Larisa V. Smekalkina

Aim. To compare the speed of onset, magnitude, and duration of the analgesic effect of two doses of ketoprofen lysine salt – 40 mg and 80 mg – for the acute treatment of tension-type headache in adults. Materials and methods. Thirty patients with episodic tension-type headache were enrolled in an open-label, prospective study and allocated to two groups of 15: KAP (ketoprofen lysine salt 80 mg) and KA (40 mg). Pain intensity (visual analogue scale, VAS) was assessed at baseline and 5, 10, 15, 30, 60, 120, and 240 minutes after intake; pain-reduction slope was also calculated. Quantitative data are presented as median and interquartile range (Me [Q1; Q3]); non-parametric methods were used. Differences were considered significant at p < 0.05. Results. Groups were comparable at baseline (VAS 8.0 [6.5; 8.5] and 7.0 [6.5; 8.0]). A significant reduction from baseline occurred by 10–15 minutes in both groups; a plateau was reached by 120 minutes, with median VAS approaching zero. Between-group differences in pain intensity and in the magnitude of reduction were not significant at any time point (p>0.20). Conclusion. Both doses provided fast (significant by 10–15 minutes) and sustained analgesia with good tolerability. No significant differences between the 40 mg and 80 mg doses were found in onset, magnitude, or duration. Given the comparable efficacy and the NSAID analgesic ceiling, either studied dose may be used; dose choice should be guided by clinical objectives and constraints (tolerability, comorbidities, adverse-event risk).

Background: Postural disability develops in almost all patients with diabetic polyneuropathy (DPN). While transcutaneous electrical nerve stimulation (TENS) has proven effective in regressing sensory and motor impairments, its efficacy in improving postural control remains insufficiently studied. Purpose: To evaluate and compare the efficacy of direct peroneal and tibial high-frequency low-amplitude (HFLA) TENS and low-frequency high-amplitude (LFHA) TENS in correcting DPN-related postural disability, among European female patients without a documented history of falls, motor deficits, or pronounced electromyographic impairments, using computerized static posturography and the tandem walk test. Materials and methods: In this single-center, three-arm, randomized controlled trial (registration number: ISRCTN47534508, 3 December 2024), we conducted a longitudinal prospective analysis of European women with DPN-related postural disability. All enrolled patients were non-fallers with no motor deficits and baseline compound muscle action potential (CMAP) amplitudes of the peroneal and tibial nerves of at least 1.5 mV. The intervention groups received HFLA TENS (n = 24) or LFHA TENS (n = 25), while the control group underwent sham TENS (n = 24). Primary endpoints were assessed via static posturography and the tandem walk test (TWT); secondary endpoints were evaluated using hypoesthesia and pain evaluation, the Modified Clinical Test of Sensory Interaction in Balance (mCTSIB), and electromyography. Assessments were performed before treatment, immediately post-treatment, and at the conclusion of a 2-month follow-up period. Results: Comparative analysis incorporating the Bonferroni adjustment demonstrated that LFHA TENS is significantly superior to HFLA TENS. Post-treatment, LFHA TENS induced a reduction in envelope area by 20.7% under the eyes-open (EO) condition (p < α_adj; α_adj = 0.0028) and 32.9% under the eyes-closed (EC) condition (p < α_adj; α_adj = 0.0028), alongside a 16.6% decrease in the Romberg uotient (RQ) (p < α_adj; α_adj = 0.0056). Furthermore, LFHA TENS elicited a significant 39.0% reduction in velocity of CoP sway (VCS) under the EO condition (p < α_adj; α_adj = 0.0042), and decreased total CoP sway excursion by an average of 35.8% (EO) (p < α_adj; α_adj = 0.0042) and 43.8% (EC) (p < α_adj; α_adj = 0.0042) compared to baseline. In contrast, no statistically significant changes in these parameters were observed after HFLA TENS. Ultimately, LFHA TENS outperformed HFLA TENS in improving postural stability by 7.04% under the EO condition (p < α_adj; α_adj = 0.0042) and by 25.5% under the EC condition (p < α_adj; α_adj = 0.0042) in both the tandem walk test (TWT) and the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB). Notably, a statistically significant increase in the CMAP amplitude of the affected peroneal nerves by 22.2% was observed exclusively following LFHA TENS treatment (p < α_adj; α_adj = 0.0056). Conclusions: The clinical efficacy of direct peroneal and tibial TENS compared to sham stimulation in reducing postural disability during both static and dynamic conditions was established in European female patients with moderate-to-severe DPN and unremarkable EMG impairments. Comparative analysis reveals a clear therapeutic superiority of LFHA TENS over HFLA TENS, as evidenced by significantly greater improvements in both posturographic parameters (envelope area, total CoP excursion under EO and EC conditions, and VCS under the EO condition) and functional clinical tests (TWT and mCTSIB), demonstrating long-term stability for up to 2 months post-intervention.

Background. Migraine frequently co-occurs with neck pain, but biomechanical impairments of the cervical spine in this phenotype remain underexplored. Objective. To assess the relationship between cervical spine biomechanical characteristics and clinical manifestations in patients with migraine and unilateral headache. Materials and methods. This cross-sectional study included 54 patients with verified migraine (77.8% women, mean age 33.2 years). Clinical assessment (neck pain, pain provocation, psychoemotional factors) and goniometry of active cervical movements (flexion, extension, lateroflexion, rotation) were performed. Results. Mobility restrictions were found in 50% of patients, predominantly in rotation. Neck pain, headache provocation by neck movements, and side concordance correlated with rotation restriction (r=0.323–0.398; pConclusions. Half of patients with migraine and unilateral headache exhibit a distinct cervical mechanical component characterized by rotation restriction associated with neck pain and its provocation. Assessment of rotation and shoulder position may help identify a subgroup that could benefit from physical rehabilitation.

Background: Retinal vein thrombosis (RVT) represents a global public health problem, ranking as the second position in prevalence among all retinal vascular pathologies and becoming an “epidemic” with the advanced age of patients. The prevalence of this pathology increases 20 times in patients aged over 80 years, compared to the age of 40– 49 years. This pathology can lead to visual impairment, blindness and causes disability, but it is reversible within the first 7 days with timely diagnosis and treatment. The response to anti-VEGF treatment is better with earlier initiation. VEGF suppression not only improves macular edema but also reopens some closed retinal vessels, prevents the progression of vessel closure, and improves retinopathy. Consequently, early diagnosis, competent treatment and rehabilitation, especially in older adults with retinal vascular pathology, are necessary to prevent vision loss and disability. However, there is a lack of studies on mechanisms of RVT development in this demographic group. Purpose of the Study Was: To provide a synthesis of the literature regarding the evaluation risk factors and pathogenesis of ocular vascular pathology, with special emphasis on examination methods, clinical characteristics, complications and modern treatment strategies in older adults with retinal vein thrombosis. Materials and Methods: PubMed, Web of Science and Cochrane Library were searched for studies, systematic reviews or meta-analyses reporting the relationship between the central retinal vein (CRV) or its branches thrombosis and patient age in the period from 2015 to 2024. Population-based or cohort studies with maximum population inclusion were selected. Results: Analysis of modern methods examination – fluorescence angiography of the ocular fundus (FA), an angio-optical coherence tomography (Angio-OCT) study of the retina and Fluorescence angiography allows revealing important pathogenetic aspects of retinal vein occlusion. Understanding all epidemiological, pathogenetic and diagnostic aspects in older adults is paramount for RVT timely effective prevention, clinical intervention and rehabilitation. Conclusion: The prevalence of retinal vein occlusion increases significantly with age. It is associated with an increase in stroke, cardiovascular events, and mortality. This requires monitoring and treating vascular risk factors.

Background: Erectile dysfunction (ED) is one of the manifestations of long COVID-19 and in most cases has an endothelial and neurogenic nature. Many experimental and clinical investigations have revealed the high efficacy of transcutaneous electrical nerve stimulation (TENS) of the pudendal nerve and low-level laser therapy (LLLT) in the treatment of ED. Purpose: To compare LLLT and TENS, and investigate the dynamics of their efficacy when combined in the treatment of patients with post-COVID-19 ED using the International Index of Erectile Function-15 (IIEF-15). Materials and Methods: This interventional, randomized controlled trial enrolled 82 patients with ED following COVID-19. All patients had their first ED diagnosis after COVID-19 within one month of the onset of respiratory symptoms. The duration of patients’ ED was not less than six months, but less than one year. Patients were divided into four groups, one of which received sham LLLT and TENS (n = 20). The remaining patients underwent effective treatment using LLLT (n = 21), TENS (n = 21), and combined LLLT and TENS (n = 20). To study the effectiveness of the treatment, IIEF-15 and an assessment of tactile sensation in the genital area before and after the treatment, as well as 3 months after the end of the treatment, were used. Results: Both LLLT and TENS had a significant effect in improving erectile function, of 38% (p ≤ 0.01) and 27% (p ≤ 0.01), respectively. The improvement in erectile function after LLLT was higher than after TENS by 8.2% (p ≤ 0.05), but the combination of these methods exceeds the result of using LLLT alone by 20% (p ≤ 0.01). The reduction in hypoesthesia after LLLT did not exceed 17.4% (p ≤ 0.05). However, after TENS, the reduction in hypoesthesia reached 48.7% (p ≤ 0.01), and with a combination of the two methods, it reached 60.9% (p ≤ 0.01). Treatment outcomes in LLLT, TENS, and LLLT + TENS groups were stable for 3 months. Conclusions: According to IIEF-15 dynamics, LLLT and TENS are both very beneficial in treatment of post-COVID-19 ED, with LLLT showing a moderately better outcome than TENS. LLLT and TENS were found to have significant positive therapeutic effects on orgasm, sexual desire, and sexual satisfaction, among other aspects of sexual function. Nevertheless, the combination of LLLT and TENS proved to be much more successful in enhancing all IIEF domains, expanding the therapeutic effect spectrum, and improving the TENS effect following LLLT application. Only after TENS did genital hypoesthesia reliably regress, and the effect was amplified when TENS and LLLT were combined.

Objective. To study the effectiveness of including stabilotraining using the multiaxial platform «HUBER 360» in a comprehensive rehabilitation program for patients with lumbar dorsopathies at the third stage of rehabilitation. Material and methods. The study included 60 patients with lumbar dorsopathies, whose average age was 59.1 ± 9.6 years. Patients were divided into two groups: group 1, the main group (n = 30) and group 2, the control group (n = 30). All patients received a standard course of treatment, including drug therapy in the amount of non-steroidal anti-inflammatory drugs and muscle relaxants, in combination with therapeutic gymnastics procedures in a group, therapeutic massage according to the classical method of the lumbosacral spine, general magnetic therapy. The duration of the rehabilitation course was 10 treatment days. In addition to the basic rehabilitation course, patients of the main group received stabilotraining procedures on the multiaxial platform «HUBER 360» (Germany). Results. As a result of the study, an improvement in mobility was revealed in patients of the main group, in comparison with the control group, so the data obtained during the ten-meter walk test showed that after the stabilotraining procedures, the number of patients in the main comparison group who completed this test increased by 50 %, while the speed of passing this segment increased by 3.9 %. The time of passing had no statistical difference p> 0.05, the number of patients who passed the test was 100 % (p < 0.05). While in the control group, patients demonstrated a lower result in assessing the level of mobility. When analyzing the dynamics of the severity of pain syndrome according to VAS, we noted a significant regression of pain syndrome as a result of the course of treatment, both within groups and in intergroup comparison. Thus, the inclusion of a course of stabilotraining to improve postural control and strengthen the back muscles helps to reduce the severity of pain syndrome. The data obtained during the stabilometric study characterize the persistent instability of postural balance control in patients of the control group, which leads to an increase in the amplitude of oscillations of the center of mass pressure compared to the results of patients in the main comparison group who underwent a course of stabilometric training, the results of which demonstrate a stable postural balance and a tendency to stabilization in a vertical position with the restoration of a physiological dynamic stereotype. The quality of life of patients in the dynamics of treatment according to the results of testing on the SF-36 scale revealed a statistically significant positive result in the components of physical and psychological health in patients of both comparison groups, but the effectiveness of recovery was more significant in the group of patients with stabilometric training. Conclusion. The inclusion of stabilometric training in a comprehensive rehabilitation program for patients with dorsopathy of various localizations during the period of abatement of exacerbation allows to effectively restore the quality of life of patients, their mobility and helps to reduce the severity of pain syndrome.

Background: To date, there have been no studies on the dynamics of areas of pain, paraesthesia and hypoesthesia after the use of various transcutaneous electrical nerve stimulation in the treatment of meralgia paresthetica. Methods: In this pilot study, we observed 68 patients with obesity-related bilateral meralgia paresthetica. Pain syndrome, paraesthesia symptoms, and hypoesthesia were evaluated using 10-point scores. In addition, pain drawing (PD) was used to determine the area of the spatial distribution of pain syndrome and paraesthesia symptoms, and body drawing was used to determine the area of hypoesthesia. Sham TENS was performed in the control group, and effective TENS was performed in the treatment group. The treatment group consisted of two subgroups. One subgroup underwent HF-LA TENS, and the second subgroup underwent LF-HA TENS. Results: Despite the greatest analgesic effect observed from HF-LA TENS, which was assessed using scoring methods, during and after treatment, the reduction in the area of pain and paraesthesia symptoms and the area of hypoesthesia was moderate, short-term, and reversible. In contrast, LF-HA TENS had a pronounced analgesic and sustained anti-paraesthesia effect, manifested by a noticeable decrease in pain and paraesthesia symptoms area in PD, gradually increasing during the first 2 months of follow-up and accompanied by an irreversible prolonged decrease in the area of hypoesthesia. Conclusion: The areas of paraesthesia and hypoesthesia correlate with affective reactions to long-term chronic pain, which noticeably regress under the influence of LF-HA TENS compared to HF-LA TENS.

Objective. To study the effectiveness of a comprehensive rehabilitation program that includes therapeutic exercise, psychotherapy, occupational therapy, massage, and physiotherapy (oxyteplochromovibrotherapy using the Alpha Capsule device) in a complex of rehabilitation measures for disabled children with cerebral palsy. Material and methods. The study included 20 disabled children aged 10 to 16 years, with level II damage according to GMFCS. Patients were divided into two groups according to the rehabilitation treatment they received. The first group (n=10 patients) underwent rehabilitation treatment in the form of therapeutic exercise, massage, and physiotherapy. In the second group (n=10 patients), psychotherapy and occupational therapy procedures were added to the complex of basic measures. Results. The inclusion of psychotherapy and occupational therapy in the rehabilitation complex for disabled children with cerebral palsy contributed to an increase in tolerance to physical activity, a decrease in anxiety and depression, and an improvement in the quality of life of patients.

Background: Vertebrogenic disorders are among the most common chronic diseases in humans, with degenerative-dystrophic changes in the spine being the most prevalent. Severe clinical manifestations of vertebrogenic diseases typically occur during active working years and are a frequent cause of temporary disability. A particularly important issue is the need for regular rehabilitation courses for patients with chronic dorsopathy to prolong remission. However, due to the working-age status of many patients, logistical and paramedical challenges — particularly in implementing therapeutic exercises — often hinder access to rehabilitation procedures. The development of remote rehabilitation using information and communication technologies, such as smartphones and computers, presents a viable alternative to in-person rehabilitation. Aim: To assess the effectiveness and safety of motor rehabilitation using telemedicine in patients with dorsopathy of various localizations in remission. Materials and methods: This retrospective study included 32 patients aged 35 to 70 years with dorsopathy of various localizations in remission who underwent rehabilitation via telemedicine. Upon completing an in-person comprehensive treatment course which included pharmacotherapy and medical rehabilitation, all patients were provided with a link to access a structured motor rehabilitation program. The effectiveness of rehabilitation was assessed using standardized questionnaires and mobility assessment tests. Results: Telemedicine-based rehabilitation for patients with dorsopathy of various localizations in remission demonstrated positive clinical outcomes. Conclusion: Specialized therapeutic exercise programs and a structured model for remote rehabilitation may serve as an effective alternative to in-person rehabilitation, particularly in cases where paramedical challenges hinder direct participation.

Objective. This study aims to analyze the prevalence and developmental factors of neck pain among students of Russian higher education institutions, with an emphasis on the impact of this pain on quality of life, academic activities, and overall well-being of students.Materials and Methods. The study is based on data obtained from 780 students through a survey conducted on the Google Forms platform. Descriptive statistics and correlational analysis methods were applied, utilizing SPSS software for data processing.Results. A high prevalence of neck pain among students (75.4 %) was identified. The analysis revealed a connection between neck pain and various aspects of life, including physical activity, stress, the use of mobile devices, and levels of physical activity. A correlation between neck pain and the psychosocial health of students was also established, particularly with anxiety and depression.Conclusions. The study underscores the necessity of a comprehensive approach in the prevention and treatment of neck pain among students. The development of programs aimed at improving the physical and psychological health of students is recommended, including exercises for neck and back, lifestyle modification, and psychological support.