[Combined rehabilitation in the patients presenting with dorsopathies of the lumbar spine and concomitant irritable bowel syndrome based at a therapeutic clinic]

BACKGROUND

Comorbidity constitutes a serious challenge for rehabilitative medicine. The comorbidity of the dorsopathy of the lumbar spine and irritable bowel syndrome mutually complicates the clinical course of both conditions, significantly reduces the patients' quality of life. and increases the costs of diagnostic procedures and restoration of the working capacity. The approaches to the non-pharmacological management of the patients presenting with these diseases remain to be developed.

AIMS

The objective of the present study was to evaluate the effectiveness of the proposed combined non-medicinal rehabilitation modality which included a course of therapy with the application of modulated sinusoidal currents, total wrappings with the use of a Rapan saline solution, and sedative inhalations additionally introduced into the basic medicinal therapy of the patients presenting with dorsopathy of the lumbar spine combined with irritable bowel syndrome in the stationary phase.

MATERIALS AND METHODS

A total of 59 patients at the age from 20 to 65 years suffering from dorsopathy of the lumbar spine and concomitant irritable bowel syndrome were examined and treated. All the patients were randomized into two groups, the main (n=21) and control (n=38) one, matched for the sex and age. The patients in the control group received the conventional medical treatment in accordance with the adopted medical and economic standards during 2 weeks. The patients of the main group received, in addition to the basal medicinal therapy, the proposed combined rehabilitative physiotherapeutic treatment that included a course of therapy with modulated sinusoidal currents, total wrapping with the use of a Rapan saline solution, and sedative inhalations of the of peony root extract. The effectiveness of these rehabilitation modalities was monitored before and after the course of therapy based on the estimation of bowel function dynamics, the severity of pain syndrome, and the patient's quality of life in terms of the health status with the use of the SF-36 questionnaire.

RESULTS

The therapeutic and rehabilitative procedures resulted in a well apparent improvement of the genera condition in the patients of the main group associated with a greater degree of reduction of the incidence of specific clinical symptoms, more rapid relief of the pain syndrome, and a more pronounced improvement of the quality of life indices in comparison with the same variables in the patients comprising the control group. After the course of the treatment and rehabilitation, the incidence of spinal pain in the patients of the main group was significantly reduced by 87% (p=0.001) compared with those of the control group (32%; p=0.005). The frequency of abdominal pain decreased in the main group by 47% (p=0.021) versus the control group (by 27%; p=0.007). The quality of life indices increased 1.2 times in the main group but remained unaltered in the control group.

DISCUSSION

The patients of the main group exhibited a more pronounced than in the control group positive dynamics of health conditions characterized by a well apparent reduction in the incidence of the major clinical symptoms of the disease, faster alleviation of the pain syndrome, and the marked improvement of the quality of life indices.

CONCLUSIONS

The results of the study with the inclusion of therapy with modulated sinusoidal currents together with total wrapping using the Rapan saline solution and sedative inhalations into the program of the combined treatment of the patients presenting with dorsopathy of the lumbar spine and concomitant irritable bowel syndrome provide a basis for recommending this physiotherapeutic modality for personalized rehabilitation of this group of patients under conditions of a therapeutic clinic.

[Non-drug rehabilitation of patients with chronic obstructive pulmonary disease concurrent with hypertension]

AIM

to evaluate the efficiency of decimeter wave therapy and halotherapy, which were additionally added to basic therapy, in patients with chronic obstructive pulmonary disease (COPD) concurrent with hypertension at the inpatient stage.

SUBJECTS AND METHODS

36 patients aged 20 to 75 years with Stages I-II COPD concurrent with Stages I-II, first-second grade hypertension were examined and treated. The clinical examination included collection of complaints and medical history data, clinical laboratory and instrumental (electrocardiography, spirography) studies, and health-related quality of life (using the SF-36 questionnaire). The patients were randomized into two groups: a study group and a comparison group. The study group patients received decimeter wave therapy and halotherapy in addition to basic drug treatment; the comparison patients had basic drug therapy.

RESULTS

Pre- and postoperative comparative analysis of the major clinical manifestations of comorbidities revealed more pronounced positive changes with the lower rate of clinical manifestations in the study group. It was also observed to have a more marked reduction in blood pressure (BP) with its goal levels achieved. The mean pulse BP decreased by 28% in the study group (p=0.000005) and did not statistically reduced in the comparison group. In the study group patients, the integral quality-of-life indicator after a package of medical rehabilitation measures became statistically significantly higher by 35%. This indicator in the comparison group was statistically significantly unchanged.

CONCLUSION

The directionality of the proposed rehabilitation complex towards the common pathogenetic components of the development and progression of COPD and hypertension, as well as the high efficiency of the complex justify its appropriate inclusion in the combination treatment and rehabilitation of this category of patients.

[Features of polymorbidity in cardiac and gastroenterologic patients from a therapeutic clinic]

AIM

To examine the incidence of polymorbidity (PM) and changes in its rates in 2003 to 2011 in cardiac and gastroenterologic patients living in the Novosibirsk Region and the Republic of Sakha (Yakutia) in accordance with gender, occupation, and residence.

SUBJECTS AND METHODS

The dynamics of PM rates was analyzed in 13 496 patients who had been examined and treated at the Cardiology and Gastroenterology Departments, Therapeutic Clinic, Research Institute of Experimental and Clinical Medicine (Novosibirsk), 2003-2011. The study used an archival research method and a statistical analysis of all nosological entities, groups, and classes in ICD-10, regardless of whether the diagnosis was primary or concurrent.

RESULTS

There was an increase in PM rates among the therapeutic clinic's patients of regardless of their gender and occupation. There were gender differences in the incidence of PM: its higher rates were noted in the women than those in the men among both the residents of the Novosibirsk Region and those of the Republic of Sakha (Yakutia). More significantly higher PM rates were registered in the male inhabitants of the Novosibirsk Region. There were also regional differences in the incidence of PM: its rates proved to be higher in the patients in the Republic of Sakha (Yakutia) than in those in the Novosibirsk Region in 2003-2007. At the same time, the growth rates for PM were more marked in the patients in the Novosibirsk region than in those in the Republic of Sakha (Yakutia); these differences levelled off in subsequent years.

CONCLUSION

The findings indicate a pronounced increase in the incidence of PM in cardiac and gastroentorologic patients and determine a need to keep in mind the influence of gender, social, and regional factors on its development in order to create and improve a primary and secondary prevention, diagnosis and treatment system.

[Combination of arterial hypertension and type 2 diabetes mellitus with obesity]

The aim of the study was to elucidate dynamics of the incidence of arterial hypertension (AH), 2 type diabetes mellitus (DM), and obesity as the main risk factor of these conditions, combinations between them and certain circulation disorders in the patients admitted to our clinic from 2003 to 2011. We analysed 25,451 case histories. Patients were regarded as having AH, DM, obesity, coronary heart disease, cardiac rhythm disturbances and cerebovascular disorders if they had verified diagnosis of nosological forms corresponding to the respective ICD-10 codes. Their occurrence was calculatedfor 3 three-year periods with reference to the mean age of the patients in different groups. It was shown that increased incidence of AH in the above time periods was associated with the enhanced occurrence of combination of AH and obesity or AH, obesity and DM. Similarly, the increased incidence of DM was associated with the enhanced occurrence of combination DM, AH, and obesity. A significant increase of the mean age was documented only in women with AH and obesity and in men with AH or AH plus obesity. The presence of DM in AH patients had no appreciable effect on the frequency of cerebrovascular pathology that increased in the presence ofAH with obesity.

[Regional features of present-day polymorbidity of internal diseases]

Analysis of transnosological and trans-systemic polymorbidity for 2003-2011 in a general therapy clinic included 23310 patients (9111 men and 14199 women). It was supplemented by comparative analysis of morbidity in southern West Siberia and Yakutiya. The assessment was performed for three age groups (16-39, 40-59, over 60 years). The mean number of nosological forms (transnosological morbidity) and affected systems of organs (trans-systemic morbidity) averaged 5.19 +/- 0.01 and 4.09 +/- 0.01 per patient respectively (4.93 +/- 0.02 and 3.92 +/- 0.02 in men, 5.36 +/- 0.02 and 4.19 +/- 0.01 in women). The prevalence of polymorbidity was significantly higher in women than in men and in Yakutia higher than in West Siberia. The differences tend to be smoothed in recent years. Transnosological morbidity coefficients in male and female residents of Novosibirsk region increased from 4.14 +/- 0.03 and 4.60 +/- 0.04 respectively in 2003-2005 to 5.48 +/- 0.05 and 6.70 +/- 0.06 in 2009-2011 (p < 0.0001). In Yakutiya this growth in men was less pronounced than in a more temperate climate and was practically inapparent in women.