UDC 577.346

 COVID-19 infection, preeclampsia and gestational diabetes mellitus in pregnancy cause similar changes in the placenta and influence development of the fetus between conception and birth in gestation. Proper uterine and placental vascularization is essential for normal fetal development. The transplacental exchange is regulated and maintained by the placental endothelium. During placental implantation, the trophoblast differentiates into two distinct layers, the inner cytotrophoblast and outer syncytiotrophoblast, which are key elements of the human placental barrier. Proinflammatory cytokines exacerbate ischemic events and create an upward spiral of an inflammatory reaction in the placenta. Placental pathology in gestational COVID-19 shows desquamation and damage of trophoblast and chronic histiocytic intervillositis. Similar lesions also occur in gestational diabetes mellitus and preeclampsia. Common ground: The systemic inflammatory response of the mother, the increased inflammation in the placenta and cytokine production by placental trophoblasts should be monitored throughout pregnancy. Placental angiogenesis can be evaluated by serum vascular endothelial growth factor, Annexin A2, placental growth factor or sclerostin. Tissue damage can be assessed by measuring levels of serum lactate dehydrogenase and myeloperoxidase. Blood flow can be monitored with three-dimensional Doppler and pathological changes can be documented with paraffin-embedded tissue sections stained with hematoxylin and eosin, and electron microscope images as well as immunohistochemistry tests for vascular endothelial growth factor, placental growth factor, sclerostin and Annexin A2. Opinion: The damage of maternal and fetal vascular perfusion (villitis and fibrin deposition) is a common mechanism of gestational diseases. The placenta lesions liberate anti-endothelial factors that lead to anti-angiogenic conditions and are the common mechanism of maternal placental vascular malperfusion in gestational diseases. 

Рatients with diabetes have more complications and higher mortality from COVID-19. This is due to the fact that diabetes impairs the immune response. Hyperglycemia causes a violation of the immune response, which in turn cannot control the spread of pathogenic microorganisms and therefore patients with diabetes are more susceptible to infections. The purpose of the work ₋₋ analysis of bibliometric databases of literature on new developments in diabetes and COVID-19 and focused on clinical recommendations for patients with diabetes infected with COVID-19. The search methods included a literature review of scientific articles that studied diabetes and COVID-19.
According to the results of the analysis of the articles obtained as a result of the search in the PubMed, SCOPUS, Web of Science, MedScape databases, a combination of the terms “diabetes and SARS-CoV-2”, “diabetes and COVID-19”, “pathogenesis of diabetes in case of COVID-19”, "pancreas", "clinical features", "diagnosis", "treatment", "clinical recommendations", we found 32 messages from 2020 to 2022. The main parameters of the study were outpatients and inpatients with diabetes and COVID-19 of middle and elderly age starting from 46 years and up to 82 years of age in France, China, the USA, Great Britain, in which a nationwide, retrospective, populationbased study was conducted. The following concomitant diseases are included in the main studies: arterial hypertension, cardiovascular diseases, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, myocardial infarction, cerebrovascular diseases. Issues of pathogenetic mechanisms in DM and COVID-19, as well as management of patients with DM and COVID-19 are highlighted.

УДК 616.831-009.II:616-053.2 

Мета роботи – оцінювання ступеня порушення функцій, обмеження діяльності та участі дитини з церебральним паралічем (ЦП); формування консультативного висновку для медико-соціальної експертизи лікарсько-консультатив- ними комісіями (ЛКК) згідно з принципами Міжнародної класифікації функціонування, обмеження життєдіяльності та  здоров’я (МКФ).

Матеріали та методи. Наводимо клінічний приклад оцінювання ступеня порушення функцій, діяльності та участі дитини з ЦП згідно з принципами МКФ із застосуванням стандартизованих інструментів визначення функціонального стану, формування категорійного профілю дитини. Під час оцінювання використали міжнародні стандартизовані шкали, рекомендовані міжнародною спільнотою фахівців до застосування в дітей із ЦП. Обстеження здійснили в ДЗ «Укра- їнський медичний центр реабілітації дітей з органічним ураженням нервової системи Міністерства охорони здоров’я  України».

Результати. Під час комплексного обстеження дитини з ЦП мультидисциплінарна команда фахівців визначила ступінь порушення основних функцій організму, ступінь обмеження діяльності та участі дитини в суспільному житті, визначила вплив факторів довкілля на рівень функціонування та соціальної адаптації дитини. На підставі цих даних склали категорійний профіль пацієнта відповідно до функціонального стану дитини, який показує всі сфери життєдіяльності. Батьки дитини отримали консультативний висновок для медико-соціальної експертизи ЛКК за місцем проживання.

Висновки. МКФ описує комплекс життєдіяльності та функціонування дітей із ЦП, показує зміни, що пов’язані з ростом, розвитком, станом здоров’я, на відміну від класичного клінічного огляду пацієнта. Визначення ступеня порушення функцій та обмеження життєдіяльності дитини з ЦП із застосуванням стандартизованих інструментів оцінювання дає змогу фахівцям у різних медичних установах уникнути розбіжностей під час медико-соціальної експертизи та формування реабілітаційного діагнозу. Завдяки визначенню рівня функціонування дитини з ЦП відповідно до принципів МКФ члени мультидисциплінар- ної реабілітаційної команди можуть вчасно виявити та корегувати порушення, здійснювати ранню професійну орієнтацію дитини відповідно до її функціональних можливостей.

Ключові слова: діти, церебральний параліч, МКФ, інструменти оцінювання, медико-соціальна експертиза.

The aim of the work is to assess the degree of dysfunction and limitation in daily life activities in a child with cerebral palsy, to provide an expert opinion for medical and social expertise by Medical Supervisory Committee (MSC) in accordance with the principles of the International Classification of Functioning, Disability and Health (ICF).

Materials and methods. A clinical example of measuring the degree of disability of the cerebral palsy child in accordance with the ICF principles using standardized tools for functional status assessment and the ICF Categorical Profile. International standardized scales recommended by the international expert group to be applied for cerebral palsy children were used at the State Institution “Ukrainian Medical Center for Rehabilitation of Children with Organic Nervous System Disorders of Ministry  of Health”.

Results. During a comprehensive examination of the child with cerebral palsy, a multidisciplinary team of specialists determined the degree of body dysfunction and limitation in daily life activities as well as environmental effect influence on the level of functioning and social adjustment. Based on these findings, ICF Categorical Profile of the patient was formed capturing all spheres of his activity according to the functional state. Parents of the child received the medical conclusion based on the results of the examination for MSC expertise at the place of residence.

Conclusions. The IСF covers the whole complex of life activity and functioning of CP children and reflects all the changes associated with their growth, development and state of health, as distinct from the classical clinical examination of patients. Standardized tools for the assessment of the degree of dysfunction and life activity limitations in CP children allow to avoid controversies between specialists from different medical institutions during medical and social assessment and when making a rehabilitation diagnosis. Members of multidisciplinary rehabilitation team can timely identify and correct dysfunctions, provide early career guidance based on child functional capacity by using the IСF principles to assess life activity in CP children.

Key words:  children, cerebral palsy, IСF, assessment tools, medical and social expertise.

Abstract Spinal dysraphism (SD) or spina bifida (SB) is a congenital deformity that results from embryonic neural tube closure failure during fetal devel- opment. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. This paper aims to evaluate the role of the physical and rehabilitation medicine (prM) physician and prM practice for children and adults with spinal dys- raphism. a systematic literature review and a consensus procedure involved all European countries delegates represented in the uEMs prM sec- tion through a delphi process. the systematic literature review is reported together with thirty-two recommendations resulting from the delphi procedure. The professional role of the PRM physician requires specific expertise in the treatment of patients with SD to plan, lead and monitor the rehabilitation process in an interdisciplinary setting and to participate in the assessment of the needs of these patients in the transitional phase from childhood to adulthood, with particular attention to the activity limitation and participation restriction.

(Cite this article as: petronic Markovic i, Nikolic d, stahl M, tederko p, hdyrya o, Negrini s, et al. Evidence-based position paper of the uEMs prM on the role of physical and rehabilitation Medicine (prM) physician in the management of children and adults with spinal dysraphism. Eur J phys rehabil Med 2022;58:511-9. doi: 10.23736/s1973-9087.22.07536-0)

Key words: spinal dysraphism; rehabilitation; physical and rehabilitation medicine; Guideline adherence; consensus.

Abstract  

Background. The article deals with the effect of physical therapy on students with vertebral artery functional compression syndrome. Constant stable flexion of the cervical spine is one of the functional factors that can cause deformation of the vertebral arteries and, as a consequence, to reduce blood flow through these arteries

The purpose of the research is to define the effect of physical therapy on vertebral artery functional compression syndrome caused by a violation of biomechanics in the cervical spine.

Material and methods. The research involved 24 students aged 18 to 23 years old. The research used the following methods: theoretical analysis and generalization of reference sources on the topic of scientific research, clinical evaluation of vegetative disorders with a questionnaire for determining signs of vegetative changes by O. M. Vein, comprehensive ultrasound examination of the head and neck blood vessels, goniometry of the cervical spine and mathematical statistics.

Results. Physical therapy helped to restore the volume of active movements in the cervical spine (p<0.05). The disappearance of the main symptoms was noted by an average of 74% of respondents, and the rest noted their decreased character. Peak systolic blood flow velocity in the vertebral arteries when performing functional tests increased (p <0.05).

Discussion. The positive results were achieved, probably due to the normalization of anatomical and functional interconnections in the cervical spine, stimulation of its reparative capabilities via manual therapy, namely post-isometric muscle relaxation.

Conclusions. The research results show that the use of physical therapy for patients with vertebral artery functional compression syndrome helps to reduce the clinical manifestations of the disease, restore proper spinal biomechanics and improve blood flow in vertebral arteries.

Key words: physical therapy, vertebral artery functional compression syndrome, post-isometric muscle relaxation, biomechanics of the cervical spine, goniometry of the cervical spine, ultrasound examination of the vertebral arteries.