Transgender population in the Russian Federation: diversity and trends.

This report presents socio-demographic data of gender incongruent patients, searching for gender affirming medical care (GAMC) in Russia by retrospective medical records analysis of patients. Data of 1117 patients were included in the analysis. Over the period from 2014 to 2021, there was a significant increase in the number of applications (+123.2%). Among all transgender individuals 44.01% were trans femine (MtF) and 55.99% (n=630) were trans masculine (FtM), 1.2% was non-binary persons. The average age for GAMC application in MtF was 26 years and in FtM was 23 years. Majority of patients experienced gender incongruence (GI) since pre-pubertal age (median 11.0). Age of acceptance oneself as a "transgender " was 17.0 years, earlier in FtM, later in MtF. The first coming-out was made at 20 (22 for MtF, 19 for FtM). Depression was diagnosed in 82,4% cases,12.6% of patients have suicide attempts. 53.6%, were already taking hormonal therapy (76.7% MtF, 32.3% FtM). The Russian transgender population is big, stigmatized, ethnically and culturally heterogeneous group, that has little visibility. Further research is essentials for formation of professional attitude in the medical environment.

Efficiency of back muscles training and balance therapy in rehabilitation of patients with osteoporotic vertebral fractures.

Medical rehabilitation of patients with osteoporotic vertebral fractures (VF) remains an insufficiently developed topic and requires additional research. Aim of the study was to assess the efficiency of back muscles training and balance therapy in rehabilitation of patients with osteoporotic vertebral fractures. Prospective, interventional, open-label, controlled study in two parallel groups, performed in inpatient department settings at "National Medical Research Center of Rehabilitation and Balneology" during 2018. The study involved 120 patients (11 men and 109 women) aged 40-80 (mean age 65.4±9.1 years) who were admitted for medical rehabilitation for systemic OP and VF. The rehabilitation program in the main group included: 1) Mechanotherapy on the Back-Therapy-Center Dr. Wolf complex with biofeedback (Germany); 2) Balance therapy on a double unstable COBS platform, with biofeedback (Germany); 3) Hydrokinesiotherapy in a pool; 4) Gymnastic exercises (Gorinevskaya-Dreving method). Results. The use of the three-week program of physical rehabilitation using mechanotherapy, balance therapy and special complexes of physiotherapy exercises in the gym and in the pool in patients with osteoporotic VF significantly increases the strength of the muscle corset, helps to eliminate the existing muscle deficit in TE and TF and results in a more physiological distribution of the strength ratio between TE and TF. The rehabilitation program improves the function of static and dynamic balance, both with closed and open eyes, which can be observed in the return of the center of gravity to a physiological position and in improved reaction speed to changes in body position. Usage of mechanotherapeutic methods in rehabilitation of patients with osteoporotic VF is effective for basic motor function improvement and disability reduction.

The Russian scientists' quality of life and cognitive status.

Aim of the study was assessment of executive functions and quality of life (QoL) among scientists aged 22-80 years working in state research centers. The screening test included several questionnairs: "Cognitive screening", "Age is not a barrier", "Geriatric Depression Scale" (GDS) and Social Functioning 36 (SF-36) survey. According to the assessment, the group of scientists showed problems related to physical health disorders and presence of numerous risk factors for professional efficiency decline. High rate of preasthenia (39.62%) and asthenia syndrome (11.32%) was identified. This might be due to high level of stress and informational load that causes depletion of functional organism reserves. The rate of cognitive executive functions decline was low (3.77%), stated in young age and possibly associated with depression and asthenia. In comparison to general population, Russian scientists showed a generally high level of quality of life (more than 70% in all domains), best indicators on the scales of "Body Pain" and "Vitality", but lower indicators of "Role functioning" due to the emotional state. In general, scientists' quality of life decreased with age, especially "Physical Functioning" and "Body Pain" scales. Social skills such as "Role functioning due to emotional state" increased with age. In the scientists group, connection between cognitive functions and the quality of life was observed. Specifically, between "Physical Functioning", "General Health", "Vitality", "Social Functioning" and "Mental Health".

Evaluation of orphan diseases global burden.

Orphan diseases is a significant socio-economic burden for both global and Russian health care systems. The global burden of disease metrics introduced by WHO, such as DALY, QALY, HALE, can be a useful tool for building economic models and prognoses, as well as medicine funding distribution. However, it is very difficult to standardize a heterogeneous group of rare diseases and it is difficult to talk about the cost-effective treatment options search, in cases where patients with an orphan disease may have only one pathogenetic therapy option. Much work needs to be done to find optimal treatment options and establish the standards of care necessary to maintain physical health, work capacity and quality of life.

Management of Cough in Patients with Chronic Obstructive Pulmonary Disease: Results of the Multicenter Randomized Placebo-Controlled Clinical Trial.

BACKGROUND: Chronic cough declines quality of life and increases risk of complications in patients with chronic obstructive pulmonary disease (COPD). Reducing cough severity and associated negative effects is important therapeutic goal in COPD. Rengalin with anti- and protussive activity is based on technologically processed antibodies to bradykinin, histamine and morphine. AIM: To evaluate efficacy and safety of Rengalin in treatment of cough in patients with COPD. METHODS: Patients (n=238, mean age 64.3±8.2 years) with stable COPD and persistent cough despite maintenance therapy (anticholinergics, beta-2-adrenergic agonists, inhaled corticosteroids) were included and randomized in the study. The severity of cough assessment (according to the "Cough Severity Score"), COPD impact on patient's life (COPD Assessment Test, CAT), and spirometry were performed at screening. Patients took Rengalin or Placebo 2 tablets 2 times daily for 4 weeks. The endpoints were proportion of patients who responded to treatment, dynamics of cough severity, and severity of COPD symptoms. Intention-to-treat (per protocol) analysis was performed. RESULTS: Positive response to Rengalin was recorded in 83.6 [85.7]% (vs 72.6 [72.7]% in Placebo group, p=0.0422 [p=0.0163]). Double decrease of cough severity was reported in 42.2 [43.8]% in Rengalin group (versus 32.7 [32.7]% in Placebo; p=0.1373 [p=0.0907]). The total CAT score decreased by 3.3±4.2 [3.6±3.9] points (versus 2.5±4.1 [2.5±4.2] in Placebo group); the difference between groups was 0.79±4.16 [1.04±4.02] points (p=0.0870 [p=0.0416]). The number of patients with adverse events (AEs) in Rengalin (n=13) and Placebo (n=12) groups did not have significant differences (p=1.00). No AEs with certain relationship with study drug were registered. CONCLUSION: Rengalin is an effective and safe drug in patients with stable COPD and persistent cough, despite stable doses of maintenance therapy according to the GOLD guidelines. Four-week therapy decreases severity of cough by two times in more than 40% of patients. TRIAL REGISTRATION: ClinicalTrials.gov (id: NCT03159091).

Balance and muscle strength tests in patients with osteoporotic vertebral fractures to develop tailored rehabilitation programs.

Authors perform a cross-sectional study of functional abilities of the patients with osteoporotic vertebral fractures (VFs). Trunk muscle isometric strength and postural balance impairments were estimated. The development of osteoporotic VFs is associated with a significant decrease in strength of all the body muscles, especially the deep spinal stabilization system, i.e trunk extensor (TE), trunk flexsor (TF), where the VFs contribute to inappropriate distribution of back muscle strength with TE:TF ration of 1:1 instead of 3:2, observed both normally and in patients with uncomplicated osteoporosis. There is also a deterioration of stabilometry and functional coordination assessment tests in patients with pathological VFs, that indicate abnormalities of both static and dynamic postural balance. The obtained data should be taken into account when developing rehabilitation programmes for osteoporosis patients who have suffered compression VFs.

Coronavirus syndrome: COVID-19 psychotrauma.

The authors propose term "coronavirus syndrome" for the mental disorder that is a psychical response to the global problem of COVID-19 pandemic. This syndrome will affect up to 10% of the population and we could already observe acute stress reactions to the spread of the infection and changes in people's ordinary lifestyle. However, the most severe response will be seen later, in this case the catastrophe is similar to the clinical picture of post-traumatic stress disorder. The problem is that coronavirus syndrome will affect the working capacity of population at the period, when economical recovery is essential. The risk groups are health caregivers who worked in COVID departments; patients recovered from a severe form of the disease; people who have lost their loved ones; and those who have suffered significant financial losses or lost their jobs. Adequate prophylaxis of coronavirus syndrome especially in high-risk groups are important for maintaining global mental health and economy.