Анализ ключевых компонентов реабилитационного диагноза у пациентов с инсультом в острейшую фазу

Introduction. There are key problems that limit patients’ functioning in the period after insult. The content of these problems determines the structure of multidisciplinary team.The objective of the study was to describe key problems that limited patients’ functioning in the period after insult and determine the structure of multidisciplinary team for resolving these problems efficiently.Material and methods. The study was observational. The sample size was 81 patients. Inclusion criteria: acute phase of post ischemic or hemorrhagic stroke (0–14 days after onset), mRs score 2 and more at admission to the hospital, the age over 18 years. Exclusion criteria: patients with transient ischemic attack, subarachnoid haemorrhage, Glasgow coma scale 2 and more at admission to the hospital. All patients – research participants received medical care in according to clinical guidelines, and multidisciplinary rehabilitation. In the course of rehabilitation, the first and second key problems that limited patients’ functioning in the period after insult were dedicated in each patient. We also investigated these problems and explored, which specialists must have been included in the structure of multidisciplinary team.Results. The key problems were non-medical in 24 % cases, poor exercise capacity were presented in 27 % cases, environment issues – 6 % cases, swallowing and speech disorders – 17 %, nursery problems – 4 %. The next specialists were needed to resolve the key problems: psychologist – 38 % cases, physical therapist– 69 % cases, occupational therapist – 28 % cases, neurologist – 27 % cases, physical medicine and rehabilitation physician – 27 % cases.Conclusion. Medical (rehabilitation physician, specialist, nurse) and non-medical specialists (occupational therapist, physical therapist, psychologist, logopaedist, etc.) must have been included in multidisciplinary team.Введение. У пациентов с инсультом в реабилитационном периоде обнаруживаются ключевые проблемы, ограничивающие функционирование. Характер ключевых проблем определяет потребность определенных специалистов в составе мультидисциплинарной бригады (МДБ).Цель исследования. Описать ключевые проблемы, ограничивающие функционирование пациентов с инсультом и определить какие специалисты должны входить в состав МДБ.Материалы и методы. Исследование наблюдательное. Размер выборки 81 человек. В выборку включены пациенты в острейшем периоде ишемического или геморрагического инсульта, с оценкой по модифицированной шкале Рэнкина 2 и более балла при поступлении в стационар, возрастом старше 18 лет. В выборку намерено не включались пациенты с изолированной транзиторной ишемической атакой, изолированным субарахноидальным кровоизлиянием, с уровнем сознания при поступлении кома 2 и более. Пациентам – участникам исследования оказана медицинская помощь в соответствии с имеющимися рекомендациями, проведена мультидисциплинарная реабилитация. В ходе реабилитации у каждого пациента выделены первая и вторая ключевая проблемы, ограничивающие функционирование.Результаты. Ключевые проблемы носили немедицинский характер в 24% случаев, снижение толерантности к физической нагрузке – 27% случаев, проблемы со средой – 6% случаев, нарушения глотания и речи – 17% случаев, проблемы сестринского характера – 4% случаев. Для решения ключевых проблем требовалось участие психолога в 38% случаев, физического терапевта – в 69% случаев, эрготерапевта – в 28% случаев, невролога – в 27% случаев, врача-реабилитолога – в 27% случаев.Заключение. В состав мультидисциплинарной бригады должны входить специалисты медицинского (врач-реабилитолог, профильный специалист, медицинская сестра) и немедицинского профиля (эрготерапевт, физический терапевт, психолог, логопед, и др.)

Vascular myelopathy: causes and mechanisms, possibilities of diagnosis and treatment

Vascular myelopathy is a rare severe disease caused by a broad spectrum of causes, among which pathology of the aorta and its branches, aortic surgery, spinal diseases, and spinal trauma occupy the main place. The processes of neuroinflammation and glutamate neurotoxicity play a leading role in the pathogenesis of myeloischemia. The clinical picture of the disease is nonspecific and depends on the location and volume of an ischemic focus. Magnetic resonance imaging is a gold standard for diagnosis. However, this method remains insensitive in the acute period and fails to detect spinal cord ischemia at preclinical stages. The investigation and introduction of specific biochemical markers (glutamate receptors and their antibodies) for neurotoxicity, which can identify ischemia in the advanced stage and predetermine its development, are promising. The treatment of vascular myelopathy has not currently been standardized and it is mainly pathogenetic and symptomatic

Vascular myelopathy: causes and mechanisms, possibilities of diagnosis and treatment

Vascular myelopathy is a rare severe disease caused by a broad spectrum of causes, among which pathology of the aorta and its branches, aortic surgery, spinal diseases, and spinal trauma occupy the main place. The processes of neuroinflammation and glutamate neurotoxicity play a leading role in the pathogenesis of myeloischemia. The clinical picture of the disease is nonspecific and depends on the location and volume of an ischemic focus. Magnetic resonance imaging is a gold standard for diagnosis. However, this method remains insensitive in the acute period and fails to detect spinal cord ischemia at preclinical stages. The investigation and introduction of specific biochemical markers (glutamate receptors and their antibodies) for neurotoxicity, which can identify ischemia in the advanced stage and predetermine its development, are promising. The treatment of vascular myelopathy has not currently been standardized and it is mainly pathogenetic and symptomatic

Surgical correction of metabolic syndromes in rats: methodological aspects

Aim. The study was aimed at detailed description of the technique of bariatric surgical interventions with varying metabolic effects in the rat. We also provided comparison between different surgical operations and considered rationale for making several types of surgery simultaneously.Materials and мethods. The study was performed on 120 male Wistar rats (380–510 g) housed in the SPF rodent facility. The animals were anesthetized using isoflurane anesthesia. The following types of surgery were performed and described: sleeve gastrectomy, gastric bypass, gastrojejunal bypass, ileal transposition, and combination of sleeve gastrectomy and ileal transposition. The technical complexity of surgery was scored according to 10-point scale.Results. The methodological aspects of sleeve gastrectomy, gastric bypass, gastrojejunal bypass, and ileal transposition in rats are considered in detail. Sleeve gastrectomy and gastric bypass are the most commonly used types of bariatric surgery, while gastrojejunal bypass and ileal transposition are specifically aimed at modeling of metabolic effects. The article considered preoperative planning as well as major stages of surgery. We focused attention on perioperative complications and technical nuances.Conclusion. Modeling of bariatric surgical interventions on the small laboratory rodents is challenging, requires sophisticated manual skills and microsurgical equipment. The illustrated description of these surgical interventions will provide a useful reference for beginners in this laborious part of experimental surgery

Analysis of key components in the rehabilitation diagnosis of acute stroke patients

Introduction. There are key problems that limit patients’ functioning in the period after insult. The content of these problems determines the structure of multidisciplinary team.The objective of the study was to describe key problems that limited patients’ functioning in the period after insult and determine the structure of multidisciplinary team for resolving these problems efficiently.Material and methods. The study was observational. The sample size was 81 patients. Inclusion criteria: acute phase of post ischemic or hemorrhagic stroke (0–14 days after onset), mRs score 2 and more at admission to the hospital, the age over 18 years. Exclusion criteria: patients with transient ischemic attack, subarachnoid haemorrhage, Glasgow coma scale 2 and more at admission to the hospital. All patients – research participants received medical care in according to clinical guidelines, and multidisciplinary rehabilitation. In the course of rehabilitation, the first and second key problems that limited patients’ functioning in the period after insult were dedicated in each patient. We also investigated these problems and explored, which specialists must have been included in the structure of multidisciplinary team.Results. The key problems were non-medical in 24 % cases, poor exercise capacity were presented in 27 % cases, environment issues – 6 % cases, swallowing and speech disorders – 17 %, nursery problems – 4 %. The next specialists were needed to resolve the key problems: psychologist – 38 % cases, physical therapist– 69 % cases, occupational therapist – 28 % cases, neurologist – 27 % cases, physical medicine and rehabilitation physician – 27 % cases.Conclusion. Medical (rehabilitation physician, specialist, nurse) and non-medical specialists (occupational therapist, physical therapist, psychologist, logopaedist, etc.) must have been included in multidisciplinary team