The modern integrated approach to the treatment of ischemic stroke (IS), in addition to pharmacotherapy, provides for the impact of physical factors. Among them is injectable carboxytherapy (ICBT). Objective. The aim of the study was to evaluate the effi cacy and safety of using ICBT in combination with a standard treatment program in patients with acute ischemic stroke. Material and methods. The main group (MG) included 39 patients with acute IS, the comparison group (GC) — 31 patients. On the second day of hospitalization, patients with MG underwent ICBT on the background of standard therapy, and GC — procedures that mimic ICBT. Clinical, laboratory and instrumental data, IS outcomes, complications, timing were assessed.Results. There were no statistically signifi cant diff erences in physiological parameters (heart rate, blood pressure, SpO2) between MG and GC during and after the course of treatment. Positive dynamics of the neurological status was observed in both groups in the form of a decrease in the NIHSS score — in the MG from 6 to 4 (p = 0.047), in the GC — also from 6 to 4 (p = 0.25). In patients with MG, trophic disorders were less likely to develop in comparison with GC — 1 (2.6%) versus 6 (19.4%), p = 0.039. ICBT did not aff ect the duration of hospitalization of patients, the duration of treatment in the intensive care unit and carrying of resuscitation and also did not contribute to reducing mortality. Changes in the indicators of the acid-base state of the blood were compensatory in nature and did not lead to changes in the pH of the blood. The decrease in pH from 7.5 to 7.4 in 30–90 minutes after the procedures was a physiological reaction of the body to the introduction of CO2 and was not accompanied by negative consequences. Conclusions. ICBT is a safe method, does not aff ect the duration of hospital stay and mortality, help lower the likelihood of complications.

Organization of post-infection rehabilitation is an urgent problem in the context of a new coronavirus infection pandemic Algo-rithm for protection of patients and staff is usually described in the literature At the same time, rehabilitation process is not ana-lyzed Therefore, experience exchange is advisable Objective To summarize the experience of rehabilitation of patients with COVID-19 infection at the intensive care unit of the Skli-fosovsky Research Institute for Emergency Care Material and methods The study included 39 patients with COVID-19 infection in severe and extremely severe condition Mean age was 60 (52;67 5) years Mechanical ventilation was required in 14 (35 9%) patients All patients underwent rehabilitation around the clock Results The rehabilitation program was determined for each patient within 48 hours after admission Rehabilitation measures included positioning (including pron-position), verticalization, mechanotherapy, physiotherapy exercises, breathing exercises, and psychological support In this manuscript, we describe the organization of rehabilitation and its features There were 674 physiotherapy exercises (excluding positioning) and 233 physiotherapy procedures Each patient underwent 2—3 physiotherapy procedures per day Patients under mechanical ventilation underwent all rehabilitation procedures without any features of toler-ance or effectiveness Psychological care was required for difficult adaptation to in-hospital conditions, advanced anxiety and im-paired mood We have developed a guide on stress management for medical staff and effective communication with patients Conclusion Organization of the intensive care unit of infectious building at the Sklifosovsky Research Institute for Emergency Care is close to the international recommendations of experts Specialists have developed the new methods of working with patients © 2020, Media Sphera All rights reserved

Abstract. Early rehabilitation (ER) of patients with acute cerebrovascular accident (ACA) is one of the priority tasks of the vascular centers; the issue of increasing the volume of rehabilitation measures in the resuscitation and intensive care units (ICU) is relevant. Objective. To evaluate the safety and effectiveness of the progressive ER program in patients with ACA. Material and research methods. The study included 129 patients with ACA in ICU. Each patient of the main group (MGr, n = 61) underwent progressive ER: at least 4–5 vertical adjustments per day, passive mode Kinesiotherapy 49 ± 9.3 minutes, a double load of physiotherapy exercises, preventive physiotherapy; the total time of classes reached 240 minutes per day. In the comparison group (СGr, n = 68), standard ER was performed no more than 120 minutes per day. The groups are comparable by sex, age, severity of the disease and comorbidity. The severity of ACA, the gravity gradient, patient mobility, functional status, degree of dependence, and the presence of complications were evaluated. Results. During a month of work with the MGr, 102 ICU bed-days, 94 days of the artificial lung ventilation use, p < 0.05 were saved. Mortality in MGr decreased -— 8 patients (13.1%) versus 14 (20.6%) in CGr (p < 0.05). In patients within CGr, pulmonary thromboembolism developed in 8.8%, in MGr – in 3.3%. The severity of the apoplectic attack decreased ( by 28% in MGr, and by 20% in CGr ), mobility increased. Comparing the modalities of post resuscitationsyndrome in MGr, it was noted that the score decreased by 2 times from 6 [5; 6] to 3 [2.3; 3.3], but it has not changed in the CGr. Patients in the MGr were 2-–3 days earlier adapted to the vertical adjustment. Conclusions. The progressive ER program in ICU is safe, effective, realisable, and allows reducing the number of bed-days in ICU, the number of days of the artificial lung ventilation use, complications, and mortality in comparison with standard medical care.

Background. The improvement of treatment tactics for nosocomial pneumonia in patients with burn and inhalation trauma is a relevant issue due to the frequency of this complication, which develops at any stage of treatment and aggravates the course of the underlying disease.Aim of study. To evaluate the effectiveness of extremely high frequency therapy (EHFT) in the complex treatment of pneumonia in patients with burn and inhalation injury.Material and methods. The results of extremely high-frequency therapy (EHFT) was compared, studying 23 burn patients with complex EHFT and 30 patients without EHFT.Results. EHFT reduces the signs of endogenous toxemia, as evidenced by a statistically significant decrease in elevated concentrations of dead leukocytes in venous blood from 147-106/L (98; 363-106/L) to 81.8-106/L (72; 150-106/L) (p=0.041, Wilcoxon test) on day 6-8 (after 5-6 procedures), whereas in the comparison group, on the contrary, an increase in the dead cells from 121-106/L (66; 210-106/L) up to 137.4-106/L (116; 207-106/L) was observed. When comparing this indicator in two groups on day 6-8 from the onset of pneumonia, a statistically significant difference was found (p=0.021, Mann-Whitney). The term of managing pneumonia in patients receiving EHFT was significantly shorter than in the comparison group, 18 (13; 23) versus 21 (18; 27) days (p=0.020, Mann-Whitney).Conclusion. EHFT reduced intensity of endogenous toxicosis and inflammation, approaching pneumonia relief for 3 days.

We have undertaken the comparison of the results of the treatment and the changes in the laboratory characteristics of 25 patients that suffered a viper bite and were given the combined treatment either with the application of wave biomechanical therapy (WBMT) (10 patients comprising the study group), and without it (15 patients making up the control group). During the rehabilitation period, all the patients exhibited the common symptoms of intoxication including fever, shortness of breath, dizziness, nausea, dilated pupils, and rapid heartbeat as well as the local changes (burning sensation, redness of the skin at the site of the bite, decreased skin sensitivity, swelling, bruising, and blisters); other pathological conditions documented in the association with the snake bite included lymphangitis, lymphadenitis of the regional lymph nodes, and extensive swelling of the extremities with severe pain which were collectively responsible for the significant prolongation of the duration of hospitalization and required an additional treatment. The laboratory studies have demonstrated the multidirectional disorders of the hemorheologic patterns and of the cellular component of toxemia, such as deviations from the normal values of practically all hemorheological characteristics, mostly in the upward direction, moderate leukocytosis, and the increase in the amount of the dead white blood cells, as well as the significant enhancement of the indicators of endotoxemia including the leukocyte index of intoxication, and the coefficient of endogenous intoxication (a 1.8-5.7 times elevation, respectively). The application of the WBMT technology gave rise to positive clinical and laboratory dynamics (more pronounced in the patients of the study group than in those of the group of comparison) in the form of the reverse development of the general manifestations of intoxication and, especially, such local changes as reduced swelling, skin redness, bleeding, feelings of pain, normalization of body temperature and heart rate, restoration of skin sensitivity. The use of WBMT was accompanied by a full and pronounced correction of hemorheological disorders (viscosity and aggregation), and the 1.5-fold higher frequency of their effective correction in the treatment group compared with that in the control patients. There was an apparent tendency towards the normalization of endogenous intoxication and higher overall contents of the blood fractions of medium molecular weight peptides (MMP) (with the 1.2 and 1.4 times reduction in the levels of the MMP254 and MMP280 fractions, respectively) while leukocyte index of intoxication showed a statistically significant fall by a factor of 3.5 in comparison with its initial value. It is concluded that the introduction of WBMT in the combined therapeutic modality makes it possible to decrease the duration of hospitalization of the patients by 1.5 times (33%) on the average.

BACKGROUND. The relevance of such an issue as the treatment of patients with unstable pelvic ring fracture is caused by the high frequency of this pathology in the general structure of polytrauma — up to 34% and a high rate of poor functional treatment outcomes — up to 20%. Purpose of the study: the improvement of rehabilitation treatment in patients with polytrauma operated on for complex fractures of the pelvis, using mechanotherapy and electro stimulation in the complex of therapy of an early postoperative period.MATERIAL AND METHODS. There were 81 patients with severe pelvic ring injuries treated in N.V. Sklifosovsky Research Institute for Emergency Medicine in 2010 – 2013. The main group consisted of 29 patients who were recommended a comprehensive methodology of rehabilitation, including therapeutic exercises (TE), mechanotherapy using the simulator “RECK MOTOmed letto2” and electro stimulation using the “Galatea” apparatus. The test group consisted of 52 patients who underwent rehabilitation treatment only by methods of therapeutic exercises. Overall effectiveness of the treatment was evaluated using the Majeed score.CONCLUSION. Early use of therapeutic exercises in combination with mechanical therapy and electrical stimulation in patients operated on for unstable pelvic ring injuries, helps reduce pain syndrome, shortens the period of bed rest from 17.5 to 7.6 days and the duration of hospital stay from 46.1 to 35.2 days. At the same time, the 14.1% increase of excellent and good functional outcomes based on Majeed score is registered.

ABSTRACT. The authors have offered an advanced comprehensive methodology of in-hospital rehabilitation for patients operated on for humerus fractures. A versatile exercise therapy has been implemented. High-tech methods of rehabilitation were used, including the electric stimulation, intermittent pneumocompression, passive and active mechanotherapy. The present comprehensive methodology makes the exercise therapy more effective, ultimately leading to an earlier limb functional recovery.

The objective of the present study was to compare the results of the treatment and changes in the measurements of the laboratory characteristics in the patients suffering from severe poisoning with the scolding liquids under effect of the combined treatment including the application of extremely high frequency electromagnetic radiation (EHF therapy). The study included ten patients given a course of EHF therapy and 10 ones treated without it. The patients of the two groups developed the oppositely directed alterations in the rheological properties of blood and hemostasis including the elevation of the hemorheological viscoelastic constituent, erythrocyte and platelet aggregation, the increase in blood viscosity at a high shear velocity and, conversely, its decrease at the low and moderate shear velocities and hematocrit. Moderate leukocytosis was observed during this period along with the 3-4 rise in the concentration of lymphocytes involved in the apoptotic process and the substantial increase (1,4 - 8,1 times) in the values of parameters of endotoxicosis (the leukocytic index of intoxication and the erythrocyte sedimentation rate). The use of EHF therapy for the management of this category of the patients at the stage of their medical rehabilitation produced a modulating hemorheological effect manifested as the reduction of the elevated hemorheological characteristics, with the especially pronounced increase in the parameters below the respective normal values. In the group comprising the control patients, the undesirable changes occurred more frequently than in the previous one; specifically, deviations of the parameters of interest from their normal values were more pronounced. EHF therapy resulted in the reduction of the concentration of dead leukocytes in blood and a two-fold decrease in the amount of lymphocytes at the later stages of apoptosis whereas the concentration of the lymphocytes just entering apoptosis was elevated; this situation reflected the process of sanogenesis. In contrast, this parameter decreased in the patients of the group of comparison. The reduction in the level of endogenous intoxication under effect of EHF therapy manifested itself as a more significant decrease of leukocytic index of intoxication and erythrocyte sedimentation rate in the patients of the main group in comparison with those of the group of comparison. It is concluded that the inclusion of EHF therapy in the combined treatment of severe poisoning with the scolding liquids reduces the time of epithelization of gastrointestinal mucosa by 4.7 days on the average. Accordingly, the duration of the hospital stay can be decreased by 3.8 days.

We developed an improved method of exercise therapy for the patients presenting with intra-articular fractures of distal humerus. In this method, the elbow joint is fixed under conditions of maximum flexion or extension of multiarticular muscles and soft tissues surrounding the joint. It results in the two-fold improvement of the movements in the wrist and shoulder joints and permits to increase the amplitude of motion in the elbow joint within a single training session compared with the traditional methods and to reduce mean duration of the treatment by 2 months.

Patients with extensive bite wounds given conventional treatment and exposed to millimetric electromagnetic waves (MEW) were compared by therapeutic benefit. MEW treatment early after the trauma enhances regeneration in the lesion thus raising therapeutic efficiency of the treatment because the exposure to MEW in hydration phase provides a fast relief of soft tissue edema, lessens intoxication, stimulates adaptation.

The trial of combined and sequential use of interference currents and exercise therapy in patients with endoprosthesis of knee joint ligaments has shown effectiveness of such treatment as it early after operation relieves pain, edema of soft tissues, improves proprioception, bioelectric activity of the neuromuscular system. This raises intensity of special methods of rehabilitation.

The results of exercise therapy were compared in patients with diaphysial leg fractures operated by standard technique and those operated by the technique of closed blocking intramedullary osteosynthesis (CBIO). After CBIO rehabilitation was more successful and required less time. This arises from the fact that in blocking osteosynthesis soft tissues of the damaged segment are not cut while intraosseous blocking screws exclude shortening of the leg and rotation instability of the fragments. That's why it is not necessary to fix the leg with a circular gypsum bandage which allows early intensification of exercise load.

Interference currents used in early treatment of patients with crural fractures accelarated recovery of the limb functions as a result of stimulation of involuntary muscular activity, reduced tissue adema and increased mobility of the ankle joint.

The authors generalized the experience of interference current apparatus application for the treatment of acute disease and trauma in the N.V. Sklifosovsky Scientific and Research Institute for Emergency Medicine (Moscow). A kind of recorder for reading the interfinger electric resistance of patient skin was offered as a biologic feedback to this apparatus aimed at individualized treatment. The values of the "resonance" frequencies shown by the recorder of the biological feedback to the interference current apparatus allow to determine the duration of the refractivity of excitable membranes in patients in the process of the complex treatment.

The authors generalized the experience of interference current apparatus application for the treatment of acute disease and trauma in the N.V. Sklifosovsky Scientific and Research Institute for Emergency Medicine (Moscow). A kind of recorder for reading the interfinger electric resistance of patient skin was offered as a biologic feedback to this apparatus aimed at individualized treatment. The values of the <<resonance>> frequences shown by the recorder for the biological feedback to the interference current apparatus allow to determine the duration of the refractority of excitable membranes in patients in the process of the complex treatment.