Duchenne muscular dystrophy is a genetic orphan neuromuscular disease caused by a mutation in the DMD gene encoding the protein dystrophin. As a result of developing and progressive muscle damage and atrophy, children lose the ability to walk, develop respiratory and cardiac disorders. The core elements of good care standards are early diagnosis, prevention and treatment of osteoporosis, daily physical therapy, regular rehabilitation, glucocorticosteroids, and control of heart and lung function. The clinical effect of new targeted pathogenetic therapies for Duchenne muscular dystrophy, restoring synthesis of full or truncated dystrophin, depend on their appropriate combination with existing standards of care.
The variation of indicators that characterize skin scarring increases in patients with metabolic syndrome, which may affect the effectiveness of therapeutic measures. It has been found that pathological processes in the skin scar in the initial state correlate to the greatest extent with the index of insulin resistance, the atherogenic coefficient and the coefficient of antioxidant protection. It is proved that the effectiveness of complex physiotherapy with the addition of the internal intake of medium-mineralized water «Essentuki №17» directly correlates with an increase in tissue sensitivity to insulin and the activation of antioxidant enzymes, as well as with a decrease in dyslipidemia. Linear regression equations are presented to determine significant predictors of treatment effectiveness, which can lead to the creation of individualized therapeutic programs using preformed and natural physical factors.
BACKGROUND: One of the effective and pathogenetically substantiated methods of therapeutic action on cicatricial changes in the skin are laser technologies in combination with collagenases. However, as previous studies have shown, the presence of metabolic syndrome in patients significantly reduces the clinical efficacy of the combined use of laser therapy and phonophoresis of Fermencol. The most reasonable solution in this situation can be scientific research and experience in the practical use of drinking mineral waters, which have a high corrective efficiency in relation to metabolic processes, the course of which is significantly impaired in type II diabetes mellitus and metabolic syndrome.
AIMS: Assessment of clinical indicators of cicatricial changes in the skin of patients with metabolic syndrome in the combined application of the method of phonophoresis Fermenkol, fractional photothermolysis and drinking mineral waters.
MATERIAL AND METHODS: The study included 60 patients (49 men and 11 women) with cicatricial changes in the skin aged 19 to 50 years, with a confirmed diagnosis of metabolic syndrome. All patients by the method of simple fixed randomization were divided into two groups: the control group (30 people) and the main group (30 people). Both groups received treatment, which included a course of phonophoresis of 0.01% Fermencol gel in combination with the technique of fractional laser therapy. Patients of the main group, in contrast to the control group, in addition to the specified physiotherapeutic treatment received bottled sodium bicarbonate-chloride water Essentuki No. 17 (mineralization 11.8 g/l) at room temperature, 200250 ml three times a day for 1520 minutes before meals for 3 weeks.
RESULTS: The addition of physiotherapeutic combined anti-scar therapy with a course of drinking mineral water Essentuki No. 17 in patients with cicatricial changes in the skin in combination with metabolic syndrome was accompanied by a significantly more pronounced clinical effect, assessed by the Vancouver scale and the Dermatological Index of Quality of Life.
CONCLUSION: Additional course use of drinking mineral water Essentuki No. 17 is accompanied by a more pronounced dynamics of clinical manifestations of cicatricial deformities of the skin and an indicator of the quality of life of patients, due to the sanogenetic mechanisms of the drinking balneofactor.
The performed study is devoted to the analysis of the effect of mesodiencephalic (MDM) therapy and normobaric hypoxia on the carbohydrate and lipid metabolism in the complex rehabilitation of patients with post-COVID syndrome. It has been shown that the metabolic potential of MDM therapy is more pronounced than that of hypoxic training, and with the combined use of these factors, the therapeutic effect is significantly enhanced. This phenomenon is explained by the involvement of the body in the response reaction to the effects of various functional systems, while a supraaditive type of synergistic interaction of physical factors is noted. It is proved that one of the factors limiting therapeutic effect is the presence of metabolic syndrome in patients. The use of MDM therapy makes it possible to increase the sensitivity of the body to the action of insulin, while the regression of the insulin resistance index correlates with an improvement in well-being. At the same time, the formation of adaptive type reactions is recorded, which is confirmed by an increase in the activity of glucocorticoids. The combined use of physiofactors helps to reduce the manifestations of oxidative stress.
The article analyzes the role of lipid peroxidation processes in the pathogenesis of cicatricial skin changes, including in patients with metabolic syndrome. Baseline indices of LPO processes and antioxidant enzymes in patients with metabolic syndrome indicate the development of oxidative stress and accumulation of cytotoxic carbonyl products. The course use of a combination of fermenkol phonophoresis, fractional photothermolysis and mineral water «Essentuki №17» in patients with cicatricial changes in the skin and metabolic syndrome is accompanied by a decrease in the severity of insulin resistance and lipid peroxidation processes. The use of a complex of physiotherapeutic factors and drinking mineral water contributes to an increase in the coefficient of antioxidant protection by 54%. The revealed dynamics of the assessed parameters is realized due to the elimination of molecular inhibitors of antioxidant enzymes in conditions of an increase in the receptor sensitivity of tissues to insulin and a decrease in the level of glycemia. The manifestation of antioxidant activity in the combined use of physiotherapeutic methods and mineral waters for drinking purposes allows this technology to be considered as an effective means of pathogenetic therapy of cicatricial deformities of the skin in combination with metabolic syndrome.
This article is focused n the analysis of the influence of transcranial magnetic stimulation on the hormonal regulation of carbohydrate and lipid metabolism in the patients presenting with metabolic syndrome. It is shown that the transcranial application of a magnetic field stimulates sensitivity of the tissues to insulin and thereby facilitates the reduction of arterial pressure and optimization of lipid and glucose metabolism.
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