MINERAL WATERS AS A PART OF SANATORIUM - RESORT REHABILITATION FOR CHILDREN IN REMISSION OF ONCOLOGICAL DISEASES - PHARMACOLOGYONLINE
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April 30, 2021
Archives• 2021 • vol.1 • 156-162
MINERAL WATERS AS A PART OF SANATORIUM - RESORT REHABILITATION FOR
CHILDREN IN REMISSION OF ONCOLOGICAL DISEASES
1
Shmakova, I. P.; 1 Shapovalova, H. А.; 1 Mokienko, А. В.; 2Badiuk, N. S.*; 1 Babienko, V. V.;
3
Gushcha, S. G.
1
Odesa National Medical University, Odesa, Ukraine
2
International European University, Kyiv, Ukraine
3
State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health
of Ukraine", Odessa, Ukraine
*badiuk_ns@ukr.net
Abstract
The aim: to make clinical and clinical-laboratory assessment of the dynamics of indicators in children
after treatment of oncohematological diseases (OHD) and solid tumors (ST) after prescription of
general rehabilitation complex (GRC) and rehabilitation complexes (RC 1-5) with addition of mineral
waters (MW).
Materials and methods. Sanatorium-resort rehabilitation of 485 children was carried out in the
sanatoriums of Ukraine (Odessa and Truskavets). GRC included a gentle motor mode; climatotherapy;
dietary food; therapeutic physical training according to the methods in special medical groups for
children with various somatic diseases; singlet-oxygen cocktail; baby herbal tea (holosas with ascorbic
acid); psychological assistance programs for sick children and their parents. In RC (1-5) mineral waters
of different physical and chemical composition ("Aqua-Libra", “Voznesenskaya", "Truskavets-Aqua-
Eco", "Morshinskaya", “Maria”) were additionally included.
Methods. Clinical, functional (electrocardiography, electroencephalography, echoencephalography,
ultrasound Doppler), laboratory (general clinical, biochemical, nonspecific adaptive reactions of the
body, indices of hematogenicity ratios, statistical.
Results. Multidirectional positive effects of rehabilitation complexes with mineral water intake have
been established. Disappearance or significant reduction of complaints, manifestations of pain,
dyspeptic and asthenic syndrome, as well as objective signs of the disease took place. The use of
differentiated programs of sanatorium rehabilitation with MW inclusion, taking into account the period
of OHD or ST remission and concomitant diseases of the hepatobiliary, cardiovascular and nervous
systems, programs of psychological support improves clinical and functional condition of the patients.
The necessity of caution regarding the use of biologically active MW and the advantages of low -
mineralized MW without specific components and compounds by gentle methods is substantiated.
All human studies were conducted in compliance with the rules of the Helsinki Declaration of the
World Medical Association "Ethical principles of medical research with human participation as an object
of study". Informed consent was obtained from all participants.
Key words: children, oncohematological diseases, solid tumors, sanatorium rehabilitation, mineral
waters, clinical indicators, clinical and laboratory indicators
http://pharmacologyonline.silae.it
ISSN: 1827-8620PhOL Shmakova, et al. 157 (pag 156-162)
Introduction based indications and contraindications for their use
in remission children.
In recent years, the effectiveness of treatment
The aim. To assess changes in clinical, functional
and prognosis in various cancers in children has
and psychosomatic state of children during SRR
significantly increased. Successes in treatment with
programs with the use of drinking courses of
the use of modern programs have increased life
mineral waters of different physical and chemical
expectancy and in 80% of cases to ensure the
composition ("Voznesenskaya", "Truskavets Aqua-
recovery of sick children. In acute lymphoblastic
Eco", "Aqua Libra", "Morshinskaya", "Maria").
leukemia, this figure is 90% [1, 15, 16].
According to literature data, more than 6% of the
working adult population was diagnosed with Methods
cancer in childhood [2-6]. The disease itself and its
treatment cause various disorders of the child’s 485 children with OHD and ST underwent SRR in
physical development, bone, cardiovascular, sanatoriums of Odessa and Truskavets (Ukraine).
endocrine, immune systems, is traumatic for the Mineral waters (MW) of different physical and
child’s and parents’ psyche. The normal course of chemical composition of Odessa, Voznesensky,
the educational process is disturbed, there is a Truskavets, Morshyn deposits (packed), Truskavets
restriction of contacts with friends and the deposit (pump-room) were prescribed.
complexity of interpersonal relationships. The general complex of rehabilitation for children
In Ukraine in the early 90's modern protocols of with oncological diseases included gentle motor
oncological diseases chemotherapy began to mode; climatotherapy; dietary food; therapeutic
introduce. At present, the treatment of physical training according to the methods in special
oncohematological diseases (OHD) and solid tumors medical groups for children with various somatic
(ST) is standardized in accordance with modern diseases; singlet-oxygen cocktail; baby herbal tea
world principles of their diagnosis and treatment. (holosas with ascorbic acid); psychological
However, polychemotherapy, radiation therapy, assistance programs for sick children and their
especially in children with comorbidities, cause parents.
various disorders of nervous, musculoskeletal, In addition to the general complex, 5 medical
cardiovascular, endocrine, immune systems, psycho- complexes included MW drinking.
emotional sphere. Rehabilitation complex № 1 was prescribed for 48
The use of targeted rehabilitation programs will children with concomitant diseases of hepatobiliary
improve the psychoneurological and general system in remission of OHD (30 patients) and ST (18
condition of sick children [7]. patients). The complex additionally included mineral
For the organization of sanatorium-resort natural medical table water "Voznesenskaya" of
rehabilitation (SRR) of sick children the indications sodium bicarbonate-sulfate-chloride content:
and contraindications to sanatorium treatment by M 1.57 Cl 39 SO4 33 HCO3 28
appointment of separate physical factors in the (Na + K) 86 Ca 6 Mg 8
general complex, conditions of selection on SRR of Rehabilitation complex № 2 was developed for 26
children with oncohematological diseases are children with concomitant diseases of hepatobiliary
defined. system after treatment of ST. Additionally mineral
The rehabilitation of children after special natural table water "Truskavets-Aqua-Eco" of
treatment is aimed at improving the quality of life, hydrocarbonate-magnesium-calcium content was
but many issues remain unresolved. In particular, prescribed:
only certain natural and preformed physical factors M 0.45–0.75 HCO3 88 SO4 7 Cl 4
are used in rehabilitation. For example, mineral Mg 54 Ca 35 (Na + K)12
waters of different physical and chemical Rehabilitation complex № 3 was used in the
composition, which are widely represented in group of 74 children with concomitant diseases of
different regions of Ukraine, are insufficiently used hepatobiliary system in OHD remission (42 patients)
due to the lack of proven effectiveness, scientifically and ST (32 patients). For them mineral therapeutic
http://pharmacologyonline.silae.it
ISSN: 1827-8620PhOL Shmakova, et al. 158 (pag 156-162)
table water "Aqua-Libra" sodium bicarbonate- Results
sulfate-chloride:
Under the influence of SRR with the use of MW
M 1.0–1.3 Cl 30–50 SO4 25-40 HCO3 20–35
"Voznesenskaya" (RC 1) in the vast majority of
(Na + K) 75
children pain disappeared or decreased its
was additionally prescribed.
manifestations. The frequency of hepatic pain
Mineral waters for children with concomitant
decreased by 5.3 (pPhOL Shmakova, et al. 159 (pag 156-162) of MW "Voznesenskaya" there was a positive frequency of low-level reactions were registered. dynamics of hemoglobin increase from (129.67 ± Stress frequency and excessive activation 1.89) to (138.68 ± 1.69) g / l, p
PhOL Shmakova, et al. 160 (pag 156-162)
6.3 ± 4.3)%, pPhOL Shmakova, et al. 161 (pag 156-162) medium levels and stress decrease from II to 0.I immune response, autointoxication, suppression of degree in 20.0% of children. macrophage activity, increased hypersensitivity, LII The ratio of nonspecific and specific protection changes. according to index of neutrophils-leukosytes ratio at At the end of SRR in ST remission children there the end of treatment was normalized in 40.0% of was no positive dynamics of immunological children. In all 40.0% of children with elevated LI / reactivity. The frequency of instantaneous ESR after the use of RK 4 autointoxication hypersensitivity indicators as a possible reaction to decreased, in 30% of them LII decreased. intercurrent acute respiratory diseases that Thus, under the influence of the rehabilitation occurred in children during their stay in the complex with inclusion of MW "Morshinskaya" in ST sanatorium increased from 45.5 to 59.1%. An remission children their well-being, functional increase from 54.5 to 86.4% of nonspecific adaptive activity, NARB decrease, leveling stress response, reactions of low level of functioning, II degree of regulating the ratio of cellular and humoral links of stress was established. Excessive activation immunity, decrease of autointoxication took place. reactions occurred in 4.5% of children. The use of MW "Maria" (RK 5) in OHD remission The changes in biochemical parameters in this children led to a decrease of fatigue in 2.2 times, group of children occurred within physiological pain in the gastroduodenal area and in the right values in remission up to 5 and more than 5 years. hypochondrium by 3.0 times, headache by 5 times, The results obtained results confirm the need for improved appetite was noted in 19.2% of children. caution regarding the use of biologically active MW. At the end of SRR, the frequency of low-level Preference should be given to low-mineralized MW NARB decreased from 46.2 to 30.8% and the without specific components and compounds frequency of III-IV degree of stress (p 0.05) reactions. After SRR with the use of RC 5 of a number of biochemical parameters, which are suppression of the effector link of the immune close to those observed in the control group only response and macrophage activity of the immune after 6 months after RT. This indicates the response remained at the level before SRR acceleration of functional activity normalization rate beginning. in a number of organs and systems in OHD children, At the same time, the hypersensitivity of the when therapeutic-table waters are included in the instant type decreased by 1.4 times (decrease of early rehabilitation treatment. According to [12], the index of leukocytes-eosinophils ratio), LII decreased internal use of MW in early rehabilitation treatment by 2.5 times, the manifestations of bacterial of OHD children at the stage of completion of intoxication decreased by 1.2 times (LI/ESR). This supporting therapy is advisable. indicates the activation of detoxification processes The authors [13] believe that mineral low- and reduce of endogenous intoxication in OHD mineralized therapeutic-table MW (both pump - remission children. room and packaged) should be recommended for The changes in children’s biochemical parameters widespread use not only under condition of a resort, in OHD remission under RC 5 influence occurred but also in out-of-resort practice - in inpatient, within the limits of physiological values, both in 5 outpatient stages of OHD rehabilitation, as well as years and more prolonged remission. for prevention and treatment of a variety of The level of erythrocytes increased from (3.9 ± comorbidities. 0.2) to (4.7 ± 0.18) • 10 12 / l, (p
PhOL Shmakova, et al. 162 (pag 156-162)
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Acknowledgments (optional)
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