Ekaterina Nikolaevna Zhumanova

Background: Comorbid patients with arterial hypertension and/or diabetes mellitus are characterized by prolonged skin healing, which is associated with impaired trophism and barrier function of the skin, chronic inflammation, and the risk of infection. AIM: To evaluate the effectiveness of comprehensive skin rehabilitation programs after laser removal of telangiectasias in comorbid patients. Methods: A prospective, randomized clinical trial included 120 patients (mean age 57.8 ± 8.5 years) divided into three groups: Group 1 (n=40) – combined rehabilitation (phonophoresis + LED therapy), Group 2 (n=40) – LED phototherapy, Group 3 (n=40) – control group. The rate and quality of healing, postoperative complications, the Dermatological Quality of Life Index (DQLI), the Скиндекс-16 index, and the EQ-VAS visual analogue scale were assessed over a period of up to 6 months. Results: Complete healing was achieved in 98 patients (81.7%), incomplete healing was recorded in 22 patients (18.3%). Group 1 (combination therapy) demonstrated the best results with a complete healing rate of 92.5% (37/40), statistically significantly superior to the control group (p0.001). Group 2 (LED therapy) showed intermediate results with 87.5% complete healing (35/40). In patients with type 2 diabetes, the complete healing rate was 90.5% versus 61.8% in the control group (p=0.019). Quality of life improved significantly in all groups: DLQI decreased from 8.9±5.2 to 1.8±2.1; Скиндекс-16 - from 25.7±9.8 to 8.4±5.3; EQ-VAS increased from 64.2±11.7 to 85.6±8.9 (all p0.001). Conclusion: The combined use of phonophoresis with Eplan cream and LED phototherapy is statistically significantly superior to LED monotherapy and the standard protocol, providing the highest rate of complete healing (92.5%), minimizing postoperative complications, and significantly improving patients' quality of life according to DQLI, Скиндекс-16 index, and the EQ-VAS.

BACKGROUND: The prevalence of sexual disorders among women in Russia is high (16.7%). Despite the lack of active healthcare-seeking behavior, these data are consistent with epidemiological studies from other countries. AIM: This study aimed to evaluate the effectiveness of non-pharmacological methods for restoration of sexual function in women. METHODS: This prospective, comparative, randomized study included 90 women aged over 18 years with complaints of sexual dysfunction, who were divided into three equal groups. In group 1, patients underwent high-intensity magnetic stimulation of the pelvic floor muscles; in group 2, radiofrequency lifting; in group 3, patients received combined non-pharmacological treatment using both methods. Medical history, clinical and instrumental data were analyzed. Female Sexual Function Index (FSFI) and Sexual Quality of Life-Female (SQOL-F) questionnaires were assessed at baseline and 1 and 3 months after treatment. RESULTS: Improvement in sexual function was observed in all women in group 3, and the effect persisted at the 3-month follow-up. The probability of achieving a favorable outcome according to the FSFI and SQOL-F questionnaires in the combined therapy group was higher than in group 2 and was similar to that in group 1 (log-rank test for groups 2 and 3, p = 0.016). The combined therapy method was more effective than that used in group 2 (odds ratio 3.60 [1.22–10.64], p = 0.035). An FSFI score ≥ 13.5 one month after the start of therapy may serve as a criterion of treatment effectiveness. Factors associated with a favorable treatment outcome may include more than six sexual intercourses per month, and perineometry values 10.5 mmHg one month and 12.5 mmHg 3 months after the start of therapy. CONCLUSION: A combined course of high-intensity magnetic stimulation of the pelvic floor muscles and radiofrequency therapy has a positive effect on sexual function in women, may be recommended as a non-pharmacological treatment method for sexual dysfunction, and the effect persists for up to three months.

Differentiated vulvar intraepithelial neoplasia (dVIN) is associated with lichen sclerosis planus and progression to invasive lesions, particularly vulvar squamous cell carcinoma. The recurrence rate of dVIN is significantly higher than that of undifferentiated VIN (uVIN). Therapeutic approaches include surgical excision with scalpel, electroexcision, or laser therapy; wide local excision is considered the preferred initial approach. Although immunohistochemistry is a valuable tool in differential diagnosis, evaluation of p53 protein expression is not a completely reliable marker for dVIN: mutant p53 expression in the basal layer of the dVIN epithelium may mimic the enhanced expression seen in reactive changes, and not all cases of dVIN are accompanied by mutations in the TP53 gene.

Telangiectasias are common cosmetic problems for both women and men. Treatment does not always achieve the desired result and is accompanied by negative side effects, incomplete resolution of the skin defect, and prolonged healing. The aim of the study isevaluation of the effectiveness of complex skin rehabilitation programs using non-drug and drug therapy methods after laser removal of telangiectasias. Material and Methods. A randomized prospective clinical trial included 120 patients (110 (91.7 %) women, aged 45 to 70 years) planning telangiectasias removal and with underlying pathology (arterial hypertension and/or diabetes mellitus). The first group included 40 patients who, following laser removal of telangiectasias, underwent a course of sequential phonophoresis (with a glycolanebased cream) and light therapy to restore the skin in the treated area daily (7 sessions). The comparison (second) group consisted of 40 patients who underwent a daily course of light therapy (7 sessions) after laser removal of telangiectasias. The control group (group 3) consisted of 40 patients who did not receive restorative therapy. Results. Complete disappearance of telangiectasias 28 days after laser treatment was observed in 39 (95 %) patients in the study group, 35 (88 %) patients in the comparison group, and 30 (75 %) patients in the control group, p = 0.010. The probability of complete skin restoration after 6 months of therapy was significantly higher in the first group than in the third, but insignificantly different from the second group; log-rank test for groups 1 and 2: p = 0.427; groups 2 and 3: p = 0.038; groups 1 and 3: p = 0.001. Complex therapy in group 1 significantly increased the likelihood of complete skin restoration (by 63 %) compared to group 3 (odds ratio 0.586 (0.360–0.954), p = 0.031). Patients’ subjective assessment of treatment effectiveness using the EQ-VAS scale showed significantly higher scores in groups 1 and 2 than in the control group after just 7 days, and after 28 days, both groups rated their condition equally highly. According to the Skindex-16 scale, patients in group 1 reported a better result after 28 days compared to groups 2 and 3, p = 0.007. Conclusion. The most effective method for skin restoration after laser removal of telangiectasias is the complex use of phonophoresis (with glycolane-based cream) and light therapy. This method increases the likelihood of complete skin restoration by 63 % compared to the control group. Isolated light therapy has a significant, but less pronounced, effect compared to the combined method. Rehabilitation methods for skin restoration after laser removal of telangiectasias can be recommended for routine use in rehabilitation and cosmetology departments.

The aim of the study was to evaluate the effectiveness of the D-Wall exerciser (DIH S.r.l., Florence, Italy) in patients in the early recovery period following total knee arthroplasty (TKR) using the International Classification of Functioning, Disability, and Health (ICF) domains. Material and methods. A prospective, randomized, controlled study was conducted involving 60 patients, average age 68.2 ± 6.5 years, who underwent primary TKR surgery in the second stage of medical rehabilitation. Patients were divided into a study group (n=30) who received rehabilitation treatment in addition to the standard rehabilitation program, including training on the D-Wall rehabilitation system, and a control group (n=30) who received a standard comprehensive rehabilitation program. Functional status was assessed before and after the 10‑day rehabilitation course. Results. Ten days after the completion of the rehabilitation course, statistically significant improvement was noted in patients in the main group compared to patients in the control group (CG): a decrease in pain intensity according to VAS by 42 % (4.1 ± 1.2 points in the I group and 6.3 ± 1.5 points in the II group patients, p < 0.01); an increase in the amplitude of knee flexion by 25 ° (115 ° ± 8 ° in the II group and 90 ° ± 10 ° in the I group patients, p < 0.001); an increase in walking speed according to C–Mill data by 35 % (0.92 ± 0.15 m/s in the II group patients and 0.68 ± 0.12 m/s in the I group, p < 0.01); an improvement in social adaptation indicators by 28 % (p < 0.05). Conclusion. Incorporating the D-Wall rehabilitation system with 3D video reconstruction and biofeedback of dynamic patterns into the early rehabilitation program for patients undergoing TKA promotes accelerated motor function recovery, gait correction, and improved quality of life.

Effective management of biological age (or slowing down the aging process) is a rapidly developing field that seeks not only to increase life expectancy but also to improve quality of life in old age, prolonging the period of active longevity. Medical rehabilitation plays a fundamental and critical role in managing biological age and promoting health, especially in the context of achieving healthy longevity. The most effective and scientifically proven tool in medical rehabilitation for managing biological age are therapeutic physical factors capable of activating primary and secondary protective and adaptive mechanisms aimed at restoring impaired self-regulation and slowing down the processes of biological aging. Objective. To evaluate the effectiveness of the integrated use of pathogenetically oriented medical rehabilitation methods on biological age indicators and patient quality of life. Material and methods. The study was conducted at the B.V. Sechenov Russian Scientific Center of Surgery. The Petrovsky Clinical Hospital involved 125 participants with an average age of 57.3±0.37 years. All patients received basic therapy (BT), including a course of physical exercise, a reduced-calorie diet, and vitamin therapy. Using a simple fixed randomization method, the entire cohort of patients was divided into 3 groups: a control group (n=42), a comparison group (n=41), and a main group (n=42). Patients in the control group received BT only. In the comparison group, in addition to BT, patients received a course of complex physiotherapy, including whole-body air cryotherapy, hypoxic-hyperoxygen therapy, and dry carbon dioxide baths. The main group of patients, in addition to the comparison group, received a course of binaural therapy. A comprehensive patient examination included anthropometric measurements (body mass index), biochemical (blood lipid profile, blood glucose levels, oxidative stress and systemic inflammation markers), and hormonal (insulin, cortisol, serotonin) parameters, as well as an assessment of biological age according to V.P. Voitenko and the aging rate coefficient. Patients’ quality of life was also assessed using the SF-36 psychometric questionnaire and the EQ VAS questionnaire. Results. The use of a physiotherapy program, supplemented by a course of binaural therapy, resulted in the maximum corrective effect, manifested by positive changes in anthropometric and laboratory parameters, as well as a decrease in biological age and the aging rate coefficient to normal values. The most significant improvement in quality-of-life indicators was also noted in the study group. An integrative comparative assessment of the effectiveness of medical rehabilitation for patients between the selected groups using a correlation adaptometry algorithm revealed that the greatest decrease in the weight of the correlation graph — a quantitative indicator that collectively reflects the strength of correlations—was observed in the study group. This finding reflects a weakening of the correlational cooperation between various variables, characteristic of an increased level of the body’s functional reserves. Conclusion. The developed non-drug technology, based on the use of therapeutic physical factors, reduces biological age and the aging rate coefficient by activating secondary sanogenetic processes, which have a corrective effect on the systemic mechanisms of aging. The observed combination of changes in various physiological and regulatory systems is aimed at increasing the functional reserves and adaptive capacity of the human body, which ultimately results in an improved quality of life for patients.

The priority goals of medical rehabilitation in the early postoperative period after total knee arthroplasty (TKR) are to eliminate abnormal movement patterns and improve patients’ quality of life. This is directly related to effective early patient activation, which is only possible with low pain severity. Modern technologies that enable graduated patient activation with training of complex, coordinated dynamic patterns in a biofeedback (BFB) system in a virtual space simulation enable ergonomic control of motor intensity, preventing increased pain in patients in the early postoperative period. Combining motor rehabilitation with physiotherapy methods promotes more effective pain relief, which complicates patient activation. Objective. Evaluation of the effectiveness of comprehensive early postoperative rehabilitation programs using a rehabilitation complex with biofeedback and 3D modeling of motor video analysis on the D-Wall rehabilitation system (DIH S.r.l., Florence, Italy), including in combination with local cryotherapy or electro-magnetic therapy in patients in the early recovery period of rehabilitation after total knee arthroplasty (TKR). Material and methods. The study involved 105 patients, aged 58 to 75 years, receiving early comprehensive postoperative rehabilitation programs after TKR surgery. All patients were divided into three equal groups: patients of group 1 (n=35) underwent a comprehensive rehabilitation program, including therapeutic exercises in the form of individual sessions, massage of the area of the operated limb in an electrostatic field, local magnetic therapy on the knee joint area. Patients of group 2 (n=35), in addition to the specified program, received procedures of complex-coordinated training in the D-Wall system and local cryotherapy on the knee joint. Patients of group 3 (n=35), in combination with the standard rehabilitation program and training on the D-Wall, received procedures of high-intensity electro-magnetic stimulation on the EMW MED device (Russia). Evaluation of the effectiveness of the rehabilitation programs was carried out before the course and after its completion (on the 14th day) using the VAS (visual analogue scale of pain), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), goniometry, 6-minute walk test, flexion and extension angles in the knee joint, analysis of complaints. All methods are interpreted from the standpoint of the International Classification of Functioning, Disability and Health (ICF). Results. Statistically significant improvement in indicators was noted in all groups (p<0.05). The largest improvements were recorded in Groups 2 and 3: pain reduction according to the VAS was 58 and 62%, respectively (versus 44% in Group 1), function improvement according to the WOMAC was 52 and 56% (versus 41%), range of motion increased to 108° and 110° in flexion (versus 102°), and 6-minute walk distance improved by 38 and 41% (versus 30%). Conclusion. Incorporating training on the D-Wall rehabilitation system into comprehensive early postoperative rehabilitation programs for patients undergoing TKA promotes faster recovery of motor function. The addition of local cryotherapy or high-intensity magnetic stimulation enhances the effect, particularly in terms of pain relief and swelling reduction.

Lumbosacral dorsopathy (LSD) with moderate exacerbation of pain remains one of the leading causes of temporary disability and decreased quality of life for patients. During the third (outpatient) stage of rehabilitation, it becomes necessary to select optimal rehabilitation care algorithms, especially in the context of the rapid growth of telemedicine technologies. It is important to determine which algorithm is most effective for patients with different baseline pain intensities and associated functional impairments. Objective. To conduct a comparative analysis of the effectiveness of various outpatient rehabilitation algorithms for patients with exacerbation of LSD depending on the baseline pain severity. Material and methods. The study included 120 patients (ICD-10: M54.5), divided into three groups and two subgroups within each group. Patients of the first group (n=40) received comprehensive rehabilitation, including therapeutic exercise (TE) in the form of group sessions; magnetic therapy; electrophoresis with 2% euphyllin solution; classical therapeutic massage of the PCOP area, the course duration was 10 days. Patients of the second group (n=40) received physiotherapy treatment and massage according to the standard program carried out in the first group, the course duration was 10 procedures; followed by a course of therapeutic exercise in the form of online sessions with an exercise therapy instructor-methodologist, lasting 10 procedures. Patients of the third group (n=40), due to paramedical reasons, did not receive a course of physiotherapy and massage; the rehabilitation course included only TE sessions in the form of telemedicine services, lasting 10 procedures. All patients received basic drug therapy with drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) and centrally acting muscle relaxants. Each patient group was stratified by baseline pain using the visual analog scale (VAS) into subgroup A (VAS 2—3 cm, n=20) and subgroup B (VAS 4—5 cm, n=20). Assessments were made before treatment (T0), after a 10-day course (T1), and after 1 month (T2) using the VAS, Oswestry Disability Index (ODI), EQ-5D-3L, SF-36, and Hospital Anxiety and Depression Scale (HADS). Statistical analysis included ANOVA, the Mann—Whitney test, and adjustment for covariates (age, disease duration, physical activity level). Results. As a result of the study, in patients of subgroup B, the greatest reduction in pain and improvement in functional status were recorded in group 1: VAS decreased from 4.7±0.5 to 1.2±0.4 cm (p<0.001), ODI — from 68.1 to 33.1% (p<0.001). In group 2, the changes were moderate (VAS: 2.5±0.7 cm; ODI: 47.6%), in group 3 — minimal (VAS: 4.1±0.6 cm; ODI: 59.5%). After a month, the effect in group 1 was maintained, in others — partial recurrence was observed. In patients of subgroup A (VAS 2—3 cm), the results in groups 1 and 2 were comparable and significantly better than the baseline (p0.05). Quality of life (EQ-5D, SF-36) and anxiety (HADS) scores correlated with changes in pain and function. Conclusion. Comprehensive outpatient rehabilitation is the most effective model for patients with high baseline pain intensity (4—5 cm on the VAS scale). For patients with moderate pain (2—3 cm), telemedicine-based physical therapy demonstrates comparable efficacy to traditional group physical therapy and can be considered a rational alternative. A personalized approach to selecting a rehabilitation model based on baseline pain severity improves its clinical effectiveness, cost-effectiveness, and accessibility.

The high prevalence of professional burnout syndrome among medical workers significantly actualizes the search for the most effective methods aimed at reducing the severity of the negative consequences of professional stress. A certain perspective in solving this problem is associated with the course use of non-drug technologies, the sanogenetic potential of which ensures the implementation of high efficiency in the correction of the main manifestations of professional burnout. The complex use of therapeutic physical factors allows achieving a pronounced clinical result due to their synergistic interaction. Objective. Comparative analysis of the efficiency of the course use of non-drug technologies (physical exercises, psychocorrection, general air cryotherapy, general magnetic therapy, hypoxic-hyperoxytherapy, hydrogen therapy and their combinations) in the correction of stress resistance and manifestations of professional burnout in medical workers. Material and methods. The studies were conducted on the basis of the Federal State Budgetary Scientific Institution Russian Scientific Center of Surgery named after academician B.V. Petrovsky with the participation of 150 patients from among medical personnel aged 30 to 60 years. Using the simple fixed randomization method, all patients were divided into 6 groups: control (n=25), comparison groups 1—4 (n=25 each), and the main group (n=25). Patients in all groups received a course of physical exercises and psychological correction. For the control group, this type of correction was exhaustive. In comparison group 1, a course of general air cryotherapy was additionally carried out; comparison group 2 additionally received a course of general magnetic therapy procedures; comparison group 3 additionally received a course of hypoxic-hyperoxytherapy; comparison group 4 additionally received a course of hydrogen therapy; in the main group, patients received a course of complex exposure to therapeutic physical factors. The study design provided for a double examination of patients in all groups using the MBI questionnaire and the DASS and PSM-25 scales. Results. Conducting a course of correction of the state of professional burnout made it possible to establish that its effectiveness was largely determined by the type of physical factor used. Less pronounced changes were noted in the control group with the use of physical exercises and psychological correction. Additional course application of therapeutic physical factors in the monofactorial impact mode (general air cryotherapy, general magnetic therapy, hypoxic-hyperoxytherapy and hydrogen therapy; respectively comparison groups 1—4) was accompanied by an increase in the positive dynamics of the assessed indicators by 12—23%. The complex use of all physiotherapeutic effects, implemented in the main group, caused the development of the most pronounced corrective effect. Conclusion. The use of non-drug technologies allows achieving high efficiency in the correction of stress resistance and manifestations of professional achievement in medical workers. The maximum corrective effect, manifested with the complex use of physical factors, is the result of the synergistic interaction of various physiotherapeutic technologies, implemented in the form of potentiation of sanogenetic mechanisms aimed at normalizing the psycho-emotional status of individuals with an extreme profile of service activity.

BACKGROUND: Female sexual dysfunction affects patients’ quality of life. Multifactorial causes include age-related, physical, and psychological characteristics. AIM: To evaluate the effectiveness of non-pharmacological methods for restoring sexual function in women of different age groups. METHODS: A prospective observational study included 90 women aged over 18 years with complaints of sexual dysfunction. Patients were divided into three equal groups: reproductive age (21–46 years), perimenopausal (47–53 years), and postmenopausal (54–72 years). Each patient received non-pharmacological treatment: high-intensity focused electromagnetic stimulation of pelvic floor muscles (HIFEM therapy) using the BTL Emsella device (BTL, UK), radiofrequency lifting using the BTL EXILIS device (BTL, UK), or combined non-pharmacological exposure using both methods. Medical history, clinical and instrumental data were analyzed. Female Sexual Function Index (FSFI) and Sexual Quality of Life-Female (SQOL-F) questionnaires were assessed at baseline and 1 and 3 months after treatment. RESULTS: Improvement in sexual function was observed in all women. HIFEM therapy demonstrated the highest effectiveness in the reproductive-age group. Radiofrequency exposure was most effective in peri- and postmenopausal women. The combined approach was more effective than each method alone. One month after therapy, FSFI 26.55 was achieved by 18 (60%) women of reproductive age, 12 (40%) of perimenopausal age, and 5 (17%) of postmenopausal age (p = 0.003). Three months after therapy, SQOL-F 65 was achieved by 28 (93%) women of reproductive age, 15 (50%) of perimenopausal age, and 12 (40%) of postmenopausal age, p = 0.0001. Favorable outcome factors included age 57 years, FSFI 13.5 1 month after treatment initiation, perineometry 10.5 mmHg at 1 month, and 12.5 mmHg at 3 months. CONCLUSIONS: HIFEM therapy has a positive effect on women’s sexual function, and its effect is maintained for three months. This course may be recommended for reproductive-age patients. Radiofrequency exposure is most effective in peri- and postmenopausal women. The combined approach was more effective than each method alone. Treatment effectiveness criteria may include age 57 years and FSFI ≥ 13.5 one month after the initiation of any type of therapy.