Rehabilitation Care In Chronic Renal Disease

Хронично бъбречното заболяване (ХБЗ) е прогресивно състояние, което може да повлияе отрицателно на мускулно-скелетната система. Предвид последиците, като ниската мускулна маса и ниската минерална плътност на костите, подходящата и навременна двигателна терапия е важна за подобряване на опорно-двигателната и бъбречна функция. Литературните данни и изследователски проучвания сочат, че двигателни упражнения, фокусирани върху възстановяване на бъбречната функция, подобряват аеробния капацитет, мускулното-скелетното функциониране, функцията на сърдечно-съдовата система, локомоцията и качеството на живот на пациенти с ХБЗ. Подходящият двигателен режим включва силови тренировки и аеробно обучение за благоприятно повлияване на вторични ХБЗ усложнения. В тази връзка физиотерапевтите са подходящи членове сред интердисциплинарния екип, предоставящ медицински и здравни услуги. Техните компетенции са напълно акуратни в лечението на съпътстващите мускулно-скелетни дисфункции при пациенти с ХБЗ.Предоставянето на възможности от законодателя за официално предписание на физически упражнения от специалист, заедно със създаване и прилагане на двигателна програма, е предизвикателство за здравеопазването на Република България. Необходимо е по-голямо разбиране и интегриране в стандартния план на рехабилитационни грижи за хора с ХБЗ.Двигателната терапия може да бъде ефективна клинична стратегия за подобряване на бъбречната функция, понижаване на риска от сърдечно-съдови заболявания при пациенти с ХБЗ.Целта на този доклад е да се обобщи влиянието на ХБЗ върху здравето на мускулно-скелетната система и да се подчертае ролята на двигателната терапия при вторичните увреждания, дължащи се на това състояние.Chronic kidney disease (CKD) is a progressive condition that can negatively affect the musculoskeletal system. Given the consequences, such as low muscle mass and low bone mineral density, appropriate and timely motor therapy is important for improving locomotor and renal function. Literary data and research studies indicate that motor exercise focused on rehabilitation of renal function improves aerobic capacity, musculoskeletal function, cardiovascular function, locomotion and quality of life of patients with CKD. A suitable motor regimen includes strength training and aerobic training to favor secondary CKD complications. In this regard, physiotherapists are good members of the interdisciplinary team providing medical and health care. Their competencies are suitable in the treatment of concomitant musculoskeletal dysfunctions in CKD patients.Providing opportunities by the legislator for official prescription of physical exercise by a specialist, together with the creation and implementation of a mobility program, is a challenge for the healthcare of the Republic of Bulgaria. Greater understanding and integration in the standard plan of rehabilitation care for people with CKD is needed.Motor therapy can be an effective clinical strategy to improve kidney function, reducing the risk of cardiovascular diseases in patients with CKD.The purpose of this report is to summarize the impact of CKD on the state of the musculoskeletal system and to highlight the role of motor therapy in secondary damage due to this condition

Rehabilitation care in patients subjected to surgical intervention for lower lung volume reduction

Emphysema is a phenotype of chronic obstructive pulmonary disease (COPD), defined as an abnormal and permanent expansion of the respiratory space distant from the terminal bronchioles and destruction of the alveolar walls. Emphysema manifests clinically with shortness of breath by restricting airflow, hyperinflation, and loss of gas exchange surfaces in the lungs (also known as increased physiologic dead space).Lung volume reduction surgery (LVRS), also called reduction pneumoplasty or bilateral pneumonectomy, is a surgical technique that may be helpful for some patients with advanced emphysema who have poor control of their disease despite maximum dose of medication.Pulmonary rehabilitation (PR) is an integral part of the preparation and recovery from surgical interventions. PR has a significant place and role in supporting the recovery and quality of life of patients undergoing LVRS. The purpose of the study is е to present the role of PR in LVRS, outline the components and describe the expected benefits.

BULGARIA’S INDEPENDENT ENERGY EXCHANGE – POSSIBILITIES FOR RISK MANAGEMENT

This article discusses the urgent problems of the Bulgarian energy market and its slow transformation from state monopoly to free exchange market. The paper aims at elaborating on the specific aspects of energy trading – basically, and in particular, the characteristics and disproportions imposed by the state and the state-owned energy holdings on the Bulgarian market. Ever since its establishment in 2014, the Bulgarian Independent Energy Exchange (BIEE) has adopted the model and rules of the north energy exchange – Nord Pool. The arguments for this choice have not been discussed publicly, but the necessity of a well-functioning energy exchange market and the need of its daily transparent activity, already in Bulgaria as well, are accepted as proven. The functioning and reliability of the Bulgarian stock exchange, however, are still the subject of certain discussions. What could have happened if the Bulgarian stock exchange had adopted the model of the European energy exchange – EEE

Informed consent for Rhinoplasty

Every surgical procedure involves a certain amount of risk and it is important that you understand the risks involved with rhinoplasty surgery. This is an informed consent document that has been prepared to help your surgeon inform you concerning rhinoplasty surgery, its risks, and alternative treatment. When rhinoplasty is performed by a qualified surgeon, complications are rare and usually minor. Nevertheless, there is always a possibility that complications may occur. We can reduce your risks by closely following the doctor’s instructions both before and after surgery.--------------------------------------Всяка хирургична интервенция предполага усложнения и риск и е от особена важност запознаването на пациента и неговата информираност. Този документ представлява информирано съгласие на пациента, което ще помогне както на хирурга, така също ще подготви пациента за хирургичната интервенция, нейните рискове и алтернативно лечение. Ако ринопластиката е извършена от квалифициран и опитен хирург, компликациите са по-малки и по-редки. Въпреки това е напълно възможно да се срещнат различни компликации при тази операция. Ние бихме могли да намалим този риск и нежеланите резултати, обсъждайки предварително с пациентите възможния изход от операцията

Respiratory Physiotherapy In Preoperative Myocardial Revascularization Surgery

Сърдечно-съдовите заболявания са сред основните причини за смърт в развитите страни.Аортокоронарен байпас е кардиохирургичен метод за реваскуларизация, при който обструкцията се заобикаля с отпрепарирана вена или артерия чрез зашиването й към аортата и към участък след запушването на засегнатата артерия (като мост). Методът рядко се ползва при пациенти с остър инфаркт на миокарда – а именно при неуспешна първична перкутанна коронарна интервенция (ПКИ/РСІ) или при неподходящи за РСІ коронарни артерии. Ясна индикация за кардиохирургично лечение са случаите с настъпили механични усложнения в хода на инфаркта. Повечето от пациентите, подложени на миокардна реваскуларизационна хирургия, развиват следоперативна белодробна дисфункция със значимо намаляване на белодробните обеми, увреждания в дихателния механизъм, намаляване обемите на белите дробове и увеличаване на дихателната работа. Намаляването на обемите и капацитета на белите дробове може да допринесе за промени в газообмена, което води до хипоксемия и намаляване на дифузионния капацитет. Като се вземе това предвид, все повече се изисква предоставяне на физиотерапевтична грижа в предоперативния период на тази операция.Целта на това изследване е да се направи преглед на литературата за различните техники на респираторната физиотерапия и тяхната ефективност в предоперативния период при миокардна реваскуларизационна хирургия, с доказан положителен ефект върху белодробните усложнения. Физиотерапията използва няколко техники в предоперативния период, като: стимулираща спирометрия, упражнения за дълбоко дишане, кашлица, обучение за вдишване на мускулите, по-ранни амбиции и физиотерапевтични ориентации.Cardiovascular diseases are one of the leading causes of death in developed countries. Aorto-coronary bypass is a cardiac surgery method for revascularization in which the obstruction is circumvented by a repaired vein or artery by suturing it to the aorta and to a section after obstruction of the affected artery (such as a bridge). The method is rarely used in patients with acute myocardial infarction - namely, failure of primary percutaneous coronary intervention (PCI / PCI) or non-PCI coronary artery failure. A clear indication for cardiac surgery are cases of mechanical complications during myocardial infarction. Most of the patients undergoing myocardial revascularization surgery develop postoperative pulmonary dysfunction with significant reduction in lung volumes, damage to the respiratory mechanism, decrease in lung volumes and increased respiratory function. Reduced lung volumes and capacity can contribute to changes in gas exchange, leading to hypoxemia and decreased diffusion capacity. With this in mind, it is increasingly required to provide physiotherapy care during the preoperative period of this operation.The purpose of this study is to review the literature on the various techniques of respiratory physiotherapy and their efficacy in the preoperative period in myocardial revascularization surgery, with a positive effect on pulmonary complications.Physiotherapy uses several techniques in the preoperative period, such as: stimulating spirometry, deep breathing exercises, coughing, muscle inhalation training, earlier ambitions and physiotherapy orientations

The personal approach in rehabilitation care - a necessary condition for improving the quality of life in patients with stroke

Rehabilitative care after stroke could last months and years. This period of treatment often exceeds all established frameworks concerning organized provision of rehabilitation. Of particular importance for the duration of rehabilitation management motor deficits and psychiatric disorders available in a considerable part of this vulnerable group. Still no consensus on how best to help survivors of stroke patients, using all available resources. The search for an answer continues to provoke professionals in search of the `golden` model for the timely provision of the needs of this population.A different approach to this process is counseling the patient and their family and the preparation of the rehabilitation plan with them. Such personal approach implies more engaged participation of the patient in the implementation of the rehabilitation program. In this sense, improving the quality of life in this vulnerable group in society is of particular importance in the context of their early social inclusion and reintegration

Rehabilitation care for patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable disease characterized by persistent respiratory symptoms and airway obstruction, and/or alveolar damage, usually caused by significant exposure to harmful particles or gas.The most common respiratory symptoms are shortness of breath, cough, and/or expectoration (GOLD 2019). Patients underestimate these symptoms. Illness is the leading cause of mortality. It affects around 329 million people worldwide. These figures show an increase of 65% since 1990. In 2013, the disease increased by 2,900,000 deaths, up from 2,400,000 in 1990. The number of deaths is expected to continue increasing, due to more pronounced exposure to risk factors, the most significant of which is smoking. Prognosis indicates that by 2020 this negative trend will deepen. According to various estimates, 4-6% of the population over 40 in Europe suffers from COPD, with the incidence of the disease increasing with age.Daily activities, such as climbing stairs or walking on a slope, become a daily battle for those living with COPD. Most people do not spend time thinking about their breathing, but other people’s daily lives are centered around it. COPD is a serious illness, but there are some steps to prevent it from getting worse. This worrying data is a strong argument in the need to do more for people with COPD to keep their condition under control.The purpose of the study is to review the literature on the usefulness of respiratory physiotherapy

Rehabilitation care for chronic venous insufficiency

Chronic venous insufficiency (CVI) is a common medical condition with a major socio-economic impact. The prevalence among the adult population is estimated at 5–30%. Her pathology is based on venous hypertension of the lower extremities. This leads to swelling, subcutaneous fibrosis, pigmentation, chronic pain and ulceration. Treatment options for CVI include medical, interventional, surgical treatments, as well as exercise. Primary treatment of CVI includes conservative approaches to reduce symptoms and prevent the development of secondary complications and disease progression. Comprehensive Rehabilitation Care (CRC) includes positional treatment, drainage technician, supportive skin care methods, structured exercise program, and physiotherapy - intermittent pneumatic compression (IPC), compression stocking (CS), patient training, and other methods. CVI is a chronic disease that needs lifelong care.The purpose of this report is to summarize the types of rehabilitation care (RG) as part of the conservative treatment approach in patients with CVD based on literature sources