ANALYSIS OF RISK FACTORS FOR ISCHEMIC STROKE IN RURAL RESIDENTS OF THE AKTOBE REGION.

Stroke continues to be a major global health concern, accounting for the fifth highest death rate and a sizable portion of the world's disability burden. Over 40,000 stroke cases are reported annually in the Republic of Kazakhstan, of which 5,000 people die within the first 10 days and an additional 5,000 within a month after discharge. Even with the establishment of regional stroke centers, a state anti-stroke program, and substantial efforts, rural communities still experience higher rates of stroke-related morbidity and mortality. The purpose of this research is to examine the complex factors, such as disparities in emergency care and elevated risk factors, that contribute to the variation in the incidence of stroke between rural and urban areas. Rural inhabitants' lesser knowledge of stroke symptoms is a result of educational and socioeconomic differences, which causes systemic delays in care. Just 1% of rural residents live within 60 minutes of a primary stroke center, indicating a lack of access to specialized stroke care. In terms of intravenous thrombolysis performed, urban hospitals perform better than rural ones. The study shows that the mean age of the patients is 62.2±11.9 years, confirming the presence of an average age in the group. Women make up 40.2%, men - 59.8%. An average BMI of 27.6±4.5 may indicate a predominance of excess weight. The NIHSS score decreases from admission (7.64±4.85) to discharge (5.98±6.02), which may indicate a positive effect of treatment. A decrease in MRS reflects improvement in disability after treatment. Analyzing the dependence on place of residence, it was revealed that the largest number of patients came from districts 5 and 10. Analyzing the NIHSS and MRS indicators, statistically significant differences were identified depending on the presence of diabetes, arrhythmia and atherosclerosis. The rate of stroke severity and disability on admission is significantly higher in patients who die. A model for predicting unfavorable outcome was developed, which showed the statistical significance of the factors of cardiac arrhythmia and NLR.

KAZAKH ADAPTATION OF THE MONTREAL COGNITIVE ASSESSMENT (MOCA).

The Montreal Cognitive Assessment (MoCA) is a brief cognitive evaluation tool that has been developed for screening of patients for Mild Cognitive Impairment (MCI). MCI is a recognized high-risk state for Alzheimer's disease development. The aim of the present study was to create a Kazakh-language adaptation of the original version of the Montreal Cognitive Assessment (version 7.1) and evaluate its reliability by determining internal consistency using the Cronbach's alpha coefficient. This prospective study involved 50 patients diagnosed with Parkinson's disease in accordance with the 2015 MDS clinical criteria with diagnosed MCI according to clinical guidelines of the Movement disorder society (MDS). Clinical and neuropsychological evaluation were carried out on all patients. The internal consistency and reliability of the translated scale were investigated by means of the Cronbach alpha coefficient. The Cronbach's alpha coefficient for the MoCA Kazakh version was 0.77. While the evaluation of discriminatory validity was not performed in this study, the Kazakh adaptation of the MoCA was shown to be a reliable tool for screening MCI among patients with Parkinson's Disease.

[DIFFERENTIAL DIAGNOSIS AND THERAPY OF PARKONSON'S DISEASE AND ESSENTIAL TREMOR: REVIEW AND CLINICAL CASE].

At present, the problem of differential diagnosis and therapy of Parkinson's disease and essential tremor is one of the topical issues of modern clinical neurology. Despite the nosological independence of these diseases, there is evidence of their pathogenetic relationship. The article presents a review of the results of modern scientific research devoted to the study of criteria for diagnosing Parkinson's disease and essential tremor. The clinical features of tremor in Parkinson's disease and essential tremor are considered in detail, and the results of studies indicating the simultaneous coexistence of these diseases are presented. Verification of the diagnosis in these nosologies is based on a thorough collection of anamnesis, including family history; specific characteristics of the tremor, taking into account the frequency, amplitude, involvement of body parts; identification of additional neurological symptoms. The article deals with modern medical and surgical methods of treatment of Parkinson's disease and essential tremor. A clinical example of differential diagnosis of Parkinson's disease and essential tremor is presented.

[PROGNOSTIC VALUE OF BIOMARKERS OF MULTIPLE SCLEROSIS ACTIVITY].

About 30-40% of multiple sclerosis (MS) patients treated with interferon-beta (IFN-ß) develop neutralizing antibodies (NABs) to IFN-ß. NABs reduce bioavailability of IFN-ß, which leads to a decrease in the therapy effectiveness. The introduction of IFN-ß induce production of several proteins, which are used as markers of the therapy effectiveness. In this study, we assessed the prognostic significance of MS activity biomarkers in relation to the clinical data of MS patients treated with IFN-ß. The study involved 30 MS patients receiving IFN-ß. The average duration of therapy was 3.5 (3.4-5.3) years. The study showed the prevalence of NAbs formation in MS patients was 13% of cases, a year later - 30%. The level of viperin in patients without exacerbations during the observation period was lower than in patients with exacerbations. The study revealed the prognostic significance of viperin in relation to the frequency of exacerbations: viperin concentration above 0.2 ng / ml is a risk factor for exacerbation of MS. The results of this study suggest that viperin concentration in the serum could be used a prognostic marker in MS patients treated with interferons.

[MODERN APPROACHES TO THE TREATMENT OF MULTIPLE SCLEROSIS (REVIEW AND CLINICAL CASE)].

Multiple sclerosis is a chronic dysimmune neurodegenerative disease of the central nervous system, that affects people of working age and inevitably leads to disability. Treatment of the disease is one of the urgent problems of modern clinical neurology, which is explained by the variety of clinical variants of the flow, the lack of an effective method of treatment. This article is devoted to a review of modern approaches to the issues of etiology, pathogenesis and treatment of multiple sclerosis. Also, the classification of multiple sclerosis depending on the course of the disease, data on modern approaches to the treatment of multiple sclerosis, the criteria for the appointment of differentiated therapy depending on the course of the disease with the use of Disease-Modifying Drugs (DMDs) are given. The main strategies for the use of DMDs are described: escalation and de-escalation. The authors of the article presented a clinical case of observation and treatment of a patient with a remitting-relapsing type of multiple sclerosis with a rapid transformation to the secondary-progressive course. The analysis of the dynamics of clinical manifestations with the reflection of the degree of progression on the EDSS scale, analysis of the the radiological study data, as well as the analysis of the prescription of the drugs of the first-line and the second-line treatment to this patient during the observation period from 2010 to 2017 are given.

[Rehabilitation of patients in the recovery period after stroke in Kazakhstan]. / Reabilitatsiia patsientov v vosstanovitel'nom periode tserebral'nogo insul'ta v Kazakhstane.

AIM: To evaluate the effectiveness of complex rehabilitation of post stroke patients in a Stroke Rehabilitation Centre. MATERIAL AND METHODS: The results of rehabilitative treatment of 86 patients, aged from 50 to 68 years, in early and late recovery periods of ischemic stroke in the middle cerebral artery were analyzed. Neurological deficit was assessed with the Scandinavian Stroke Scale, the dynamics of recovery of neurological disorder with Barthel daily activity index, the degree of misbalance with the modified Rankin scale. RESULTS AND CONCLUSION: After the rehabilitation, a decrease in neurological deficit, improvement of gait and self-service skills, decrease in disability level were observed. The average scores before and after rehabilitation were 35.9±3.9 and 42.7±4.1 on the Scandinavian Stroke Scale, 41.8±4.9 and 52.4±4.4 on Barthel index, 3.3±0.6 and 2.5±0.5 on the modified Rankin scale, respectively. The importance of complex multidisciplinary approach to rehabilitative measures is emphasized.

[Work experience of a stroke center in the Western region of Kazakhstan]. / Opyt raboty insul'tnogo tsentra v zapadnom regione Kazakhstana.

Objectives. To analyze results of the work of a regional stroke center in Aktobe city opened in Kazakhstan according to a state program of Health Care development for 2011-2015 years "Healthy Kazakhstan". Material and methods. In total 1177 stroke patients were hospitalized, including 721 patients (61.2%) with ischemic stroke, 268 (22.8%) patients with hemorrhagic stroke, 108 (9.2%) with transitory disturbances of cerebral blood circulation, 26 (2.2%) with subarachnoid hemorrhage and 54 (4.6%) with unspecified stroke. Results. The use of thrombolytic therapy (TLT), a highly specialized method of treatment of ischemic stroke, was analyzed. Other aspects of the work, including the measures of early and continued rehabilitation, are presented. During the first day after TLT, a significant reduction in neurological disorders was observed in 22 patients (84.6%). The partial recovery was seen in 3 patients (11.5%). One patient (3.8%) had hemorrhagic transformation. Conclusions. The use of TLT in the acute stage of ischemic stroke allows to achieve the complete recovery of neurological functions so patients can return to work and full life.