Relevance. Medical rehabilitation of children with chronic constipation is one of the urgent and socially significant problems in modern pediatrics due to the high prevalence of the disease and the possibility of developing complications in the form of encopresis, rectal fissures, and paraproctitis. Currently, one of the promising areas of modern physiotherapy is the development of methods for the combined use of physical factors in order to increase the effectiveness of treatment. The article discusses the scientific basis and efficacy of the combined effects of conductive cryotherapy and transcutaneous electrical nerve stimulation in children with chronic constipation. Purpose: scientific substantiation of the use of conductive cryotherapy and its combined effects with transcutaneous electrical nerve stimulation for chronic constipation in children. Material and methods. Clinical and functional studies were carried out in 120 children aged 3 to 15 years. The functional state of the colon before and after treatment was assessed using ballonography and anorectal profilometry. Results. It has been established that the use of the combined effects of conductive cryotherapy and transcutaneous electrical nerve stimulation, i.e. cryoelectrical nerve stimulation, increases the effectiveness of treatment of children with chronic constipation compared to patients who received separate exposure to each of the physical factors, which was confirmed by indicators of the functional state of the colon (ballonography, anorectal profilometry). The obtained results allow substantiating the possibility and necessity of recommending methods of conductive cryotherapy and cryoelectrical nerve stimulation in the medical rehabilitation program for children with chronic constipation.

Lichen sclerosus (LS) is a chronic inflammatory disease that is 6–10 times more common in women than in men. LS affects between 1 in 1,000 and 1 in 300 people in the general population, but the exact prevalence is unknown since the disease is often asymptomatic. Objective: to evaluate the effectiveness of PDT in patients with LS in comparison with standard therapy methods. Material and methods: The study included 45 patients diagnosed with LS aged from 45 to 72 years (median age was 59 years). Depending on the therapy performed, the groups were divided into subgroups: Group 1A — patients with LS who were prescribed therapy with external glucocorticoids, Group 1B — patients with LS who were prescribed photodynamic therapy, Group 1C — patients with LS who were prescribed combined treatment: external glucocorticoids + PDT. Results: The study developed a special visual analogue scale to assess the objective condition of the vulva. VAS included the following parameters: pigmentation, skin pattern, turgor (skin fold straightening time), presence of cracks or erosions, and moisture. According to the data obtained, a complex treatment method using photodynamic therapy in patients with vulvar lichen sclerosus et atrophicus causes a higher effect than drug therapy and mono-PDT, which is confirmed by the dynamics of the total VAS index: 50.8 % compared with 28.2 % and 35.1 % in the comparison groups, respectively, therefore, it can be recommended for use in practical healthcare.

Relevance. Damage to the para-articular structures in the area of the joints can lead to chronic pain, which imposes mental and social restrictions on a person’s life, disrupts his/her mobility, and therefore, represents a global healthcare problem. Subject and methods. An open randomized controlled trial was conducted among patients with post-traumatic ligamentitis of the knee joint with pain in the subacute stage, aged 30.2 ± 10.4 years (n = 40). The patients were divided into two groups: group 1 (n = 10, control group) received standard drug therapy, while group 2 (n = 30, main group) additionally received SWT. To assess the intensity of the pain syndrome, we used the visual analog scale (VAS index) and the Lequesne index, which determines the daily activity of patients with injuries in the knee joint. Results and discussion. According to statistics, against the background of an increase in the number of injuries per 100,000 population in the Russian Federation, the absolute number of injuries of the knee joint and lower legs is also growing. At the same time, there was a high direct correlation between these indicators. In this observation, the patients in the 2nd (main) group who received complex treatment with the use of shockwave therapy showed positive dynamics of the VAS index score and the Lequesne index, and a strong direct correlation was noted between the indicators. Meanwhile, according to the data of correlation and regression analysis, it was possible to predict the stability of clinical improvement for two future periods. In the patients in the 1st (control) group, no pronounced clinical picture was observed. Conclusion. Thus, after complex treatment, including drug therapy and shockwave therapy, in the patients in the 2nd (main) group with knee ligamentitis with pain in the subacute period, a pronounced stable positive effect was noted, which was accompanied by a decrease in pain syndrome, an increase in motor activity, and an improvement in the quality of life of patients.

Relevance. Adenomyosis (or endometriosis) is a common and intractable disease, which, according to various studies, affects up to 45% of women of reproductive age worldwide and is often aggravated by the presence of chronic pelvic pain leading to the development of psycho-emotional disorders. Objective: To study the effect of complex treatment, including ozone therapy, on emotional and pain stress in women with diffuse adenomyosis stage II. Subject and methods. An open randomized controlled study was conducted in 40 women with stage II diffuse adenomyosis aged 32.5 ± 9.4 years, who were divided into two groups. Group 1 (control, n = 10) received standard drug therapy; group 2 (main group, n = 30) received additional ozone therapy. The effectiveness of the treatment was assessed using the VAS scale and the MH component of the SF-36 questionnaire, as well as statistical analysis before treatment, after treatment, and after 1, 3 and 6 months of follow-up. Results and discussion. Before the start of treatment, the patients in both groups showed significant differences in the VAS scale and the MH component compared to the norm, which confirmed a significant deterioration in their socio-psychological status, as well as the presence of severe pain. After the course of treatment and up to 6 months in the 2nd (main) group, the VAS score and MH components tended to their physiological norm. At the same time, in the patients in the 2nd (main) group, a statistically significant strong inverse correlation between VAS scores and the MH component was revealed. In the patients in the 1st (control) group, the studied parameters changed little during treatment, which was evidence of the insufficient analgesic effect of drug therapy and a high level of neuropsychic distress and emotional instability in these patients. Conclusion. The inclusion of ozone therapy in complex treatment for the patients in the 2nd (main) group contributed to a decrease in the severity of pain and symptoms of mental trauma. In addition, the trend line of the VAS indicator and the MN component tended to its normal values, which indicated a positive forecast for two more future periods. In the patients in the 1st (control) group who received only drug therapy, no significant improvement was observed.

The experience of conducting medical and medical-psychological rehabilitation in the FSBI Evpatoria Military Children’s Clinical Sanatorium named after E. P. Glinka of the Ministry of Defense of the Russian Federation is analyzed. Purpose of the study: an analysis of the implementation of medical and medical-psychological rehabilitation activities in the FSBI Evpatoria Military Children’s Clinical Sanatorium named after E. P. Glinka of the Ministry of Defense of the Russian Federation and a scientific substantiation of approaches to their improvement. Material and methods. An analysis of rehabilitation measures for 3,795 military personnel. Results. Based on the analysis of rehabilitation activities carried out over the past 5 years among 3,795 military personnel, the trends in changes in the structure of contingents sent for rehabilitation are presented. The need to develop individual rehabilitation programs based on standards and clinical recommendations is emphasized.

Corticosteroid injections, ointments, and patches are quite effective for hypertrophic scars. In addition to their direct anti-inflammatory effects, steroids also act by causing vasoconstriction. Current evidence suggests that 5-FU is an alternative to glucocorticoids for the treatment of hypertrophic scars. According to research, 5-FU can significantly improve the appearance of pathological scars and reduce the likelihood of relapse. Recently published studies have shown the effectiveness of laser therapies, including pulsed dye laser, fractional CO₂-laser, copper bromide laser, and UVA1 phototherapy. Purpose: to evaluate the effectiveness of pneumokinetic administration of drugs. Material and methods. The study group included 34 patients with hypertrophic scars who underwent 2 procedures of pneumokinetic therapy with glucocorticoids and 5-FU, with an interval of 2 months. After another 1 month, laser therapy was performed with a neodymium laser (1064 nm). Efficiency control was carried out using DUB SkinScanner, a device for ultrasound examination and determination of morphofunctional parameters of the skin. Results. The study group showed pronounced positive dynamics. The thickness of the epidermis increased by 25.4%; echodensity decreased by 17.8%. The thickness of the dermis and its echodensity are more indicative; in relation to these parameters, the following dynamics were noted: a decrease in the thickness of the dermis by 48.0% and an increase in echoicity by 46.6%. Ultrasound data revealed a higher efficiency of the combined use of pneumokinetic therapy with glucocorticoids and 5-FU with sequential laser therapy (neodymium laser at 1064 nm). Conclusion: The combined use of pneumokinetic therapy with glucocorticoids and 5-FU with sequential laser therapy (neodymium laser at 1064 nm) is a highly effective method of treating hypertrophic scars and can be recommended for use in practical healthcare.

The aim of the research is to study the effectiveness of using «Tonus» gel by Balneomed (Russia) in the resort treatment of patients with gonarthrosis. Material and methods. Under the conditions of «Metallurg» Sanatorium (Essentuki), 65 patients with gonarthrosis at the age of 40 to 65 years old underwent resort treatment. By simple randomization, 2 groups were formed: in the comparison group, the patients had treatment in accordance with the federal clinical guidelines; in the main group, «Tonus» gel by Balneomed (Russia) was additionally included in the form of ultraphonophoresis and applications. The efficiency control was performed using tables of clinical symptoms by S.P.Mironov, pain scores were assessed according to the Lequesne index, and quality of life — according to the European Quality of Life Questionnaire (EQ-5D). Results. After the resort treatment, there was a more significant positive dynamics in the main group (p < 0.05): the Lequesne index decreased by 2.1 times (p < 0.01), compared to 1.8 times (p < 0.01) in the comparison group; according to the EQ-5D questionnaire, in 10-12 months after the treatment, the quality of life improved on average in 62.4% of patients in the main group and in 53.2% in the comparison group. Conclusion. The analysis of the obtained data indicates an increase in the effectiveness of treatment of patients with gonarthrosis using ultraphonophoresis with «Tonus» gel by Balneomed.

Immunotherapy is becoming an increasingly popular cancer treatment method due to its high specificity and potential to be more effective than traditional approaches. The problem of the use of concomitant rehabilitation measures remains in the highlight, as they can help reduce unwanted side effects of the main treatment and improve the overall quality of life of patients. Purpose of the study. To expand the comparative analysis of the quality of life of patients diagnosed with melanoma and receiving immunotherapy, as well as the overall response rate during treatment with the use of accompanying rehabilitation magnetotherapy. Materials and methods. The study included 128 patients diagnosed with melanoma and receiving immunotherapy with pembrolizumab or nivolumab. The patients of the study group (n = 67) underwent a course of immunotherapy and an accompanying course of rehabilitation magnetotherapy. The patients in the control group underwent a course of immunotherapy without accompanying rehabilitation magnetotherapy. Treatment efficacy was assessed according to iRECIST 1.1 criteria. The EORTC QLQ-C30 questionnaire was used to study the quality of life. The degree of adverse events was assessed according to CTCAE 5.0 criteria. Results. The objective response rate in the study group (70.1%) was higher than in the control group (65.6%). Stabilization was the most frequent response to systemic treatment in most cases: 41.8% in the study group and 49.2% in the control group. In the study group, the improvement in the overall quality of life was more noticeable and amounted to 9.6%, while in the control group, the improvement was at the level of 6.2% (Т = 0.4, р = 0.023). Improvement in the general level of health was noted by 10.9% in the study group and by 5.4% in the control group (Т = 0.43, р = 0.015). Conclusion. The use of accompanying rehabilitation magnetotherapy during the course of immunotherapy led to an improvement in the overall quality of life of patients and a decrease in treatment side effects. Further research in this area is needed in order to determine the potential of magnetotherapy as an additional rehabilitation method.

The purpose of this work was to conduct an analytical review of scientific sources from Russian and foreign literature that present modern information about the risk factors of obesity; the most effective methods of treatment and rehabilitation are described. Based on the studied material, the main directions in the therapy of obesity, i. e. invasive and non-invasive, were identified. The essential components of a comprehensive approach for successful therapy of this chronic pathological process, in the context of a healthy lifestyle, mandatory dietary therapy, and correction of concomitant pathology, are physiotherapeutic procedures, therapeutic physical exercise, and psychological training. Modern physiotherapeutic methods include balneotherapy, electrotherapy, cryotherapy, ozone therapy, shockwave therapy, and others. Physiotherapeutic procedures significantly improve metabolism and contribute to weight stabilization with subsequent gradual normalization of body mass. Preference, especially in pediatric practice, is given to non-invasive physiotherapeutic methods, which are maximally safe for children, demonstrably effective, well-tolerated, and have a general strengthening effect on the growing and developing organism.

The literature review presents and analyzes the modern view of Russian and foreign authors on atopic dermatitis and the effectiveness of using physiotherapeutic methods for the treatment and rehabilitation of this disease in adults and children. The relevance of the problem of achieving a stable therapeutic effect in the treatment of chronic recurrent dermatosis is indicated. The drug therapy of atopic dermatitis, taking into account the severity of the disease, is described. A detailed review of physiotherapeutic methods used in the complex therapy and rehabilitation of atopic dermatitis, their effects, and the possibility of using them in adults and children is presented. Physiotherapeutic methods that have proven effectiveness and wide practical application and methods that require additional study are described. In addition, the importance of spa-resort treatment in order to increase preventive, therapeutic, and rehabilitation effects is presented.

The article presents a review of the literature on the prevalence, relevance, and social significance of scoliosis in children. Much attention is given to the role and place of physiotherapy methods used in medical rehabilitation programs for children with scoliotic spinal deformity. Impulse currents occupy key positions among the numerous methods of physiotherapy for scoliosis (SMT, DDT, interference therapy, etc.) due to their specific effect on the neuromuscular apparatus in order to increase the tone of weakened muscles. The article presents the results of studies on the use of high-intensity impulse magnetic therapy, EHF therapy, vibrotherapy, biofeedback therapy (BFB), etc. in medical rehabilitation of scoliotic spinal deformity in children. In recent years, the role of balneotherapy and climatotherapy at the sanatorium-resort stage of the rehabilitation of such patients has increased. The methods of physiotherapy presented in the work are quite diverse, have different efficiency, and can be individually used in combination with physiotherapy exercises in numerous programs for medical rehabilitation of children with scoliosis.