[Mental disorders associated with acute COVID-19: clinical picture, therapy approaches]. / Psikhicheskie rasstroistva, assotsiirovannye s ostroi fazoi techeniya COVID-19: klinika, podkhody k terapii.

BACKGROUND: The purpose is to study the structure of clinical manifestations of mental disorders in the acute period of COVID-19 among patients, who were hospitalized with a new coronavirus infection and their relations with the severity of the immune response, to assess the efficacy and safety profile of the spectrum of used psychopharmacotherapy. MATERIAL AND METHODS: A study was conducted of patients, hospitalized to the department of infectious diseases and repurposed for COVID-19 clinical departments with a diagnosis of COVID-19 (compliance with the criteria for ICD-10: U07.1) from September 2020 to March 2021. Study design: single center opened retrospective cohort study. The main group is consisted of 72 patients, average age - 71 [56.0; 81.0] years, the part of women - 64.0%. The control group (n=2221) was formed from those hospitalized in the same period with a diagnosis of U07.1 without mental disorders during the hospitalization period, average age 62 [51.0; 72.0] years, the part of women - 48.7%. Mental disorders were diagnosed in accordance to ICD-10 criteria, the following peripheral markers of inflammation, that were evaluated: neutrophils, lymphocytes, platelets, ESR, C-reactive protein, interleukin; also coagulogram indicators: APTT, fibrinogen, prothrombin time, D-dimers. RESULTS: In the following range of mental disorders were identified: a depressive episode (ICD-10 F32) by 31 patients, by 22 - a disorder of adaptive reactions (ICD-10 F43.2), by 5 - delirium not caused by alcohol or other psychoactive substances (ICD-10 F05), by 14 - mild cognitive impairment caused by damage and disfunction of the brain or somatic diseases (ICD-10 F06.7). In comparison with the control group, these patients showed a statistically significant (p<0.001) increasing the level of inflammatory markers (CRP, IL-6) and changes in the coagulogram. and anxiolytic drugs were used most often. Regarding psychopharmacotherapy, drugs from the group of atypical antipsychotics - quetiapine was prescribed in 44% patients in average dose 62.5 mg per day, and Melatonin receptor type 1 and 2 agonist and antagonists of serotonin 5-HT2C receptors: agomelatine was prescribed in 11% patients in average dose 25 mg per gay. CONCLUSION: The results of the study confirm the heterogeneity of the structure of mental disorders in the acute form of coronavirus infection, revealing the relations between the clinical picture and laboratory parameters of the immune response to systemic inflammation. Recommendations are given for the choice of psychopharmacotherapy, in conformity with the peculiarities of pharmacokinetics and interaction with somatotropic therapy.

[Sleep and wake disorders in epilepsy]. / Narusheniya sna i bodrstvovaniya pri epilepsii.

OBJECTIVE: To summarize published data on the prevalence, characteristics and diagnostic criteria of sleep disorders in epilepsy. MATERIAL AND METHODS: A search of published articles was performed in Medline (Pubmed), Scopus, Web of Science and e-library databases. RESULTS: Epidemiologic, clinical and diagnostic aspects of excessive daytime sleepiness, obstructive sleep apnea and central apnea, restless leg syndrome and parasomnias related to slow-wave and REM-sleep in patients with epilepsy were analyzed. CONCLUSIONS: Further studies are needed to gain an insight into the complex associations of sleep disorders in epilepsy to optimize diagnostic and treatment approaches and to improve the quality of life in that patient population.

[Clinical and ultrasonic predictors of postoperative complications after carotid endarterectomy].

For the period from 2007 to 2012 carotid endarterectomy was performed in 150 patients with cerebrovascular insufficiency I-IV degrees and atherosclerotic lesion of carotid arteries. Dynamic observation was performed by using of duplex scanning of brachiocephalic arteries, transcranial duplex scanning, multislice CT with contrast study of extracranial and intracranial arteries. Different degrees of vascular wall thickening of operated internal carotid artery including neo- and myointimal hyperplasia, restenosis and other complications were observed in 19 (12.6%) patients after carotid endarterectomy on background of cerebrovascular insufficiency progressing. It was revealed that transient ischemic attack or stroke, acute heart failure in early postoperative period, arterial hypertension with crisis course predominantly, diabetes mellitus 2 type, obesity, male sex, elderly age and smoking were clinical markers for complications after carotid endarterectomy. Ultrasonic markers of complications after carotid endarterectomy included terms of development and degree of vascular wall thickening in case of neointimal hyperplasia and restenosis, hyperperfusion syndrome and stroke, significant changes of blood flow velocity and indexes of peripheral vascular resistance.

[Postmastectomy syndrome after the radical treatment of the breast cancer with the preservation of the intercostal nerve].

Postmastectomy syndrome often follows the radical surgery oа the breast cancer. The intersection of the branches of the intercostal nerve is an infrequent cause of the postmastectomy syndrome development. We studied the long-term follow up results in 30 patients after radical mastectomy by Madden with preservation of the branches of the intercostal nerve on the level of Th1-Th3. The method demonstrated the decrease of the postmastectomy syndrome and the improvement of quality of life.

[Surgical treatment of hemodynamically significant kinking of internal carotid arteries].

38 patients with different forms of vascular cerebral insufficiency, caused by kinking and atherosclerotic changes of internal carotid arteries were operated on. Various types of reconstructive operation on extracranial carotid arteries were performed. The color duplex ultrasound scanning and computed tomography proved to be highly informative noninvasive means for detecting carotid pathology in patients with vascular cerebral insufficiency. Reconstructive operations on internal carotid arteries can serve as prophylactic and treatment measure of chronic cerebral insufficiency. Authors propose the principle of "six types" of reconstructive operations which individualizes the surgical approach. Carotid surgery for asympomatic patients should be performed on strict indications.

[Prognostication of the probability of ischemic stroke].

The study included 405 patients with ischemic stroke and 35 ones with transitory ischemic attack. Predictors of stroke are considered and approaches to its prognostication proposed The results can be used to distinguish patients in need of preventive therapy of ischemic stroke.

[Sphingosine-1-phosphate signaling system and the innovative mechanism of action of fingolimod in treatment of multiple sclerosis: review of foreign literature].

Over the last years, sphingosine-1-phosphate signaling function (S1P) is thought to play a key role in the development of immunological and neurological components of multiple sclerosis (MS). Modulators of the S1P-system are highly effective in MS treatment. Fingolimod, a structural analogue of endogenous sphingosine, is a first generation drug of a new class of medications known as "modulators of sphingosine-1-phosphate receptors". The inhibition of S1P receptors by fingolimod in MS reduces the recirculation of autoreactive central memory T-cells and their infiltration of the CNS where they cause a damage that clinically reveals in the decrease in the number of MS exacerbations and less severe inflammatory brain changes in MRI.

[Neuroimaging diagnosis and aspects of therapy of hemorrhagic stroke]. / Neirovizualizatsionnaia diagnostika i osobennosti lecheniia gemorragicheskogo insul'ta.

The peculiarities of the clinical manifestations of the hemorrhages into the brain were analyzed in 215 patients regarding both the degree of the blood break into the ventricular system and the size of the perifocal edema. It is demonstrated that the clinical picture, course and prognosis of the disease depend on the volume of the hemorrhage, the degree of the ventricular tamponage, presence of both acute occlusive hydrocephalus and secondary truncal syndrome. The presence of the blood in the ventricular system was not fatal, but, in some cases, led to the improvement of the patients' state because of the decrease of the voluminal influence of the hematoma. Therapy of patients with hemorrhagic strokes must be differential and be determined by the size of the perifocal edema in the ischemic tissue, the state of the system of the hemostasis as well as the presence of angiospasm of intracerebral vessels. Combined administration of calcium antagonists, antioxidants, antiedemic and antiprostaglandin preparations was grounded.

[Autonomic regulation of cardiac activity and the status of central hemodynamics in patients with idiopathic mitral valve prolapse]. / Vegetativnaia reguliatsiia deiatel'nosti serdtsa i sostoianie tsentral'noi gemodinamiki u bol'nykh s idiopaticheskim prolapsom mitral'nogo klapana.

The vegetative regulation of heart rhythm was estimated from mathematical analysis of heart rhythm in 79 patients with prolapse of mitral valve (PMV) and in 15 patients with abnormal position of chordae (ADC). The sympathetic tone elevation was more typical for patients with HMV. Meanwhile the decrease of sympathetic tone was observed in patients with PMV and ADC with vegetative crises in anamnesis. The hyperkinetic type of blood circulation was revealed both in patients with PMV and ADC.

[Clinical polymorphism of neoplastic and vascular brain diseases: pathogenetic characteristics]. / Klinicheskii polimorfizm opukholevykh i sosudistykh zabolevanii mozga: patogeneticheskie osobennosti.

Using evidence on 533 patients with an atypical course of brain tumors and vascular diseases, the author discusses the role of the vascular factor in polymorphism of clinical manifestations of tumors and metastases to the brain. It is shown that in 55.4% of cases brain tumors simulated CNS affections. Of these most frequent was the picture of cerebral circulatory disturbances. Mechanisms causing cerebral circulation impairment in various tumors and metastases to the brain are considered. It is found that pathologically changed circulation and angioarchitecture of the tumors may contribute to a wide spectrum of clinical signs typical for vascular brain diseases. The conclusions are based on the analysis of the results obtained with present-day techniques of angio- and neurovisualization and postoperative as well as autopsy examinations of the tumors.

[Hemorrhages into the cerebral hemispheres and acute obstructive hydrocephalus: new findings in their pathogenesis and the treatment procedure]. / Krovoizliianiia v polushariia mozga i ostraia obstruktivnaia gidrotsefaliia: novoe v patogeneze i taktike lecheniia.

CT study of 106 patients with non-traumatic supratentorial intracerebral hemorrhages in the acute period has found a fairly high incidence (29.3%) of the occurrence of acute obstructive hydrocephalus (AOH). It is regarded to be one of the important constituents in the process of an increase in the brain volume leading alongside with other factors to an elevation of the intracranial pressure and dislocation of the brainstem. AOH had no tendency towards the reverse development, was resistant to conservative methods of treatment and usually ended in lethal outcome. Only the differentiated surgical treatment in 250 patients with hemorrhagic stroke including that in hematomas with AOH performed predominantly by the stereotactic method as well as ventricular drainage used as an auxiliary or independent operation provided success of the treatment. In certain volumes and localizations of the hematoma the stereotactic method had an advantage over the open method, as a result of this the postoperative mortality rate decreased 2.5 times. The importance of the timely (CT) detection of AOH and the differentiated surgical treatment as the method of treating a kind of critical condition in patients with cerebral hemorrhages is emphasized.

[Diagnosis, clinical course and prognosis of parenchymatous- ventricular hemorrhages]. / Diagnostika, techenie i prognoz parenkhimatozno-ventrikuliarnykh krovoizliianii.

As many as 61 patients with hemorrhagic brain stroke and blood penetration in the ventricular system were subjected to a clinical analysis. Based on the data available, attempts were made to predict an outcome of brain stroke. The authors describe the results of studying different aspects of the diagnostic algorithm of parenchymatous ventricular hemorrhages. In accordance with the clinical and computer-aided tomography data, consciousness disturbances, occlusion hydrocephalus, secondary stem syndrome as well as the localization, volume of hematomas and the degree of the blood filling of the ventricular system may serve as diagnostic predictors of brain hemorrhages. The authors' observations correspond with the conclusions made by foreign scientists that ventricular hemorrhages are not always fatal. Parenchymatous ventricular hemorrhages are likely to eventuate in a favourable outcome owing to the drug treatment.

[Computed tomography in the diagnosis of intracranial meningiomas]. / Komp'iuternaia tomografiia v diagnostike vnutricherepnykh meningiom.

CT scans in 91 patients revealed the increased density ovoid or circular structures with sharply defined borders to be most characteristic of the intracranial meningiomas. However, these often had densities very low or indistinguishable against the background of the surrounding tissues' absorption coefficients. Irrespective of the initial tumor density CT will reveal the contrast media accumulating in it, diffuse as a rule. Perifocal edema is also typical of the meningiomas, manifested by the early detected shifts and compression fo different brain structures. CT and pathological data compared, the structural features of the meningiomas were identified which determine their density, borders and contrasting media accumulation.