Vol 76, No 5S (2021)

Background. Modernity is characterized by an avalanche-like increase in the frequency of gestational diabetes mellitus (in 4–5 times over the past 20 years). The main tasks of the work in the risk strategy of gestational diabetes mellitus are: prediction of pregnancy complications and the searchingh for new technologies for their delivery. To date, there are still very controversial questions about the timing and methods of delivery of patients with gestational diabetes mellitus. Due to the high incidence of unfavourable perinatal outcomes in gestational diabetes mellitus, the percentage of cesarean sections in some countries reaches 60%, which leads to maternal morbidity and a decrease in the reproductive health of the population. Aims — is to improve of maternal and neonatal outcomes based of the rational choice of delivery technology in gestational diabetes mellitus. Methods. A retrospective analysis of delivery methods was performed in 9769 patients with gestational diabetes mellitus at full-term gestation. Results. The developed and implemented programmed delivery technique was an alternative to cesarean sections, it allowed to reduce the frequency of abdominal delivery, while improving maternal and neonatal outcomes. The frequency of cesarean sections in programmed delivery was 2 times lower than in the presented facilities and significantly lower than in the population (10.0–10.7%). In the programmed delivery group there was a significant reducing morbidity of hypoglycemia in newborns compared to planned caesarean section — by 2 times and respiratory distress syndrome — by 2.5 times (p < 0.05). The indices of cerebral status impairment, birth traumatism corresponded to physiological childbirth and did not exceed the average population. Conclusions. The method of programmed delivery presented in this paper was one of the reserves for reducing the frequency of cesarean sections and allowed to personalize delivery in respiratory distress syndrome.

Background. Successful correction of the psychological consequences of motor disorders is the key to improving the effectiveness of medical rehabilitation. The literature data on the use of immersive technologies in the correction of psychoemotional disorders of various origins suggest that they can also be effective in the context of psychorehabilitation of patients with motor disorders. However, at the moment there is no scientific and methodological base that allows for the widespread introduction of high-tech VR and AR tools into the practical work of a medical psychologist in a rehabilitation hospital. Aims — evaluation of the effectiveness of the inclusion of immersive technologies in the complex psychological rehabilitation of patients with motor disorders. Materials and methods. The design was planned as a controlled empirical randomized open study conducted during 1 calendar year on the basis of a medical rehabilitation hospital, which involved 336 patients with motor function disorders that occurred as a result of a previous stroke or against the background of chronically occurring degenerative-dystrophic diseases of large joints and spine. The results were compared in three groups for each studied high-tech tool – the main, comparison and control. 81 patients were included in the study of the effectiveness of the use of the Visual Medicine program in patients with stroke. The effectiveness of the inclusion of the HTC Vive Focus Plus EEA virtual Reality System in the psychological correction of pain syndrome against the background of degenerative and dystrophic diseases was studied in 130 patients. The study of the possibility of using the PRAK — hardware and software complex included 125 people with motor disorders: the consequences of stroke (n = 65) and the consequences of chronic degenerative-dystrophic diseases (n = 60). The basis for assessing the stability of indicators of higher efficiency of psychocorrective measures with the inclusion of immersive technologies in comparison with the comparison groups and control groups was the reliability of the results obtained at p < 0.05. Results. With a high degree of confidence recorded a positive trend in relation to recovery all kinds of praxis in patients with movement disorders due to stroke, by using the Visual Medicine program; in the case of psychological correction of neuropathic and mixed pain in patients with chronic flowing RSD — with the application of the HTC Vive Focus Plus EEA virtual Reality System; to achieve a stable positive dynamics in the correction of the psychoemotional state of patients with impaired motor functions-when the PRAK — hardware and software complex is included in the “relaxation” mode in the complex of psychological rehabilitation. Conclusions. The clinical effectiveness of the use of immersive technologies in relation to the psychological consequences of motor disorders is shown, which makes a significant contribution to solving the problem of optimizing the work of a medical psychologist in a rehabilitation hospital.

Background. COVID-19 increases the risk of developing thromboembolic complications, including acute myocardial infarction, in the acute period of the disease. The long-term consequences of COVID-19 are poorly understood. At the same time, the available data on an increased risk of acute coronary syndrome after infectious diseases allow us to make an assumption about a similar risk in COVID-19. The aim of the study was to study the anamnestic and laboratory diagnostic data in patients with acute coronary syndrome after COVID-19. Methods. The study included 185 patients with acute coronary syndrome who were admitted to the State Clinical Hospital No. 13 in Moscow in the period from May to December 2020. 2 groups were identified: group 1 — 109 patients with ACS who had previously suffered COVID-19, group 2 — 76 patients with ACS without COVID-19 in the past. The patients were collected anamnesis, including: the fact of smoking and alcohol consumption, heredity, previous diseases, including diabetes mellitus, acute myocardial infarction, previously performed PCI. Information about the COVID-19 infection has been collected (the duration of the disease, the course of the disease). A clinical and laboratory examination was conducted, including the determination of body mass index (BMI), examination for antibodies to COVID-19, determination of the lipid profile level (total cholesterol, LDL, HDL, triglycerides), blood glucose level, C-RB. The analysis was performed on automatic biochemical analyzers Hitachi-902, 912 (Roche Diagnostics, Japan). All patients underwent coronary angiography. Results. In patients with ACS with previously transferred COVID-19, the development of the disease occurred at a younger age compared to patients without transferred COVID-19. Among the patients with COVID-19, body weight was significantly lower, there were fewer smokers, concomitant type 2 diabetes mellitus and transferred ONMC were less common. In laboratory parameters, lower triglyceride levels were observed in patients with ACS with COVID-19 compared with those of patients without COVID-19. In the laboratory parameters of blood clotting in patients with ACS with COVID-19, higher APTT, thrombin time, fibrinogen level, D-dimer were noted. The indicated laboratory parameters in the groups had statistically significant differences. In ACS patients with a previous COVID-19, compared with patients without COVID-19, the lesion of 2 or more coronary vessels was more common in the anamnesis. Conclusion. According to the results of our study, it was revealed that multivessel coronary artery damage in patients after COVID-19 in comparison with patients without COVID-19 develops significantly more often, while these patients are significantly less likely to have DM and previously suffered ONMC, the level of TG is significantly lower.