[B vitamins and diseases of the peripheral nervous system]. / Vitaminy gruppy B i zabolevaniya perifericheskoi nervnoi sistemy.

Various diseases of the peripheral nervous system are associated with metabolic disorders of B vitamins. A lack of neurotropic vitamins, which began in the early stages of the development of a bacterial disease, led to its more rapid development. The article analyzes data on B vitamin deficiency in the pathogenesis of the most dangerous diseases of the peripheral nervous system. Information is provided about the dangers of the clinical use of the drug Combilipen for the treatment of such patients.

[Digital health: elderly use of electronic services.]

Since the first decade of the XXI century the digitalization of the healthcare system in Russia has been actively carried out according to interrelated federal and regional projects. The older generation has well-established habits and prefers traditional channels for obtaining information and services - by phone and during a personal visit, and moreover, they are even afraid to use electronic services. The vulnerability of the elderly was especially exacerbated during the CODID-19 pandemic and after, when strict restrictive measures on freedom of movement were introduced and many services began to be provided remotely. The article presents the results of pilot studies conducted in two medical institutions of St. Petersburg. The analysis also used the unique objective data of the state information system of St. Petersburg in the field of healthcare on the dynamics of changes in the indicators of the use by the population of St. Petersburg of various channels of access to the doctor's appointment service. The main objective of the study was to study the specifics of the use of digital health services as a factor affecting the status and social well-being of the elderly in Russia. In conclusion, recommendations are given on minimizing the social risks of older people feeling alienated, eliminating digital inequality when introducing medical remote electronic services.

[Neurological manifestations of postcovid syndrome]. / Nevrologicheskie proyavleniya postkovidnogo sindroma.

The problem of postcovid syndrome (PCS) attracts great interest due to the wide prevalence and variety of clinical manifestations. The main neurological manifestations of PCS are considered. The information about the proposed mechanisms of the formation of PCS is given. The possibility of using the drug Mexidol for the treatment of patients with PCS is discussed.

Neurological Signs of Postcovid Syndrome.

The challenge of postcovid syndrome (PCS) is of great interest due to its wide distribution and variety of clinical signs. The main neurological signs of PCS are discussed. Data on the presumptive mechanisms forming PCS are presented. The potential for using the drug Mexidol to treat patients with PCS is addressed.

[New possibilities of treatment of low back pain]. / Novye vozmozhnosti lecheniia patsienta s poiasnichnoi bol'iu.

Low back pain (LBP) is a syndrome caused by degenerative spine diseases and a common reason for referral for medical care. LBP is mostly often caused by osteoarthritis (OA) that needs long-term treatment with nonsteroidal anti-inflammatory drugs. The treatment is associated with a risk of side-effects. The authors consider the possibility of using slow-acting drugs for symptomatic treatment of OA (SYSADOA) in patients with LBP and present the data on anti-inflammatory effects of chondroitin sulfate on the chondral tissue in OA. The results of the studies on the use of SYSADOA in LBP are analyzed.

[Pathogenesis of chronic disorders of cerebral circulation]. / Patogenez khronicheskikh rasstroistv mozgovogo krovoobrashcheniia.

Chronic disorders of cerebral circulation are a common syndrome, in the pathogenesis of which the important role play structural and functional alterations in large and small arteries, autoregulation of cerebral circulation and the level of systemic arterial pressure. Drugs that increase cerebral blood flow and restore the ability to its autoregulation are used, among others, in treatment of patients with CRMC. The possibility of using nicergoline (sermion) for the treatment of patients with CRMK is considered.

[The use of neurobion in neurological practice].

Vitamins are actively involved in many metabolic processes of the nervous system. Their deficit may cause severe and, sometimes, irreversible consequences. Mechanisms of the therapeutic effects of the vitamin B complex neurobion are considered. Results of the studies on the efficacy and safety of neurobion in patients with polyneuropathies, including those caused by diabetes mellitus, pain syndromes of origin (skeletal/muscle pain, trauma etc) are presented. The necessity of using neurobion in treatment of a wide spectrum of nervous system diseases is emphasized.

[Neurospecific proteins and autoantibodies in serum of patients with acute ischemic stroke].

Neurospecific enolase (NSE), gliofibrillar acid protein (GFAP), S100 protein and autoantibodies (AAB) to these proteins have been measured in the blood of 42 patients with acute ischemic stroke. Concentrations of all parameters we re increased in patients compared to the control group. There were a positive correlations between contents of AAB to GFAP and AAB to NSE (r = 0.470; p < 0.015) and a reverse correlation between concentrations of NSE and AAT to NSE (r = -0.301; p < 0.028). A study of the relationship between intensity of neurological deficit and AAB concentrations revealed the reverse correlation between the level of AAB to GFAP and scores on the European Stroke scale (ESS) (r = -0.509; p < 0.009) at the first day of ischemic stroke, i.e. in patients with marked neurological deficit (low scores on ESS) the levels of AAB to GFAP were higher. The higher concentration of AAB to NSE was found for the satisfactory rehabilitation, while the neurological deficit was significantly more severe (p = 0.034) at the AAT to NSE level less than 1.19 relative units. The more complete rehabilitation to the 21st day was reverse-correlated to the NSE concentration (r = -0.309; p < 0.026). There was the positive correlation between the restoration of lost functions (the increase of ESS scores from the 1st to 21st days) and levels of AAB to GFAP (r = 0.505; p < 0.023) and AAB to S100 (r = 0.450; p < 0.046).

[Peculiarities of the course of ischemic stroke in patients with diabetes mellitus type 2].

Two hundreds and eighty-seven patients, aged from 46 to 78 years, mean age 60.2 +/- 9.4 years, with confirmed diagnosis of ischemic stroke have been studied. The correlations between glycemia and severity of neurological deficit in the 1st (r = -0.433; p < 0.001) and the 21st days (r = -0.289; p < 0.05) of hospitalization were found. The glucose concentration in the venous blood plasma on an empty stomach was significantly higher in the fatal cases compared to the survived patients in the 1 (9.8 +/- 0.6 mmol/l and 5.7 +/- 0.4 mmol/l; p < 0.01), 3rd (9.1 +/- 0.4 mmol/l and 5.6 +/- 0.4 mmol/l; p < 0.05) and 5th days of stroke (9.3 +/- 0.4 mmol/l and 5.5 +/- 0.5 mmol/l; p < 0.01). The level of glycemia on an empty stomach was significantly correlated with the fatal outcome (r = 0.367; p < 0.01). The correlation between the development of lacunar infarction and the presence of previously developed diabetes mellitus type 2 (r = .0.756; p < 0.01) was also noted. The results obtained suggest a significant effect of diabetes mellitus type 2 on the course of ischemic stroke and the necessity of correction of glycemia in these patients.

[Correction of free-radical oxidation as a pathogenetic approach to the treatment of acute ischemic stroke].

Free-radical oxidation is one of the central mechanisms of brain damage in acute ischemia. Results of experimental and clinical studies indicating the link between the activation of the development of free-radicals and severity of ischemic stroke are presented. The authors consider possibilities of using preparations inhibiting the production of oxygen radicals and products of lipid peroxidation which can be used for treatment of patients with ischemic stroke. Results of studies using the domestic drug mexidol in these patients are analyzed. Mexidol can be prescribed in the early period of stroke, i.e. in the pre-hospitalization stage, and used in the treatment of stroke regardless of stroke type.

[Autoantibodies to glial fibrillary acid protein in patients with different forms of cerebral vascular pathology].

Autoantibodies to neurospecific proteins are currently reported to play a role in the development of organic brain damage. To study a diagnostic value of concentration of autoantibodies to glial fibrillary acid protein (AAB to GFAP), the latter was determined in the blood serum of patients with different forms of cerebral vascular damage. The 1st group included 22 patients with cerebral vascular insufficiency, stage II, the 2nd - 14 patients with ischemic heart disease without sings of cerebral damage and the 3rd - 27 patients with acute ischemic carotid stroke. A control group consisted of 35 healthy volunteers. AAB to GFAP level was determined using ELISA. The maximal concentration of AAB to GFAP was found in patients with stroke (2,27+/-0,30 mkg/ml) that was significantly higher compared to the controls (0,95+/-0,03 mkg/ml, p<0,05) and the 2nd group (0,95+/-0,04 mkg/ml, p<0,05). The AAB to GFAP concentration was higher (2,98+/-0,45 mkg/ml, p<0,05) in patients with favorable outcome of stroke than in those with fatal outcome or severe debilitation (1,29+/-0,08 mkg/ml, p<0,05). The data obtained show a correlation of AAB to GFAP concentration with character and severity of cerebral vascular pathology that allows to suggest their assessment as a predictive factor.

[Patogenetic therapy of patients with diabetes mellitus type 2 and cerebral vascular insufficiency].

Effectiveness of halidor preparation was assessed in a randomized open 8-weeks study in 44 patients with diabetes mellitus type 2 and chronic cerebral blood circulation disorders. A control group included 15 patients with the same pathologies who did not receive halidor. Administration of halidor in doses 100 mg 3 times daily led to the improvement of clinical state in 32 (72,7%) patients that was confirmed by statistically better performance (p<0,05) on the neuropsychological tests: MMSE by 14,7%, clock-drawing test by 16,8%, the Schult test by 23,5%. The blood flow in middle and posterior cerebral arteries was increased by 21 and 23%, respectively (p<0,05), and the vascular tonus was reduced. The possibility of halidor administration to patients with diabetes mellitus with concomitant chronic cerebral blood circulation disorders is discussed.

[Pneumonia in patients with acute brain stroke].

One hundred and thirty-two patients, 86 men and 46 women, aged from 46 to 78 years, mean age 67 +/- 9 years, with ischemic stroke have been studied, the diagnosis confirmed using CT or section study. Pneumonia was developed in 15 (11%) of patients, its frequency was significantly higher in patients with hemorrhage stroke and brain infarction of the complex genesis as compared with other types of stroke (chi2 = 10.42, p < 0.05). Pneumonia was developed more often in patients with total infarction in the system of inner carotid artery than in patients with partial infarction in the carotid system (26.9 and 4.8%, respectively, p < 0.05) as well as in patients with consciousness and swallowing disorders in the acute period of disease. The correlation between the frequency of pneumonia and neurologic deficit has been studied. Higher mortality and disability rates were observed in the group of patients with pneumonia.

[Clinical and pathogenetical features of ischemic stroke of young age]. / Kliniko-patogeneticheskie osobennosti ishemicheskogo insul'ta v molodom vozraste.

A clinico-instrumental study of 78 young patients (mean age 41.3 +/- 4.2 years) with ischemic stroke was carried out. A prevalence of such risk factors as severe arterial hypertension, innate and acquired heart valvular disease, familial loading were characteristic of these patients, while ischemic heart disease and diabetes mellitus occurred less often. Comparing to elderly patients, no significant differences in dynamics of neurological deficit were found in young patients with ischemic stroke. The data of neuroimaging examination indicated less frequency of the signs of cerebral atrophy and leucoareosis in young patients. The results obtained confirm the presence of modifying risk factors for ischemic stroke in young patients that grounds realization of preventive measures.

[Markers of inflammation, autoantibodies to neurospecific antigens and outcome in patients with acute ischemic stroke]. / Markery vospaleniia, autoantitela k neirospetsificheskim antigenam i kharakter iskhoda u bol'nykh s ostrym ishemicheskim insul'tom.

To identify biochemical markers for carotid stroke outcome, blood serum levels of inflammation markers (C-reactive protein, orosomucoid, soluble p-selectin) and autoantibodies (AAB) to neurospecific antigens (glial fibrillary acidic protein, neuron specific enolase, S-100 protein) were studied in 27 patients (mean age 64 +/- 6 years) with acute ischemic stroke in inner carotid artery system on day 1-2 and 21 of the disease onset. To day 21, patients with good rehabilitation of neurological functions (group 1) demonstrated a decrease of C-reactive protein and soluble p-selectin concentrations, and unfavorable disease course was associated with a significant (p<0.05) increase of concentrations of these indices. On day 1 and 7, a level of AAT to glial fibrillary acidic protein was higher (p<0.05) in group 1 than in that with minimal rehabilitation and to day 21 it decreased relatively the baseline level. At the same time, patients with minimal rehabilitation had a stable AAT level. On day 7, the AAT level correlated with expression of neurological deficit on day 21 (r=0.510; p=0.019). No stroke-course-dependent differences were found in dynamics of orosomucoid as well as of AAT to neuron specific enolase and S-100 protein levels.