[Genetic basis of postoperative cognitive dysfunction]. / Geneticheskie osnovy postoperatsionnoi kognitivnoi disfunktsii.

This review highlights literature data on potential genetic markers that potentially influence the development of postoperative cognitive dysfunction, such as TOMM40, APOE, TREM2, METTL3, PGC1a, HMGB1 and ERMN. The main pathogenetic mechanisms triggered by these genes and leading to the development of cognitive impairment after anesthesia are described. The paper systematizes previously published works that provide evidence of the impact of specific genetic variants on the development of postoperative cognitive dysfunction.

[Cognitive impairments in various types of cardiac remodeling]. / Kognitivnye narusheniya pri razlichnykh variantakh remodelirovaniya miokarda.

The review of the literature highlights current studies proving the relationship between cognitive impairment and various types of myocardial remodeling. The main pathophysiological mechanisms of development of concentric and eccentric myocardial hypertrophy and their influence on the formation of cognitive impairments are described. Direct causal relationships have not yet been found, but several linking factors in the development of cognitive impairment and myocardial remodeling are being investigated: arterial hypertension, increased arterial stiffness, endothelial dysfunction, microglial activation, hyperreactivity of the sympathetic nervous system, and obesity.

[Cognitive consequences of COVID-19]. / Kognitivnaya disfunktsiya pri COVID-19.

An analysis of foreign publications illustrates changes in ideas about the etiology, pathogenesis, target organs, leading pathophysiological syndromes and clinical manifestations of nervous system damage in COVID-19 over 2.5 years of the pandemic. It has been demonstrated that, according to modern concepts, COVID-19 is considered as a pathology with a tendency to multiple organ damage, where the symptoms of damage to the nervous system not only determine the severity of the course of the disease, but also indirectly affect the development of severe somatic manifestations, such as distress syndrome. Particular attention is paid to the analysis of publications summarizing the available data on the frequency of cognitive deficit in the acute period of COVID-19 and in the post-COVID period, risk factors, recovery prospects. Putative mechanisms underlying cognitive deficit in COVID-19 are considered. Despite a significant number of observations and publications, many mechanisms of nervous system damage in COVID-19 and the selectivity of the cognitive deficit pattern remain unexplored. In modern publications, there is no information and long term forecast of the cognitive state dynamics, which is an important argument in favor of the need to continue research.

Sleep Disorders in Patients after COVID-19.

Healthy sleep is required to ensure the body's homeostatic stability, the consistency of immunological reactions, and optimum functioning of the internal organs, the nervous system, and cognitive functions. Patterns of changes to the circadian rhythms have been studied in many diseases, though infection with SARS-CoV-2 is a new reality and the basic mechanisms of functioning of the body in this pathology require deeper investigation. Despite the difficulty of analytical investigations in pandemic conditions, experience of the diagnosis of COVID-19 has now been acquired and treatment algorithms have been developed for different clinical situations; vaccines have been developed. Least studied are questions of the long-term sequelae of COVID-19. At the same time, there are good grounds for suggesting that patients need long-term rehabilitation in the post-covid period of SARS-CoV-2, for reasons including damage to the nervous system. Analysis of publications - from descriptions of clinical cases to literature reviews - allows empirical experience to be accumulated, providing the opportunity for future identification of prognostic markers for the disease for effective prevention of long-term sequelae. The results of current prospective studies draw attention to the occurrence of dyssomnia and obstructive sleep apnea not only as a common consequence of coronavirus infection, but also as a factor significantly worsening the prognosis in the acute period of illness. It has repeatedly been shown that sleep deprivation has adverse influences on the body's resistance, including to SARS-CoV-2, and requires correction to improve prognoses in the acute and long-term periods of illness in COVID-19 patients.

[A case of tuberculous meningoencephalomyelitis]. / Sluchai tuberkuleznogo meningoentsefalomielita.

Tuberculosis of the central nervous system has a large proportion among all extrapulmonary tuberculous lesions forms and is an urgent and socially significant problem, despite the development and availability of modern diagnostic methods (radiation diagnostics, cerebrospinal fluid PCR) and treatment. A high disability and mortality level in tuberculous meningoencephalomyelitis is often caused by an untimely clinical diagnosis, which may be associated with an atypical clinical picture of the disease, as well as insufficient information content of the results of instrumental and immunological examination. The authors present a case of tuberculous meningoencephalomyelitis in a female patient without concomitant HIV infection, in the absence of manifestations of visceral, including pulmonary, tuberculosis throughout the disease. Despite the fact that the tuberculous nature of the nervous system lesion was suspected at the initial neurological examination stage, the diagnosis was complicated by the lack of laboratory confirmation by a positive PCR test for Mycobacterium tuberculosis during repeated cerebrospinal fluid studies. Nevertheless, due to the dramatic development of the situation (progressive deterioration of the patient's condition, confusion of consciousness deepening to the coma level) and the direct threat to the life of the patient, it was decided to prescribe anti-tuberculosis therapy «ex juvantibus¼, which led to a rapid neurological symptoms regression and, ultimately, almost complete neurological deficits recovery. The case is atypical because tuberculous damage to the nervous system (in the form of a positive PCR test for Mycobacterium tuberculosis) was confirmed only on the third day of anti-tuberculosis therapy, and microbiological confirmation of tuberculosis invasion was established only on the 12th day from the start of specific therapy (the 23rd day of illness).

[Sleep Disorders in Patients After COVID-19]. / Rasstroistva sna u patsientov, perenesshikh COVID-19.

Healthy sleep is necessary to ensure the stability of the body's homeostasis, the consistency of immunological reactions, the optimal functioning of internal organs, the nervous system, and cognitive functions. The patterns of changes in circadian rhythms have been studied in many diseases, however, SARS-CoV-2 infection is a new reality, and the basic mechanisms of the body's functioning in this pathology require in-depth study. Despite the complexity of analytical work in a pandemic, experience in diagnosing COVID-19 has already been accumulated, treatment algorithms have been developed in various clinical situations, and vaccines have been developed. The least studied issues are the long-term consequences of COVID-19. At the same time, there is every reason to believe that patients need long-term rehabilitation in the «postcovid period¼ of SARS-CoV-2, including due to damage to the nervous system. Analysis of publications, from descriptions of clinical cases to literature reviews, allows us to accumulate empirical experience, which will make it possible in the future to establish markers of prognosis of the disease for effective prevention of long-term consequences. The results of current prospective studies draw attention to the presence of dyssomnias and obstructive sleep apnea syndrome not only as a frequent consequence of the postponed coronavirus infection, but also as a factor that significantly worsens the prognosis in the acute period of the disease. It has been repeatedly established that sleep deprivation adversely affects the body's resistance, including to SARS-CoV-2, and requires adjustment to improve the prognosis in the acute and long-term periods of the disease in patients with COVID-19.

[Percutaneous Coronary Interventions in Patients With ST-Elevation Myocardial Infarction: 10-Years Follow-up].

Aim      To study long-term results and to identify predictors of death in patients with ST-segment elevation acute myocardial infarction (STEMI) who underwent endovascular revascularization.Materials and methods This study included 283 patients registered in the hospital registry of percutaneous coronary interventions (PCI) for STEMI from 2006 through 2009. Analysis of 10-year results included all-cause and cardiovascular death rate, incidence of recurrent myocardial infarction (MI), repeated revascularization, stroke, stent restenosis and thrombosis. Also, a composite endpoint МАССЕ (Major Adverse Cardiovascular and Cerebrovascular Events) was evaluated, which included death, recurrent MI, repeated PCI, stent restenosis and thrombosis, coronary bypass, and stroke.Results Information about the health condition was provided by 204 (72.1 %) patients. Mean follow-up period was 120.1±9.5 months. All-cause mortality was 25.5 % with cardiovascular death determined in 19.1 % of cases. Recurrent MI developed in 21.6 % of patients; in 1.5 % of cases, recurrent MI resulted from thrombosis of previously implanted stents. Repeated PCI was performed for 31.9 % of patients; in 13.7 % of cases, the PCI was performed for stent restenosis. Coronary bypass was performed for 5.4 % of patients. Incidence of stroke was 10.3 %. Major cardiovascular and cerebrovascular complications (МАССЕ) during the follow-up period were determined in 60.3 % patients. According to the Cox proportional hazards regression model, age ≥65 years (odds ratio (OR), 3.75 at 95 % confidence interval (CI) from 1.75 to 8.03; р=0.001) and incomplete coronary revascularization (OR, 3.09 at 95 % CI from 1.52 to 6.30; р=0.002) were independent predictors of death based on data of the 10-year observation.Conclusion      Therefore, at 10 years following endovascular revascularization, STEMI patients showed a moderate death rate with a high incidence of major cardiovascular and cerebrovascular complications. The leading causes for fatal outcomes were recurrent cardiovascular complications. The major predictors of death for the coming 10-year period included age ≥65 years and incomplete myocardial revascularization.

[Alzheimer's disease]. / Bolezn' Al'tsgeimera.

Alzheimer's disease (AD) is a serious medical and social problem of our time, while remaining the most common cause of dementia in the elderly. The leading symptom in the clinical picture of the disease is a progressive loss of memory with further development of behavioral disorders. In the early stages of AD, patients are mostly managed by neurologists and differential diagnosis is carried out with a variety of neurodegenerative diseases. The authors present clinical criteria of AD diagnosis and consider diagnostic possibilities in the predementia stage using biological markers. With this purpose, modern concepts of the etiology and pathogenesis of AD and genetic aspects of pathology are considered. Contribution of many environmental factors to the initiation and progression of the disease process is evaluated. Mechanisms of cerebral amyloidosis and its characteristic neurological manifestations are considered.

[Prognostic biochemical markers of thrombolytic therapy in ischemic stroke]. / Biokhimicheskie markery prognoza tromboliticheskoi terapii pri ishemicheskom insul'te.

AIM: To assess prognostic value of endothelial dysfunction, endogenous intoxication and oxidative stress in the acute period of ischemic stroke (II) at the stage of making a decision on using thrombolytic therapy (TLT) as well during the follow-up in order to personalize treatment. MATERIAL AND METHODS: The study included 57 patients stratified into control group 1 (n=29) and TLT group (n=28). Contents of C-reactive protein (Nsrb), matrixmetalloproteinase-9 (MMP-9) erythrocyte lipid peroxidation products were measured in the blood of patients. Clinical outcomes were evaluated with the modified Rankin scale and the Rivermead Mobility Index. RESULTS: Increased levels of Nsrb and MMP-9 were the biomarkers of poor TLT outcome. CONCLUSION: TLT has a positive effect on the basic patterns of IS pathogenesis and biochemical predictors allow to rationalize the treatment.

[The membrane stabilizing effect of glatiramer acetate in multiple sclerosis].

The effect of glatiramer acetate on the structure of the lipid phase of cell membranes of red blood cells, the status of lipid peroxidation and antioxidant defense system in patients with relapsing forms of multiple sclerosis. It is shown that during treatment with glatiramer acetate reduces the initially high, level of phospholipase A2, and the concentration of lipid peroxidation products - diene conjugates and Schiff bases. At the same time against the increase initially reduced activity of the antioxidant defense normal structure of erythrocyte membranes in patients with relapsing-remitting multiple sclerosis. Based on the analysis of the dynamics of laboratory parameters proved membranoprotektiv effect the drug.