[Efficiency of erenumab in neurologist's real practice]. / Rezul'taty otsenki effektivnosti erenumaba v ambulatornoi praktike nevrologa.

OBJECTIVE: To assess the effectiveness and safety of erenumab in real-life study. MATERIAL AND METHODS: 33 patients with episodic and chronic migraine (30 females, mean age 39.2±9.2, 3 males, mean age - 49.3±7.6) received erenumab 70 mg for each 3 months. Patients achieved a 50% reduction in the number of days with headache, pain intensity, duration, the number of days of acute medication use, effect on daily activity (HIT-6), side effects, neuropsychological testing (Beck Depression scale, Spielberger-Khanin questionnaire, Hospital Depression and Anxiety Scale) were assessed. RESULTS: During the first month of therapy, a 50% decrease in headache days was observed in 48% of patients, during the second - in 53% of patients, during the third - in 51.5% of patients (p<0.001), a reduce in pain intensity, HIT-6 score, duration of migraine attack was observed (p<0.005). A decrease in situational anxiety was revealed (Spielberger-Khanin questionnaire, p=0.02), but not depression. There was a decrease in the consumption of triptans (p<0.0005) and other analgesics (p=0.0018). 1 patient noted transient constipation. CONCLUSION: The effectiveness and safety of erenumab in the outpatient practice is shown.

[Milk raw materials from retrovirus infected cows: questions of safety and quality of produced products].

The questions of quality control and safety of milk raw materials has always been relevant for the dairy industry. One of the most common cattle infection is bovine leukemia (causative agent - BLV), which often occurs in conjunction with a closely related infection -bovine immunodeficiency (causative agent - BIV). These retroviruses are considered to be species-specific, so the key issue for the dairy industry is the nutritional and raw value of milk of infected cows (without clinical signs). Milk of infected with leukemia cows has changed physical and chemical properties and microbiological parameters, but it is allowed to be processed after a single pasteurization. Thus, there is a possibility of getting of the infected with retroviruses cow's milk into the bulk milk, which can affect the quality of the processed products. Characteristics of BlV-positive cow's milk have not yet been studied. The aim of the research was the study of influence of BLV- and BLV- BIV-infected cows' milk impurities (10, 30 и 50%) on organoleptic, physicochemical and microbiological parameters of produced kefir drink. It is revealed that with increasing the mass fraction of infected with retroviruses cows' milk, acidity of composite samples increased of 1-3 °T and total viable bacteria's count rose by 1-3 orders of magnitude, while the total protein in milk decreased by 0.05-0.95% contrasted with an increasing of milk fat content by 0.3-0.9%. However, these characteristics were within normal limits. In samples containing 50% of milk infected with retroviruses cows, coliforms were detected in 0.1 ml, and the rate of total viable bacteria's count exceeded the permissible limits. Therefore, microbiological characteristics are determination markers of dairy raw materials with the high content of milk of the infected with retroviruses cows. The kefir drink was produced from pasteurized samples. It was found that the acidity of the product was lower by 1-10 °T, while the processing time increased by 4-50%, correlating with the mass fraction of infected with retroviruses cows' milk, compared to control. When the mass fraction of infected with retroviruses cows' milk was 30 and 50%, the processed product had a heterogeneous consistency with flake clots. At the same time, the lactic-acid-producing bacterium count in kefir drink decreased by 2-3 orders, and mold and coliforms were found in it. Thus, the presence more than 10% of milk from infected with retroviruses cows in raw materials leads to a decrease in its technological properties, and dose 30 and 50% leads to non-compliance of the processed product with hygienic standards.

[The clinical significance of the lamotrigine pharmacokinetic variability]. / Klinicheskoe znachenie farmakokineticheskoi variabel'nosti lamotridzhina.

AIM: To estimate pharmacokinetic variability of lamotrigine (LTG) and its clinical significance. MATERIAL AND METHODS: One hundred patients, including 74 women, aged from 18 to 77 years (38.23±14.37 years), with focal epilepsy were examined. Monotherapy with LTG was administered to 54 patients, duotherapy to 46 patients (LTG and valproic acid combination to 27 patients, LTG and liver enzymes inducers to 19 patients). Patients underwent procedures of therapeutic drug monitoring (TDM). Minimal (Cssmin) and maximal (Cssmax) steady-state LTG plasma concentrations, and concentration-to-weight ratio (CDR) were calculated. RESULTS AND CONCLUSION: In patients who used LTG in monotherapy, LTG Cssmin was 5.6±4.65 mg/l, Cssmax 7.59±5.54 mg/l. In the group that received LTG in combination with valproate, LTG Сssmin was 7.8 [5.4; 11.8] mg / l and Cssmax 11.4 [7.3; 15.3] mg/l. In the group that received LTG in combination with drug-inducers of glucuronidation, Cssmin was 2.5 [1.99; 4.32] mg/l, Cssmax 4.73 [2.91; 6.70] mg/l. Statistically significant differences in CDR parameter between groups with LTG monotherapy and duotherapy, both with inducer and with inhibitors, as well as between groups of duotherapy with inductors and with inhibitors were obtained. The results of the study indicate a pronounced pharmacokinetic variability of the LTG. Conducting TDM allows the establishment of individual therapeutic concentrations of LTG in blood plasma and setting a correction vector for antiepileptic therapy.

[Results of proximal vertebral arteries endovascular interventions].

OBJECTIVE: To evaluate immediate and long-term clinical and ultrasound efficacy of proximal vertebral arteries stenting. We studied 74 subjects (age 61+/-10 years) who underwent transluminal balloon angioplasty with stenting of vertebral arteries (77 vessels). Technical success (i.e., residual stenosis < 20%) was achieved in 95% patients. No events (acute stroke, myocardial infarction, or death) were recorded during the procedure or in early postoperative period. Clinical improvement was seen in 81% patients presented with symptoms of vetebrobasilar insufficiency at the baseline (n = 52). Sixty six patients (89%) were followed up in the late postoperative period (6 to 54 months after the intervention). No events of acute stroke were recorded in the vertebrobasilar circulation. Relapse of vertebrobasilar symptoms after temporary improvement was seen in 13% patients. Stent restenosis/occlusion was diagnosed in 36% patients although no relationship was revealed between the alteration of stent patency and relapse of clinical symptoms. Restenosis correlated with initial stenosis of > or = 70% (p < 0.05) and type of stent material. Use of cobalt chromium stents was associated with 2-fold decrease of restenosis rate vs non cobalt chromium stents (24% vs 50%, respectively, p < 0.05). Therefore, stenting of proximal vertebral arteries yields good technical and clinical results. High restenosis rate is a major problem of endovascular treatment of atherosclerosis and needs further evaluation.

[Asymptomatic stenoses and thromboses of the carotid arteries: hemodynamic and ultrasound aspects]. / Asimptomnye stenozy i trombozy sonnykh arterii: gemodinamicheskie i ul'trazvukovye aspekty.

The problem of asymptomatic stenoses of the internal carotid artery (ICA) has become a matter of great concern especially after ultrasonography of the great arteries of the head and, first of all, duplex scanning were introduced on a wide-scale basis into practice of the physicians of varying specialties. The growing population of patients with asymptomatic stenoses raises the problem of their further management with the purpose of preventing ischemic stroke. In connection with significant advances in vascular surgery carotid endarterectomy (CEE) has assumed an increasing role in the treatment of carotid stenoses. In spite of the fact that the efficacy of CEE for hemodynamically significant stenoses has already been proven, nevertheless at present there is no final decision concerning the problem of the indications for surgical treatment of patients with asymptomatic stenoses. The aim of this study was to assess in detail the vascular system of the brain in patients presenting with stenosis greater than 60% and ICA thrombosis, to distinguish the groups at a high risk for stroke and to delineate the treatment measures for its prevention.