[Effectiveness and safety evaluation of a cough stimulation device in early postoperative respiratory rehabilitation in cardiac surgery patients]. / Otsenka effektivnosti i bezopasnosti apparatnoi stimulyatsii kashlya pri rannei posleoperatsionnoi respiratornoi reabilitatsii u kardiokhirurgicheskikh patsientov.

Postoperative respiratory complications in cardiac surgery patients occur in 22-30% of cases, mostly associated with ineffective cough and evacuation of bronchial secretion. OBJECTIVE: To evaluate the effectiveness and safety of cough stimulation using the mechanical in- and exsufflator in the early postoperative period in cardiac surgery patients. MATERIAL AND METHODS: The study included 37 patients; mean age was 57±12.3 years. Inclusion criteria: age over 18 years; post-extubation spontaneous breathing; fully conscious and cooperative; adequate gas exchange with oxygen therapy; adequate pain control (2 points or less on 10-point visual analogue scale). Exclusion criteria: need for re-intubation and mechanical ventilation; noninvasive mask ventilation; high-flow oxygen therapy; acute cerebrovascular event; uncontrolled bleeding; heart failure (inotropic score over 10); shock; need of extracorporeal blood purification; neuromuscular disease; pneumothorax, hydro- or hemothorax. Cough stimulation was performed using the mechanical in- and exsufflator Comfort Cough Plus («Seoil Pacific Corporation¼, Republic of Korea). The device provides cough stimulation after high-frequency vibrations transmitted through a special vest and lung tissue recruiting by changing the airways pressure of the gas mixture, delivered through the anesthesia face mask. RESULTS: Cough stimulation device use was associated with an increase in the cough effectiveness; the number of patients with productive cough increased 8-fold, from 4 (10.8%) to 32 (86.4%), p=0.0000. The increase of blood oxygen saturation (SpO2) on room air from 92% to 96% (p=0.000001) and inspiratory capacity (IC) from 750 mL to 1200 mL (p=0.000002) was observed. The number of patients with IC of 1200-1500 mL increased 3-fold, and those with an IC over 1500 mL increased 2.6-fold. The proportion of patients with low oxygenation (SpO2 less than 92%) decreased 5-fold after the procedure (p=0.0011). Good tolerability and no side effects of the procedure were noted in all patients. CONCLUSION: Impaired sputum expectoration early after cardiac surgery is observed in most patients and may cause low oxygenation. The main effects of the cough stimulation device were improvement of sputum expectoration and an increase in oxygenation. An increase in blood oxygen saturation and inspiratory capacity after a single procedure with this device was demonstrated. It resulted in a significantly decreased proportion of patients with respiratory insufficiency. No adverse effects of the procedure were observed.

[Complementary methods of rehabilitation in borderline mental disorders].

The article covers treatment results of 417 patients (186 males and 231 females) aged 18 to 71 years, with borderline mental disorders. Findings are that using specified complementary methods, more when treatment complex is applied, causes better psycho-emotional state in patients with borderline mental disorders, that is supported by results of medical diagnostic tests including psychometry tests (abridged minnesota multiphasic personality inventory, Beck depression inventory, Spielberger-Hanin, test "feeling, activity, mood").

[Combined treatment of palmoplantar syndrome in patients under antitumor therapy].

Observation covered 12 patients under various antitumor medications. Group 1 was formed of patients with developed palmoplantar syndrome varying in severity, who received complex treatment including IR-therapy and local antioxidant medication. Group 2 included patients without palmoplantar syndrome, who received preventive treatment with IR-therapy. All patients of group 1 demonstrated lower severity of palmoplantar syndrome manifestations. In group 2, 80% of the patients avoided palmoplantar syndrome development, and 20% of the patients had light course of the syndrome manifestations. Patients at high risk of palmoplantar syndrome under antitumor therapy are recommended to undergo IR-therapy and local antioxidant medication.

[Approaches to phototherapy in children with chronic dermatosis (review of literature)].

The article covers main aspects of phototherapy and photochemotherapy in treatment of skin diseases in children, risks of such methods usage, prophylactic and therapeutic measures, and precaution means for such treatment in pediatrics.

Efficiency of controlled halotherapy in rehabilitation of patients with occupational lung diseases.

The study was aimed at features and efficiency of controlled halotherapy method in patients with occupational chronic obstructive lung disease (COLD). Examination covered 73 patients with occupational mild and moderate stages of COLD, aged 45 to 64. All the patients were randomized to 2 comparable groups - main and reference (37 and 36 examinees respectively). The main group in addition to conventional medical therapy received courses of controlled halotherapy (10 procedures with certain concentration of sodium chloride dry aerosol in accordance to methodic recommendations). Based on complex evaluation of clinical, functional and laboratory methods, the authors assessed efficiency of controlled halotherapy in patients with occupational COLD. Considerable improvement was seen: for mild COLD-- in 40% of cases, for moderate COLD - in 30%, with general efficiency for these patients of 90 and 85% respectively. Analysis of the results obtained enables to evaluate controlled halotherapy as an effective method of rehabilitation and prevention in occupational COLD patients.

[The promising directions for the further development of halotherapy in pediatric medicine]. / Perspektivnye napravleniia razvitiia galoterapii v pediatrii.

This article is focused on the modern possibilities for the application of halotherapy with a view to prevention, treatment and rehabilitation of the children with special reference to the main bio-physical properties of the principal active factors of halotherapy including dry finely-dispersed sodium chloride aerosols and specific features of the mechanism of their therapeutic action. The extensive studies have been underway in the recent years for the purpose of development of the new effective methods for the reconstitution of the aerodispersive environment. Halotherapy can be provided either on an individual (haloinhalation) or a group (exposition in the halochambers and halorooms basis. Halotherapy has been shown to produce well apparent anti-inflammatory, draining, mucolytic, immunomodulatory, and sanogenetic action. The high effectiveness of halotherapy for the prophylactic application in the frequently ill children is emphasized together with the possibility of its extensive use for the treatment of acute respiratory diseases and combined medical rehabilitation of the children presenting with chronic ENT disorders, respiratory and skin diseases. The optimal technologies for the clinical application of various types of halotherapy are discussed.

Halotherapy for treatment of respiratory diseases.

This work elucidates the questions upon the development of a new drug-free method of a respiratory diseases treatment. Halotherapy (HT)--is mode of treatment in a controlled air medium which simulates a natural salt cave microclimate. The main curative factor is dry sodium chloride aerosol with particles of 2 to 5 mkm in size. Particles density (0.5-9 mg/m3) varies with the type of the disease. Other factors are comfortable temperature- humidity regime, the hypobacterial and allergen-free air environment saturated with aeroions. The effect of HT was evaluated in 124 patients (pts) with various types of respiratory diseases. The control group of 15 pts received placebo. HT course consisted of 10-20 daily procedures of 1 hour. HT resulted in improvements of clinical state in the most of patients. The positive dynamics of flow-volume loop parameters and decrease of bronchial resistance measured by bodyplethysmography were observed. The changes in control group parameters after HT were not statistically significant. The specificity of this method is the low concentration and gradual administration of dry sodium chloride aerosol. Data on healing mechanisms of a specific airdispersive environment of sodium chloride while while treatment the respiratory diseases are discussed.