Physiotherapy technologies in rehabilitation programs in patients with urolithiasis before and after percutaneous nephroscopy

Urinary stone disease (urolithiasis) is one of the most common urological diseases, the prevalence of which is growing every year, despite the development of new approaches to treatment. In recent decades, various endoscopic methods of treating urolithiasis, in particular, percutaneous nephroscopy, have become the most popular, however, even with such minimally invasive and non-invasive methods, the percentage of complications ranges from 5% to 11%. Despite the fairly widespread use of various physical factors in the urolithiasis treatment, it is still not possible to reduce the incidence rate. All this dictates an urgent need to search for new, more effective and safer, mainly non-drug technologies for the treatment of urolithiasis and prevention of the disease recurrence and postoperative complications. The aim of the study was to assess the effectiveness of the combined use of intravascular laser blood irradiation, ozone therapy, and light therapy (bioptron zepter) in the complex treatment of patients with urolithiasis after percutaneous lithotripsy, according to the data of ultrasound examination of the kidneys. Research materials. The study included 60 patients with urolithiasis who underwent percutaneous nephroscopy in the Urology Department of the PHI Railway Clinical Hospital “RZhD Meditsina”, Rostov-on-Don, in 2019–2020, with subsequent rehabilitation. The patients were divided into three relatively equivalent groups according to age, calculus size (from 7 to 20 mm), and stone composition. In the first (control) group, patients received standard therapy after surgery: antispasmodics, antibiotic therapy taking into account the bacterial culture of urine, non-steroidal anti-inflammatory drugs, which served as a background in the main group and the comparison group. In addition to the standard therapy, the patients in the second group (comparison group) underwent intravenous laser blood irradiation (ILBI) and ozone therapy. The patients of group 3 (main group) received intravenous laser blood irradiation (ILBI) and ozone therapy — 6 procedures each in the preoperative period against the background of standard therapy; polarized light and ILBI — 6 procedures each in the early postoperative period. Results. The article shows a higher efficacy of the combined use of ILBI, ozone therapy and light therapy in the complex treatment of patients with urolithiasis before and after percutaneous nephroscopy. Conclusion. Combined use of a course of intravenous laser blood irradiation (ILBI) and ozone therapy in the preoperative period and a course of polarized light and ILBI in the early postoperative period after percutaneous nephroscopy against the background of standard therapy in patients with urolithiasis contributes to a significant improvement in blood flow in the kidney and a reduction in the recovery period of the renal parenchyma, which made it possible to reduce the patient’s stay in the hospital, due to the prevention of the development of postoperative complications.

Potentials of intravenous laser blood irradiation to correct peroxidation and antioxidant activity as a result of surgical distress

Purpose: to reveal protective effects of intravenous low-level laser blood irradiation (ILBI) during surgical interventions at the gallbladder as well as to study the state of antioxidant activity, lipid peroxidation and endogenous intoxication.Material and methods. In the perioperative period, 40 patients from the main group (I) had traditional treatment which included pharmacological preparations and sessions of intravenous laser blood irradiation. 45 patients from the control group (II) had only traditional (pharmacotherapeutic) treatment. In both groups during surgery, the anesthetic protection consisted of classical neuroleptanalgesia. The age of patients in both groups did not differ significantly. Intravenous laser blood irradiation was done with helium-neon laser “Atoll” 632 nm (Fokon Ltd, St-Petersburg, Russia). During surgery, three irradiation sessions were performed at radiation power of 20 mW and exposure 15 minutes at various stages of surgery: 30 minutes before induction of anesthesia, at the traumatic stage and 30 minutes before the expected finish of the surgery. Ceruloplasmin and transferrin levels in the blood plasma were assessed with the electron paramagnetic resonance technique. The ratio of ceruloplasmin/transferrin which characterizes the level of antioxidant activity was also established. The level of endogenous intoxication was assessed using the previously published technique. The quantitative characteristics of endogenous intoxication by this technique is the value of optical density (D280) and total optical density of components related to high molecular weight and low molecular weight fractions.Results. ILBI sessions in patients neutralize changes in the level of ceruloplasmin and transferrin in blood. The data obtained also confirm ILBI protective effects at protein SH-groups or activation of the restoration of protein SH-groups that were damaged by oxidation as a result of surgical aggression and trauma.Conclusion. The protective effect of intravenous laser blood irradiation in addition to the standard preoperative therapy optimizes pharmacological anesthetic protection during surgery under the existing traditional schemes of combined general anesthesia.

INFLUENCE OF ULTRAVIOLET BLOOD IRRADIATION ON COVID-19 ASSOCIATED COMMUNITY-ACQUIRED PNEUMONIA

The pandemic of 21st century caused by the SARS-Cov-2 virus has posed a challenge for the global medical community. Community-acquired polysegmental pneumonia caused by the novel coronavirus infection (COVID-19) proceeds in a variety of types and may be complicated by a potentially lethal immune response - a cytokine storm. The latter is characterized by rapid proliferation and increased activity of T-cells, macrophages and natural killer cells releasing various inflammatory cytokines and chemical mediators by protective cells [5,8]. This pathological condition can be treated by recombinant humanized monoclonal antibody against monofunctional cytokine human interleukin-6 receptor. The effect of IL-6 blockers is to selectively bind and inhibit both soluble and membrane IL-6 receptors (sIL-6R and mIL-6R). There are studies demonstrating a positive effect and increased survival rate while using drugs that block the production of interleukin-6 [7,11]. The new coronavirus infection causes inflammation of the artery wall with intravascular thrombogenesis, which justifies the high efficiency of anticoagulant and hormone therapy [6,9,10].The standards of drug treatment of the studied infection include antiviral, anti-inflammatory, anticoagulant, mucolytic, symptomatic, intravenous infusion and oxygen therapy.Methodological recommendations for the diagnosis and treatment of a new coronavirus infection, issued by the Ministry of Health of the Russian Federation, are regularly updated in accordance with the accumulation of positive treatment results by global and local medical communities. In addition to drug therapy, there are other methods of body detoxification. One of the additional methods for treatment of community-acquired pneumonia along with viral "vasculitis" and correction of the immune response can be provided by ultraviolet blood irradiation (UBI).It is well known that ultraviolet radiation has a disinfecting effect. The wavelengths used in UVBI affect the efficiency of UV absorption by DNA molecules of the pathogen. Bactericidal UV radiation at certain wavelengths causes thymine dimerization in DNA molecules. The accumulation of such changes in the DNA of microorganisms leads to a slowdown in the rate of their reproduction and extinction. The photohemocorrection method is characterized by immunostimulatory, anti-inflammatory, anti-hypoxic, membrane stabilizing, antioxidant and detoxifying effects [1]. In the current study we obtained data on a significant decrease in the systemic inflammatory response, marked and fast decrease of the C-reactive protein in blood tests of patients while receiving ultraviolet blood irradiation. The relief of the systemic inflammatory reaction had a positive effect on the reduction of infiltrative changes in the lung tissue, as well as the timing of discharge from hospital.

Modern principles and prospects of conservative treatment of chronic lower limb ischemia

The article presents an analysis of a review of world literature on the diagnosis and treatment of critical lower limb ischemia (CLLI). The concepts and nature of critical lower limb ischemia are analyzed in detail. The main modern examination methods are described, in particular, the assessment of blood circulation through large and peripheral vessels. The work also reflects the modern principles of complex conservative treatment using vasoconstrictive drugs to a new generation of angioprotectors in combination with intravenous laser blood irradiation (ILBI).

Influence of intravenous laser blood irradiation on lymphovenous outflow and the state of humoral and cellular immunity in patients with postthrombophlebitic disease of the lower extremities

Post-thrombophlebitis of lower extremities occurs in 14–29 % of cases and develops within the fi rst two years after the episode of deep vein thrombosis of lower extremities in 20–50 % of patients. Objective: to apply intravenous laser blood irradiation (ILBI) for optimizing outcomes in patients with post-thrombophlebitic disease of their lower extremities. Materials and methods. 52 patients were treated with ILBI. They were randomized into two groups by the following clinical criteria: stage of occlusion – 18 patients (Group 1) and stage of recanalization – 34 patients (Group 2). ILBI course included 7 sessions: irradiation power – 3–15 mW, pulse frequency – 80–3000 Hz, exposure time – 5–15 minutes. Parameters of venous outfl ow and inguinal lymph nodes were monitored by ultrasound examination. Radial immunodiffusion was used to determine levels of IgG, IgM and IgA in blood plasma and serum; turbidimetry – to determine immune complexes; T-lymphocytes – by the receptors to erythrocytes. B-lymphocyte level was monitored with luminescence-serological and complementary rosette formation techniques. Results and discussion. A statistically signifi cant increase in linear and volumetric blood fl ow in great vessels was revealed in both groups. In Group 1, linear blood fl ow in the great saphenous vein increased by 5.2 %; volumetric blood fl ow increased up to 113.0 ± 2.14 mL/min (p < 0.01). In Group 2, volumetric blood fl ow slowed down by 4.1 %. Lymph nodes contracted statistically signifi cantly; the medullary layer narrowed up to 0.32 ± 0.05 cm (p < 0.05), level of IgG, IgM and CIC decreased; number of T-lymphocytes increased up to 60.2 ± 1.7 % (p < 0.05). Conclusion. The revealed effects of intravenous laser blood irradiation at the venous outfl ow, lymph nodes and humoral and cellular immunity in patients with post-thrombophlebitic disease of lower extremities give a reason to recommend the implementation of the discussed technique into a wide clinical practice.

The state of lipid exchange, hemostasis, inflammatory reaction and potentials for their correction in indirect revascularization in patients with critical ischemia of lower extremities (a correlation statistical analysis)

Aim: to study the state of lipid metabolism, hemostasis, inflammatory reaction and the potential for their correction after indirect revascularization in patients with distal steno-occlusion of arteries and critical ischemia of lower extremities (critical ILE).Material and methods. Changes in hemostasis and dynamics of its parameters during the complex surgical treatment in 131 patients with critical ILE and distal arterial stenoocclusion were analyzed. To achieve the targeted goals, patients were divided into the following groups: 34 patients had traditional care (control group); 32 patients had intravenous laser blood irradiation in combination with standard therapy (Group I); 32 patients had cytokine therapy with roncoleukin in combination with standard therapy (Group II); 33 patients had intravenous laser blood irradiation combined with cytokine therapy and standard therapy (Group III). Parameters of lipid metabolism were studied in dynamics (total cholesterol, very low density lipoproteins, high density lipoproteins, triglycerides); products of lipid peroxidation (malondialdehydes, conjugates, superoxide dismutase); inflammatory mediators (C-reactive protein, sialic acids, seromucoids, fibrinogen A, circulating immune complexes); hemostatic parameters (fibrinogen, fibrinolytic activity, fibrin degradation products, antithrombin III activity). Hemostatic indices were compared with identical parameters of 48 apparently healthy individuals (reference group).Results. On admission, patients with critical ILE and distal wall occlusion had sharp changes in their lipid metabolism, inflammatory reaction, and hemostasis. Conclusion. The inclusion of intravenous laser blood irradiation and cytokine therapy separately and in combination in a set of therapeutic measures led to the leveling of the studied homeostasis indicators. The best results were obtained in the group where patients had combined perioperative intravenous laser blood irradiation with cytokine therapy in indirect revascularization.