Vol 20, No 6 (2021)

BACKGROUND: COVID-19 is an infectious viral disease caused by SARS-CoV-2 virus with high morbidity and mortality, especially among the elderly and those with concomitant factors such as diabetes mellitus, chronic lung and heart disease. For patients who have undergone coronavirus pneumonia, given the severity of the disease, rehabilitation measures are needed to restore the consequences of the disease.

AIMS: To evaluate the effectiveness of the use of low-frequency magnetic therapy with a running magnetic field in the complex of rehabilitation treatment of patients who have undergone pneumonia caused by SARS-CoV-2 (COVID-19) at the stage of convalescence.

MATERIAL AND METHODS: Examination and treatment of 42 patients (24 men and 18 women) aged 40 to 65 years, who had community-acquired pneumonia (J16.8) caused by the new coronavirus SARS-CoV-2 (COVID-19), were carried out. The first (main) group of patients included 22 people who underwent physical therapy, aeroinotherapy, low-frequency oscillatory massage of the chest in an electrostatic field, intravenous laser blood irradiation, high-frequency oscillation of the chest and carbon dioxide baths. Against this background, starting from the 20th day after discharge from the hospital, this group of patients received low-frequency, low-intensity magnetotherapy from the POLIMAG-02M apparatus. The second (control group) included 20 patients who received the same treatment, except for magnetotherapy from the POLIMAG-02M apparatus.

RESULTS: The course of rehabilitation treatment led to an increase in the functional capabilities of the cardio-respiratory system in patients of both groups, an increase in chest excursions, an increase in the vital capacity of the lungs, the normalization of the act of breathing and ventilation of the lungs, and an improvement in the psychosomatic status of patients. In the main group, these changes are more pronounced than in the control group, which is associated with the inclusion of low-frequency magnetotherapy with a running magnetic field in the complex treatment.

CONCLUSION: The use of low-frequency magnetic therapy with a running pulsed magnetic field in the complex of rehabilitation measures for patients who have undergone pneumonia caused by the COVID-19 virus significantly improves the somatic status of patients, increases exercise tolerance, and optimizes the function of external respiration. The data obtained make it possible to recommend the inclusion of the factor in clinical guidelines for the rehabilitation of patients who have undergone COVID-19.

BACKGROUND: The study of the features of the formation of postoperative scars under the influence of rehabilitation programs in patients with chronic paraproctitis in the early postoperative period after minimally invasive surgical hospital-replacing technologies expands our understanding of the pathological condition and methods of its treatment.

AIM: To study the effect of various rehabilitation programs on the formation of postoperative scars in patients with chronic paraproctitis in the early postoperative period after minimally invasive surgical hospital-replacing technologies.

MATERIAL AND METHODS: The study summarized and analyzed the experience of surgical treatment of 180 patients with chronic paraproctitis using minimally invasive surgical hospital-replacing technologies and rehabilitation programs in the early postoperative period. Laser ablation of the fistula tract — the classic FiLaC technology was performed in 90 patients; modified FiLaC technology — 90. Each of the subgroups was divided into 3 groups: group 1 (main) included 30 patients who underwent a 4-component rehabilitation complex from the second day after the operation; group 2 (comparison) — 30 patients who underwent a 2-component rehabilitation complex from the second day after the operation and group 3 (control) — 30 patients, without an additional physiotherapeutic rehabilitation program. A comprehensive assessment of the features of the formation of postoperative scars was carried out as a criterion for the effectiveness of treatment, one of the tools of which was a complex transrectal ultrasound with color Doppler mapping, Dopplerography and sonoelastography at different stages of treatment.

RESULTS: All patients tolerated the course of treatment well: there were no cases of interruption of rehabilitation programs. The dynamic analysis of the data showed a statistically significant result: the best — in patients of the main group against the background of a 4-component rehabilitation program, the formation of postoperative scars accelerated, the formation of a mature scar occurred earlier, the risks of developing postoperative complications and relapses of the disease decreased.

CONCLUSION: The use of rehabilitation programs in patients with chronic paraproctitis in the early postoperative period after minimally invasive surgical hospital-replacing technologies can improve clinical results due to the complex physiotherapeutic effect. Complex transrectal ultrasound with color Doppler mapping, Dopplerography and sonoelastography in patients with chronic paraproctitis is an effective non-invasive diagnostic method: monitoring the formation of a postoperative scar and assessing the ongoing treatment.

With an increase in requests for the correction of aesthetic imperfections with dermal fillers based on hyaluronic acid, cases of adverse events and complications have become more frequent. Hyaluronic acid in the form of a dermal filler is one of the most popular procedures in aesthetic medicine and has a high safety profile. Despite the fact that hyaluronic acid is an integral part of the extracellular matrix, fillers based on it can also cause complications. The use of an antidote in the form of hyaluronidase allows you to correct possible adverse reactions such as hypercorrection, the Tyndall effect, the formation of granulomas, and the development of tissue ischemia. Hyaluronidase is widely used in all branches of medicine, including the treatment of adhesions in the body, is used in in vitro fertilization, improves the absorption of drugs into the lesion in the treatment of cancer patients, and is also successfully used in the treatment of dermatological patients. In cosmetology, the use of enzyme helps to cope with such severe phenomena as tissue ischemia due to intravascular occlusion by the drug. And the use of ultrasound diagnostics makes it possible to correct adverse events using the enzyme strictly in the focus of the filler, thereby improving the quality of the treatment.

An electronic search for publications on the features of the course of COVID-19 in patients with the most common chronic noncommunicable diseases (arterial hypertension, diabetes mellitus and obesity) was carried out using the Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, Global Health, CyberLeninka databases, RSCI, as well as journals peer-reviewed by the Higher Attestation Commission. The review analyzed the effect of comorbidity on the prognosis of a new coronavirus infection (complication rate, severity of the course, mortality). It has been shown that previous noncommunicable diseases are a significant risk factor for adverse outcomes in patients with COVID-19, and if the effect of arterial hypertension is not confirmed by all authors, then type 2 diabetes mellitus, as well as any degree of obesity, are important prognostic signs of an unfavorable course of the new coronavirus infections.

Thus, in the context of the COVID-19 pandemic, patients suffering from chronic noncommunicable diseases need more careful monitoring and preventive measures aimed not only at preventing infection with the new coronavirus, but also at slowing the progression of these pathologies and their complications.

Cancer treatment with chemotherapy, targeted and immunotherapy is associated with a wide spectrum of dermatologic adverse events. Xerosis (dryness) of the skin is the most prevalent skin side effect in oncologic patients, which occurs both during treatment with "classic" chemotherapy drugs and modern cancer drugs, such as targeted therapy and immunotherapy.

Despite the high prevalence of this side effect, current approaches to the correction of skin xerosis in cancer patients are very limited. At the same time, in the absence of adequate supportive treatment of xerosis, the formation of persistent fissures, eczematization and secondary infection is observed, which may lead to antitumor therapy regimen modification. Thus, optimization of prophylactic and treatment strategies for xerosis in patients treated with anticancer drugs remain an important interdisciplinary problem. Balneotherapy is a promising method for the correction of skin xerosis due to a complex positive effect on the level of skin hydration, a decrease in the intensity of inflammatory processes, a beneficial effect on the state of the skin barrier function, as well as an increase in antimicrobial protection. Available data on the use of balneotherapy in the supportive treatment of skin xerosis as a dermatological adverse event of anticancer therapy confirms the high efficacy and safety, as well as good tolerability of this method in cancer patients.

The use of low-temperature plasma is a modern and developing direction in medicine, including rehabilitation. Low-temperature plasma (LTP) has a high antiseptic, wound-healing activity, and is also a safe method of physical exposure. In the in-patient facility of clinical unit of Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation named after Prof. Yu.N. Kasatkinа, a patient was treated with low-temperature argon plasma after selective right cervical lymph node dissection, resection of the mandible, and tissues of the oral floor with defect plasty with a fibular autograft for cancer of the gingival mucosa of the mandible on the right pT4aN0M0, stage IVa. In the process of EBRT (external beam radiation therapy), the patient developed a complication in the form of a local radiation reaction with the formation of a fistulous opening in the area of the postoperative scar. The fistulous opening and the affected area were treated with a cooled air-plasma flow. During the continued use of LTP, the termination of pyorrhea, a decrease in hyperemia and edema in the area of tissues damaged by ionizing radiation were noted. The patient was promptly continued radiation therapy.

Thus, the use of this therapeutic factor in the program of medical rehabilitation is an effective way of local impact on the pathological focus, allows you to achieve a quick reparative effect, eliminates and prevents the development of bacterial complications. In addition, the use of an air-plasma flow contributes to the rapid relief of manifestations of radiation reactions, having a beneficial effect on damaged tissues, as well as shortening the rehabilitation period for severe cancer patients in the postoperative period and during the course of EBRT. The results of LTP action have a positive effect on the general condition of patients and improve their quality of life.