Investigation of the Effectiveness and Safety of the Rehabilitation Program for Patients with Long Covid Using Aquatic Training

Aim. To evaluate the effectiveness and safety of aquatic training in diluted sodium chloride bromine brine in restoring the functional state of the organism of patients with portcovid syndrome in comparison with aquatic training in fresh water. Material and methods. Specialists of the National Medical Research Centre of Rehabilitation and Balneology of the Ministry of Health of Russia conducted an open, prospective, randomized study to evaluate the effect of a course of aquatic training in a bromine sodium chloride brine pool. The study included 28 subjects, who were divided into 2 equal groups. Patients in both groups were comparable for gender (χ2 =0.45;p=0.31) and age (U=99.5;p=0.7) and all had post COVID-19 (U 09.9) as their primary diagnosis. The intervention group received a course of aquatic training (7 treatments) in a pool with bromine sodium chloride brine (well No. 69, 32 Novy Arbat Street, Moscow) with mineralization of 120 g/dm3 and its preliminary dilution to 40 g/m3. Control group - a course of aquatic-exercises (7 treatments) in a fresh water pool. Patients, after signing informed consent, underwent load tests: 6-minute walking test, laser Doppler flowmetry (“LASMA ST”, Russia), cardiointervalography (“Health Reserves-R”, Russia). Results and discussion. These data confirm the “null” hypothesis of a more favorable effect of the chemical composition of the diluted brine that acts during aquatic training on the patient's body compared to fresh water, especially in the presence of microcirculation disorders after suffering COVID-19. The group of patients who received aquatic training in the pool with bromine sodium chloride brine revealed a significant decrease in excessive sympathetic nervous system activity (T-11.0;p=0.02) at the end of the study. According to LAZMA-ST data, there was a twofold increase in the oxidative metabolism of the cell (IOM T-16.0;p <0.01), an increase in exercise tolerance (6-minute walk test T-10.0;p = 0.01). IOM increased statistically significantly threefold (U-32.0;p<0.001), mean microcirculation doubled (U-120.0;p<0.05) and BMI decreased by 20.0% (U-58.0;p<0.05) in the intervention group compared with the control group. There were no significant differences between patient groups on safety parameters (χ2= 1.36;p>0.05). These data confirm the “null” hypothesis of a more favorable effect of the chemical composition of the diluted brine that acts during aquatic training on the patient's body compared to fresh water, especially in the presence of microcirculation disorders after suffering COVID-19. Conclusion. Aquatic training in sodium chloride bromide brine effectively reduces the sympathetic nervous system activity, increases oxidative metabolism and improves microcirculation compared to aquatic training in fresh water. © 2022 Rostovskii Gosudarstvennyi Meditsinskii Universitet. All rights reserved.

Use of Probiotics in Treatment and Rehabilitation of Patients after a New Coronavirus Infection

As of January 2022, 343 million cases of SARS-CoV-2 were reported globally. COVID-19 is a multi-faceted, multi-systemic illness in which all age groups are susceptible. A number of research findings have shown that COVID-19 is associated with dysbiosis, leading to the development of local and systemic pathologies. It was found that the use of probiotics in the complex therapy of patients with COVID-19 reduces the severity of the disease and the development of complications. According to the researchers, several mechanisms could explain the therapeutic effect of probiotics, including the ability to suppress pro-inflammatory cytokine formation and modulate the functional activity of the immune system. In Russia, probiotics in the treatment of COVID-19 patients are only used to correct diarrhea, while literature suggests that probiotics have much greater therapeutic potential. Introducing oral bacterial therapy into the treatment and rehabilitation of COVID-19 patients requires further clinical trials. © 2022 Rostovskii Gosudarstvennyi Meditsinskii Universitet. All rights reserved.

CHALLENGES AND APPROACHES TO MEDICAL REHABILITATION OF PATIENTS WITH COVID-19 COMPLICATIONS

The Covid-19 pandemic could reach several million people worldwide. Presumably, 5-15% of them will need medical rehabilitation after suffering from pneumonia and acute respiratory distress syndrome. A comprehensive search was performed in the databases MEDLINE, CENTRAL, EMBASE, Web of Science and MedPilot, CyberLeninka, and eLIBRARY on-drug rehabilitation methods that prevent the development of Covid-19 complications. The goals of medical rehabilitation at the preclinical stage are to achieve the correction of diseases that contribute to the development of Covid-19 complications (COPD, bronchial asthma, rhinosinusitis, diabetes mellitus), mainly due to non-drug methods. Non-drug technologies have a number of advantages over medications that have a side effect, and such as glucocorticoids and antibiotics lead to a worse prognosis of the underlying disease. Medical rehabilitation in the intensive care unit is aimed at reducing the risk of complications and increasing the functional reserves of the body, as well as reducing the area and degree of lung damage, preventing extrapulmonary complications, including secondary infection. The main goal of medical rehabilitation in a hospital is to reduce the severity of symptoms, resorption and repair in the lesion of lung tissue, reduce the development of fibrosis, and provide bronchial drainage to prevent secondary infection. In addition, timely transfer of the patient to a specialized stage of medical rehabilitation can increase the functional reserve of the respiratory muscles and exercise tolerance. The second, specialized stage of medical rehabilitation can be carried out in the conditions of a sanatorium-resort organization. The goals of this stage are not only to reduce symptoms and increase tolerance to physical activity, but also to improve the quality of life, psychological rehabilitation, and recovery. Пандемия Covid-19 может охватить несколько миллионов человек во всем мире. Предположительно, 5-15% из них будут нуждаться в медицинской реабилитации после перенесенной пневмонии и острого респираторного дистресс синдрома. Проведен комплексный поиск в базах данных MEDLINE, CENTRAL, EMBASE, Web of Science и MedPilot, CyberLeninka, eLIBRARY.RU немедикаментозных методов реабилитации, препятствующих развитию осложнений Covid-19. Целями медицинской реабилитации на доклиническом этапе является достижение коррекции заболеваний, способствующих развитию осложнений Covid-19 (ХОБЛ, бронхиальная астма, риносинуситы, сахарный диабет), преимущественно за счет немедикаментозных методов. Нелекарственные технологии имеют ряд преимуществ по сравнению с лекарственными препаратами, которые имеют побочный эффект, а такие как глюкокортикоиды и антибиотики приводят к ухудшению прогноза основного заболевания. Медицинская реабилитация в условиях реанимационного отделения направлена на снижение рисков развития осложнений и повышение функциональных резервов организма, а также уменьшение зоны и степени поражения легких, профилактику внелегочных осложнений, включая вторичную инфекцию. Главной целью медицинской реабилитации в условиях стационара является снижение выраженности симптомов, рассасывание и репарация в очаге поражения легочной ткани, уменьшение развития фиброза, обеспечение бронхиального дренажа для профилактики вторичной инфекции. Кроме этого, своевременный перевод пациента на специализированный этап медицинской реабилитации позволяет повысить функциональный резерв дыхательной мускулатуры и толерантность к физической нагрузке. Второй специализированный этап медицинской реабилитации может быть проведен в условиях санаторно-курортной организации. Целями данного этапа является не только уменьшение симптомов и повышение толерантности к физической нагрузке, но и улучшение качества жизни, психологическая реабилитация, восстановление работоспособности.