Clinical evaluation of different treatment strategies for motor recovery in poststroke rehabilitation during the first 90 days

Background: Motor recovery after stroke is based on neuronal plasticity and the structural reorganization of the brain. Questions are debated about the proper moment to start rehabilitation in the acute period of stroke, the significance of rehabilitation interventions during the so-called “plastic window”, and the advantages of modern and traditional programs. The aims of this study were to evaluate the role of different rehabilitation strategies and their combinations for motor recovery and the impact on functional disability by way of neurological and functional outcomes 3 months after ischemic stroke. Methods: We used three rehabilitation approaches: early rehabilitation from the first day of stroke (Phase I), traditional exercise programs (Phase II), and an author’s new method of biofeedback rehabilitation using motion sensors and augmented reality (AR) rehabilitation (Phase III). Clinical and functional outcomes were measured on the 90th day after stroke. We developed algorithms for quantifying the quality of movements during the execution of tasks in the motor domains of the AR rehabilitation program. Results: Phase I of rehabilitation led to an improvement in functional independence, and the recovery of motor functions of the extremities with an absence of mortality and clinical deterioration. AR rehabilitation led to significant improvement both with respect to clinical and functional scores on scales and to variables reflecting the quality of movements. Patients who were actively treated during Phases II and III achieved the same final level of motor recovery and functional outcomes as that of participants who had only received AR rehabilitation during Phase III. Patients who underwent outpatient observation after Phase I showed a deficit of spontaneous motor recovery on the 90th day after stroke. Conclusions: Early rehabilitation was successful but was not enough; rehabilitation programs should be carried out throughout the entire “sensitive period” of poststroke plasticity. The newly developed AR biofeedback motion training is effective and safe as a separate rehabilitation method in the early recovery period of moderately severe, hemiparalytic, and ischemic stroke. These two rehabilitation approaches must be applied together or after each other, not instead of each other, as shown in clinical practice

Crimean-Congo haemorrhagic fever virus in Kazakhstan (1948-2013)

AbstractCrimean-Congo haemorrhagic fever (CCHF) is a pathogenic and often fatal arboviral disease with a distribution spanning large areas of Africa, Europe and Asia. The causative agent is a negative-sense single-stranded RNA virus classified within the Nairovirus genus of the Bunyaviridae family.Cases of CCHF have been officially recorded in Kazakhstan since the disease was first officially reported in modern medicine. Serological surveillance of human and animal populations provide evidence that the virus was perpetually circulating in a local enzoonotic cycle involving mammals, ticks and humans in the southern regions of the country. Most cases of human disease were associated with agricultural professions such as farming, shepherding and fruit-picking; the typical route of infection was via tick-bite although several cases of contact transmission associated with caring for sick patients have been documented.In total, 704 confirmed human cases of CCHF have been registered in Kazakhstan from 1948-2013 with an overall case fatality rate of 14.8% for cases with a documented outcome.The southern regions of Kazakhstan should be considered endemic for CCHF with cases reported from these territories on an annual basis. Modern diagnostic technologies allow for rapid clinical diagnosis and for surveillance studies to monitor for potential expansion in known risk areas

Methodology of Epidemic Risk Management in Kazakhstan with Open-Source EIDSS

In order to transition the forecasting, estimation and management of epidemic risks to individual administrative areas, the Agency for Consumer Rights Protection of Kazakhstan has developed the Regional Sanitary-Epidemiological Passport (RSEP). The RSEP will contain information on the infectious incidence rate dynamics according to the main infections (7 nosologies) with a forecast for 2-3 years, and natural and soil foci GIS maps for especially dangerous pathogens with their activity forecast for 3-5 years. Approbation of RSEP was conducted for the Crimean-Congo hemorrhagic fever. Planned work includes estimation method adjustment, retrospective databank formation, GIS archive creation and Open-source EIDSS system application

Modernization of Epi Surveillance in Kazakhstan: Transition to Risk Assessment and Real-Time Monitoring Based on Situational Center

The paper presents a concept for sanitary-epidemiological monitoring system reinforcement in Kazakhstan based on the deployed electronic surveillance system, risk assessment and management approach, and establishment of a Situational Center. It outlines the internal and external information sources for their further analysis and formulates tasks to implement proposed concept

Modernization of Epi Surveillance in Kazakhstan: Transition to Risk Assessment and Real-Time Monitoring Based on Situational Center

The paper presents a concept for sanitary-epidemiological monitoring system reinforcement in Kazakhstan based on the deployed electronic surveillance system, risk assessment and management approach, and establishment of a Situational Center. It outlines the internal and external information sources for their further analysis and formulates tasks to implement proposed concept

Scissored pair control moment gyroscope inverted pendulum

International audienceMotivated by non-anthropomorphic dynamic stabilization of a walking robot, we are working on a 2D inverted pendulum stabilized with a scissored pair of control moment gyroscopes. This inverted pendulum is a fair approximation of a robot, allowing us to study the dynamics in simplified settings. In this paper we propose a model for the pendulum; the model neglects all unessential terms and thus is suitable for analysis. We also propose a simple control law based on the linearization of the model and we validate it experimentally

Unilesional follicular mycosis fungoides: report of two cases with progression to tumor stage and review of the literature

Mycosis fungoides (MF) is the most common type of cutaneous lymphoma and has protean clinicopathological manifestations. Follicular or folliculotropic MF (FMF) is a rare variant, which histopathologically is characterized by pronounced folliculotropism of neoplastic T cells, with or without follicular mucinosis, and clinically by an impaired prognosis compared to classic MF. In contrast, unilesional MF is a very rare variant with an excellent prognosis, with a single case of large-cell transformation reported to date. The combination of folliculotropic and unilesional MF is very unusual, with only two cases reported to date. Here we report two patients with unilesional folliculotropic MF with progression to tumor stage in both patients. To the best of our knowledge, this is the first report on the disease evolution with large-cell transformation and progression of unilesional FMF. Complete remission was achieved by local radiation therapy in both patients. The differential diagnoses, classification and implications for the treatment of unilesional FMF as well as the pertinent literature are discussed

EIDSS Application for CCHF Foci Activity Epi-Analysis and Prediction in Kazakhstan

Electronic Integrated Disease Surveillance System (EIDSS) was used to applied epi-analysis and prediction capabilities for situation in CCHF foci in Kazakhstan. Three indicators were used: population density in the CCHF-disadvantaged area; tick infection rate; human incidence rate. Maps generated in EIDSS allowed visualizing information and conducting a milti-factor epi-analysis. The CCHF outbreaks risk areas were identified. EIDSS software is easy to use, available for practical epidemiologists and can be used for analysis and prediction of vector-borne virus infections foci. EIDSS can serve as a basic working tool for field epidemiologists and the basis for managerial decision-making by the concerned ministries

Accuracy of EIDSS Software Prognosis on CCHF Natural Foci Activity in Kazakhstan

Based on the actual situation in the CCHF natural foci of Kazakhstan for the first half of 2013, the authors, using EIDSS version 4, evaluated the accuracy of the earlier prognosis of situation development in the CCHF natural foci of Kazakhstan for 2013 (EIDSS Application for CCHF Foci Activity Epi-Analysis and Prediction in Kazakhstan). The prognosis of situation development in 2013 for 11 districts of Kazakhstan (estimated in 2012 as the districts with a high risk of CCHF) proved to be accurate in 90.9% of cases.