGROUND: In the pathogenesis of true eczema, an important place is occupied by stress, under the influence of which stimulation of the hypothalamus and brain stem occurs, as well as activation of the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. Stress-induced secretion of neurotransmitters impairs the barrier function of the epidermis, slows wound healing, increases itching and inflammation, and suppresses immunity by changing the immune response of T-helper cells.

AIM: Assessment of the severity of the corrective effect of a course of application of supravenous laser irradiation of blood and broadband medium-wave phototherapy on the blood levels of adrenocorticotropin, cortisol and beta-endorphin in patients with true eczema with a moderate form of the course.

MATERIALS AND METHODS: The study was carried out with the participation of 120 patients with a moderate form of true eczema. Using simple fixed randomization, all patients were divided into 4 groups. The first group (control, n=30) received only basic drug therapy, including the use of detoxification, hyposensitizing, antihistamines and topical glucocorticosteroids. Patients of the second group (comparison group 1, n=30) additionally underwent a course of supravenous laser irradiation of blood. In the third group (comparison group 2, n=30), broadband medium-wave phototherapy was performed against the background of basic therapy. Patients of the fourth group (main group, n=30) in addition to basic therapy received a course of combined exposure to supravenous laser blood irradiation and phototherapy. The concentrations of adrenocorticotropin, cortisol and beta-endorphin were determined in the blood of patients twice (before the start of treatment and 1 month after the start of therapy) using ELISA. The clinical condition of patients in the groups was assessed by changes in the EASI index. Additionally, we studied the dynamics of the level of reactive and personal anxiety using the Spielberger–Khanin questionnaire.

RESULTS: Positive dynamics of adrenocorticotropin, cortisol and beta-endorphin were noted only in the comparison groups and the main group, which proves the high efficiency of correction of the neurohumoral status of patients through a course of complex use of supravenous laser blood irradiation and broadband mid-wave phototherapy. Quantitative changes in the assessed parameters during complex therapy with therapeutic physical factors indicate a supra-additive version of their interaction, realized through different modalities, points of application and mechanisms for realizing the biological potential of physiotherapeutic effects.

CONCLUSION: The results obtained convincingly prove the effectiveness of an additional course of use of supravenous laser irradiation of blood in combination with broadband medium-wave phototherapy when correcting the neuroendocrine status in patients with true eczema. The close correlation between neurohumoral indicators and clinical and psychological patterns of the disease proves the pathogenetic significance of the studied neuroendocrine indicators, which allows us to consider their dynamics as informative criteria for the effectiveness of the treatment.

BACKGROUND: For modern urology the problem of optimisation of approaches to medical rehabilitation of patients after surgical treatment of the prostate gland is relevant due to the high frequency of early and late surgical complications, such as secondary lower urinary tract infections, urodynamic disorders, erectile dysfunction and others.

AIM: To study the effectiveness of medical rehabilitation of patients after surgical treatment of prostate adenoma at the third outpatient stage of medical rehabilitation with the inclusion of extracorporeal magnetic stimulation.

MATERIALS AND METHODS: There have been observed 88 patients after surgical treatment of prostate adenoma. They were divided into 2 groups by simple randomization: in the comparison group (n=43) the patients had physical therapy, psychocorrection, alpha1-adroenblock Tamsulosin, transrectal magnetic therapy at the outpatient stage; in the main group 45 patients were additionally prescribed extracorporeal electromagnetic stimulation. The effectiveness of rehabilitation measures was monitored using ultrasound examination of pelvic organs, uroflowmetry, the assessment of the severity of urinary disorders and quality of life ― the International Prostate Symptom Score (IPSS).

RESULTS: Performing stage-by-stage medical rehabilitation of the patients after surgical treatment of prostate adenoma using extracorporeal electromagnetic stimulation provides a significant leveling of urodynamic disorders (p <0.01), in the comparison group positive dynamics was expressed less (on average by 8–10%) in the absence of intergroup differences. The overall score and Quality of Life index according to IPSS significantly improved (p <0.01) immediately after rehabilitation in the main group, and 6 months later the positive dynamics of these indicators was significantly better compared to those in the comparison group (p <0.05).

CONCLUSION: The implementation of the outpatient rehabilitation program after surgical treatment of prostate adenoma using extracorporeal electromagnetic stimulation provides a significant leveling of urodynamic disorders (p <0.01), restoration of quality of life (p <0.01).

BACKGROUND: In recent decades, there has been a progressive increase in the number of patients with chronic kidney disease worldwide, which is associated with both an actual increase in the incidence of the disease, associated with cardiovascular pathology and type 2 diabetes mellitus, among other things, and an increase in the life expectancy of patients.

AIM: To assess hemodynamics of renal vessels during a course of magnetic laser therapy with the patients suffering from diabetic nephropathy caused by arterial hypertension against the background of the standard of care for this category of patients.

MATERIALS AND METHODS: There has been carried out a randomized controlled trial on 100 patients with diabetic nephropathy caused by arterial hypertension. Their average age was 61,7 [52,8; 69,7] years old, the duration of arterial hypertension ― 24,1 [14,5; 36,1], type 2 diabetes mellitus ― 16,6 [14,9; 19,1] and diabetic nephropathy ― 6,1 [4,2; 8,9] years. In addition to general clinical studies, the patients in the control group (49 people) before and after prescribing the standard medication, and in the main group (51 people) with additional use of magnetic laser therapy, had their renal blood flow examined by Doppler ultrasound.

RESULTS: The obtained data indicate the positive effect of magnetic laser therapy with the patients suffering from diabetic nephropathy caused by arterial hypertension on the hemodynamics of renal vessels with improved blood flow in arteries of both medium and small caliber, which, in turn, apparently should contribute to the normalization of the function of the capillary system of the renal parenchyma.

CONCLUSION: The results of the given study allow us to recommend the use of magnetic laser therapy in the complex rehabilitation treatment of the patients with diabetic nephropathy caused by arterial hypertension taking into account the criteria for their strict selection.

BACKGROUND: To date, there are few studies in the literature that have examined the efficacy of extracorporeal magnetic stimulation alone for urinary incontinence in patients after radical prostatectomy.

AIM: The purpose of the study is to obtain preliminary data on the effectiveness and safety of a low-frequency low-intensity traveling pulsed magnetic field in patients with long-term urinary incontinence after radical prostatectomy.

MATERIALS AND METHODS: 22 patients (mean age is 66.3±6.8 years) with stage TI-IIIAN0M0 prostate cancer were observed. To assess the type and degree of urinary incontinence, urination diaries, a cough test, a 24h pad-test, the number of nocturnal mictions, and the OAB-q SF questionnaire were analyzed. Patients were divided into 2 comparable groups: 1 (main group) ― a combination of exercises for the pelvic floor muscles and a local pulsed magnetic field, 2 (control group) ― exercises for the pelvic floor muscles, a rehabilitation course of 10 days.

RESULTS: All patients showed a stressful form of urinary incontinence. Mild urinary incontinence was observed in 75% of patients in group 1 and in 70% of patients in group 2; moderate urinary incontinence was observed in 25% and 30% of the group, respectively. 50% of patients suffered from nocturia. According to the OAB-q SF questionnaire, there were no statistically significant differences between patients in both groups: 8.1±1.6 points versus 8.0±1.5 points (p=0.9), respectively. As a result of the rehabilitation course, the cough test remained positive in 66.7% of patients in the main group and in 80% of patients in the control group. According to this indicator, the combined method of rehabilitation was more effective than exercise therapy by 13.3%. Nocturia stopped in half of the patients in the main group and in 10% of the patients in the control group. The overall incidence of urinary incontinence episodes decreased in 75% of patients in the main group and in 40% of patients in the control group. The effectiveness of the combined rehabilitation method was 35%. The OAB-q SF questionnaire showed no statistically significant differences between the groups: 6.2+0.9 and 6.9+1.3 points (p=0.8), respectively.

CONCLUSION: Local traveling pulsed magnetic field increases the effectiveness of therapeutic exercises in rehabilitation of patients with long-standing urinary incontinence after radical prostatectomy. The obtained data can serve as a basis for further well-organized studies on a larger number of patients allowing to make unambiguous conclusions.

The relevance of the treatment of dry eye syndrome is associated with the widespread prevalence of this disease. Along with the development of information technology and an increase in time spent in front of screens, the number of people suffering from this disease is steadily growing.

The basis of treatment for dry eye syndrome is the use of “artificial tears” preparations, which are instilled into the conjunctival cavity to replenish moisture deficiency. But the effect of tear replacement therapy in case of dysfunction of the meibomian glands does not last long. In this regard, the use of physiotherapeutic methods for treating dry eye syndrome to prolong the effect of drug therapy for this pathology is of particular importance.

Each of the methods of physiotherapeutic treatment of dry eye syndrome has its own unique mechanisms of action and indications for use. Physiotherapeutic methods are an effective tool in the treatment of dry eye syndrome, providing the opportunity to improve the quality of life of patients suffering from this common ophthalmic disease.

Demyelinating inflammation of the pudendal nerve associated with COVID-19 has been clinically identified in many cases and has been proven in animal experiments. Many authors associate the development of erectile dysfunction after suffering COVID-19 with endothelial disorders in the urethra and other endocrine and psychological disorders.

In clinical practice, after the start of the COVID-19 pandemic, we have identified many cases of erectile dysfunction with confirmed neurophysiological and clinical disorders of the pudendal nerve. Despite active medical treatment, not all patients improve. In this regard, we decided to demonstrate this clinical case. The patient underwent a course of pelvic floor muscle training and transcutaneous electrical neurostimulation after the lack of effect of pharmacotherapy.

The diagnosis of erectile dysfunction against the background of damage to the pudendal nerve as a result of a history of COVID-19 was established on the basis of the patient’s complaints, anamnesis, clinical picture, biochemical, neuroimaging and neurophysiological methods of research. Before treatment, the pain syndrome was 7/10 points, the strength of the pelvic floor muscles was 2/5 points, the erectile function according to the erectile function index was 8/30 points and the quality of life as a result of erectile dysfunction was 46/60 points. The use of transcutaneous electrical nerve stimulation of the pudendal nerve in combination with training of the pelvic floor muscles proved to be very effective in the treatment of patients with severe pudendal neuralgia accompanied by severe erectile dysfunction, weakness of the pelvic floor muscles and impaired urination. Against the background of debilitation, the pain syndrome regressed by 78%, erectile dysfunction decreased by 2 times, the quality of life improved by 82.6% and the strength of the pelvic floor muscles increased by 75% and urination disorders completely regressed.