[Clinical case of MELAS syndrom]. / Klinicheskii sluchai sindroma MELAS.

Clinical case of mitochondrial encephalomyopathy manifested with lactic acidosis and stroke-like episodes was presented. The patient diagnosis was performed in childhood, based on clinical manifestation, and was confirmed with molecular genetic test (mutation m.3243A>G in gene MT-TL1 was revealed). Appropriate patient management required united efforts of different medical specialists with simultaneous administration of different drugs, modulating intracellular energy production. Due to contemporary medical science achievements, life expectancy of patients with mitochondrial diseases increases, and in age 18 such patients should be treated by adult-practice physicians. Due to such pathology rare incidence the adult-practice medical practitioners are insufficiently informed about principles of mitochondrial disease treatment, that has negative influence on patients condition.

[Portable telemedical complex usage perspectives for medical care of elderly and senile patients with cerebrovascular pathology.]

The article discusses perspectives of medical care in elderly and senile patients with cerebrovascular pathology with portable telemedical complex use. Analysis of telemedical cooperation physician-consultant-patient and discussion of medical equipment criteria for telemedical complex selection and organizational together with legal issues of medical data transfer, storage and access were performed. The important clinical features of cerebrovascular pathology in elderly patients were presented, which determined necessity of highly qualified medical specialist involvement in management of such patients. The opportunities of portable medical complex usage were discussed.

[Prevention of cognitive disorders in elderly and senile patients.]

The aim of the study was to evaluate the effect of vitamin D on the cognitive functions and quality of life in elderly and senile patients with cerebrovascular disease. 100 elderly and senile patients with cerebrovascular disease were examined: 60 people - level 25 (OH)D in blood serum <20 ng/ml (deficiency, pronounced deficiency), in 40 people this indicator was ≥30 ng/ml (within the normal range). Cognitive functions were evaluated according to neuropsychological scales (MMSE, MoCA, FAB, «clock drawing test¼, Schulte tables). To study the quality of life, all patients filled out a general questionnaire SF-36. The body's vitamin D supply was judged by the content of 25 (OH)D in the blood serum. Patients with low vitamin D levels (25 (OH)D <20 ng / ml) were divided into two subgroups: 30 people were prescribed cholecalciferol at a dosage of 8 000 IU/day for three months and 30 people who were not treated with cholecalciferol. The study showed that patients with low levels of vitamin D [25 (OH)D <20 ng/ml] had significantly worse indicators when assessing both cognitive functions and quality of life. The work proved that cognitive functions affect the quality of life. In patients with extremely low levels of vitamin D [25 (OH)D <20 ng/ml], after taking cholecalciferol at a dosage of 8000 IU/day for three months, there was a normalization of the level of 25 (OH)D (the average level of which was 34,10±7,42 ng/ml) in the blood serum and there was a significantly significant positive dynamics in assessing cognitive functions and quality of life.

[Gender differences in clinical and hemoreologic disorders in elderly patients with non-cardioembolic ischemic stroke].

Clinical manifestation and platelet homeostasis parameter results in elderly patients with atherothrombotic and lacunar strokes are presented. There is platelet activation in these patients manifested by increasing of P-selectin expression in response to adenosindiphosphate induction on flow-cytometry. Agregometry method was not informative for platelet activity estimation in these patients. Von Willebrand factor receptor expression on the platelet may have prognostic value for acute period. The fibrinogen receptor expression on the platelet was increased in women with stroke comparing with men.

[The application of combined physiotherapeutic methods for the complex treatment of patients with dyscirculatory encephalopathy].

This article reports the results of applying basic pharmacotherapy (enalapril, cytoflavin) and its combination with physical factors (transcranial electrostimulation, combined application oftranscranial electrostimulation and low-frequency magnetic therapy) in the complex treatment of patients with stage I-II dyscirculatory encephalopathy. The study has demonstrated that the combined treatment with cytoflavin, enalapril, transcranial electrostimulation and low-frequency magnetic therapy produced the most pronounced therapeutic effect (82.5%), as confirmed by positive dynamics of clinical and functional parameters.

[The complex energy correction of chronic brain ischemia].

Considerable disturbance of all quality of life domains that worsens social adaptation and daily living and results in an asthenic-neurotic syndrome, along with neurologic and mnestic-intellectual disturbances, was revealed in patients with chronic brain ischemia (stages I, II, III). Based on the results of the double blind placebo-controlled trial, the high clinical efficacy of cytoflavin in patients with chronic brain ischemia has been shown. The treatment with cytoflavin decreases the severity of subjective symptoms and complaints thus increasing the working ability of patients, improves balance and gait, decreases the severity of asthenic and neurotic syndromes, improves cognitive and memory functions (information storage, reasoning and attention), positively effects on quality of sleep and all aspects of quality of life, in particular, on physical activity, self-rating of health and viability as well as social activity, mental health and emotional lability.

[Therapeutic efficiency of cytoflavine solution for infusion in emergency conditions].

The author reports results of clinical assessment of cytoflavin for injections in the treatment of different pathological condition including critical ones. It was shown that therapy reduces mortality among patients with acute disturbances of cerebral circulation to 4.8-9.6% compared with 11.7-17.1% in controls. Positive dynamic of neurologic status was documented in 79% of the patients with dyscirculatory encephalopathy versus 25% in control. Duration of comatose state decreased 1,7-fold, length of stay in resuscitation and intensive therapy wards 1.8-fold, and frequency of internal complications secondary to the effect of neurotropic poisons 2-fold. Cytoflavin corrected the level of metalloproteides and stabilized antioxidative potential of sera and cerebrospinal liquid in patient with meningitis including that of zoonotic etiology. In the period of post-narcosis rehabilitation cytoflavin restored conscience in 77% of the patients within 20 min. The drug also inhibited pathological alcohol addiction within 5 days after the onset of therapy as apparent from the improvement of intellectual-mnestic status and activization of attention. The frequency of infectious complications in patients with acute surgical abdominal pathology decreased by 5.1% and lethality by 3.6% compared with placebo group. Cytoflavin exhibited cardioprotective action in patients with myocardial infarction, during cardiosurgical intervention, and chronic brucellosis. It had hepatoprotective effect in iatrogenic hepatic conditions as well as ophthalmo- and oto-protective activity.

[Efficacy of cytoflavin in the treatment of chronic cerebral ischemia].

The author presents results of multicentre randomized studies of therapeutic efficiency of cytoflavin tablets in patients with chronic cerebral ischemia including asthenovegetative syndrome. Cytoflavin was shown to reduce clinical manifestations of asthenia, anxiety, depression, cognitive and emotional disorders and simultaneously improve quality of life. The efficiency of cytoflavin is confirmed by improved physical and psychic state of the patients, their enhanced social activity.

[Efficacy of cytoflavin in patients in the acute ischemic stroke].

We present the results of a multicenter study on efficacy of cytoflavin in the treatment of patients with acute ischemic stroke. Seventy patients (41 of the main group and 29 of the control group) were enrolled in the study. All patients received basic therapy aimed at improving systemic hemodynamics, rheological blood properties and at the prevention of stroke complications. Patients of the main group were treated with cytoflavin as follows: days 1-10 - 20 ml (in 400 ml of the 0,9% NaCl solution) twice a day intravenously in drops; days 11-35 - 850 mg twice a day. We assessed the dynamics of restoration of lost functions (NIHSS, the Rankin scale, the Barthel index) and volumes of ischemic lesion (MRI T1-, T2-, diffusion-weighted images). Results of the study on patients of the control group were supplemented with literature data about 306 patients studied using clinical scales and 40 patients studied with MRI. We revealed a trend towards an effect of cytoflavin on the preservation of brain matter in the acute phase of stroke. Cytoflavin reduced the neurological deficit and improved activities of daily living in patients that may be explained by the less brain damage.

[The use of topiramate at patients with combined craniovertebral anomaly].

Twenty-eight patients with concomitant cranio-vertebral anomaly: Kimmerle anomaly and Chiari type I malformation were examined. A main reason for visiting a doctor was headache, dizziness and sleep disturbance. Topamax (topiramate) was used for stopping the symptoms. It was prescribed in dosage 25 mg in the evening to 16 patients and in dosage 25 mg in the first two weeks and then in dosage 50 mg in the evening for 60 days - to 12 patients. The use of Topamax led to the reduction and /or disappearance of headache, sleep normalization and improvement of cerebral bioelectric activity. The drug was well tolerated.

[Aspects of ischemic stroke course in patients with heart-related embolism]. / Osobennosti techeniia ishemicheskogo insul'ta u patsientov s kardiogennym istochnikom émbolii.

193 patients with acute ischemic hemispheric stroke were examined. We divided them into two groups. Group 1 included patients with cardiac embolism (n = 49), patients without embolisms (n = 144) formed Group 2. We revealed that patients of Group 1 were significantly older and had severe neurologic deficit and higher mortality. The size of ischemic foci assessed by computed tomography were larger, and the disturbances of cerebral blood flow estimated by transcranial Doppler ultrasonography were more severe in Group 1. The reason to be supposed may be a larger size and pattern of cardiac emboli.

[Reaction of the autonomic nervous system of children to a magnetic field]. / Reaktsiia vegetativnoi nervnoi sistemy detskogo organizma na vozdeistvie magnitnogo polia.

A study was made of some reactions of the child's body to the magnetic field action with the aid of thermography, investigation of the parameters of vegetative functions and determination of the changes in the amount of the formed elements of white blood in 20 normal children and 20 patients aged 6-15 years suffering from chronic gastroduodenal diseases. It has been established that the changes in infrared radiation on the surface of the anterior abdominal wall in the patients mirror the adequacy of the compensatory reactions of the vegetative nervous system to the magnetic field action. The parameters of the function of the vegetative nervous system, mainly those of its sympathetic part, are indicative of the effect of the magnetic field on the patient's body.