[Clinical results and prospects for the use of phenosanic acid in patients with focal epilepsy]. / Klinicheskie rezul'taty i perspektivy primeneniya fenozanovoi kisloty u vzroslykh patsientov s fokal'noi epilepsiei.

OBJECTIVE: To study the efficacy and safety of using a new original synthetic antioxidant - phenosanic acid as an adjunct therapy in patients with focal epilepsy. MATERIAL AND METHODS: A randomized, double-blind, placebo-controlled, parallel-group study evaluated the efficacy and safety of phenosanic acid as an adjunct therapy to basic antiepileptic drugs in 120 patients with focal epilepsy. Primary purpose: to study the dynamic of seizure frequency. Secondary purposes: to study the dynamic of seizure-free days, the dynamics of bilateral tonic-clonic seizures, the results of questionnaires and scales (General Dynamics Assessment, Visual Analogue Scale (VAS), Quality of Life in Epilepsy (QOLIE-31-P), European Quality of Life Questionnaire (EQ-5D), Hospital Anxiety and Depression Scale (HADS), Frontal Asstssment Battery (FAB), Mini-Mental State Examination (MMSE)). RESULTS: Phenosanic acid (Dibufelon) showed statistically significant benefit over placebo in the primary indicator of efficacy (reduction in the frequency of epileptic seizures by at least 50%) and in the secondary indicators. The drug was safe and well tolerated by the patients. CONCLUSION: The addition of phenosanic acid (Dibufelon) to base antiepileptic drugs seems to be perspective because of its positive effect on reducing the number of epileptic seizures, as well as on comorbid disorders in the emotional and cognitive spheres.

[The modification of predictors of course of acute period of craniocerebral trauma under implementation of stream model of medical care support].

The specificity of course of acute period of craniocerebral injury and organization of medical care support are the factors determining outcomes for this category of patients. The purpose of the study is to investigate changes in predictors of course of acute period course of craniocerebral injury under implementation of stream model of medical care organization. The sampling included 150 patients with moderate and severe craniocerebral injury based on data obtained in 2013 and 2019, respectively. The clinical characteristics of patients (gender, age, level of consciousness, alcoholic intoxication, type of injury) and the characteristics of organization of medical care (mode of admission, qualification of hospital physician, time prior to surgery intervention) were evaluated. The selection of predictors significant for prognosis of outcomes of acute period of craniocerebral injury was implemented on the basis of logit-regression analysis and artificial neural network technology. The sampling of patients was divided into groups on the basis of outcomes of acute period of craniocerebral injury. The groups with relatively favorable and unfavorable course of acute period of craniocerebral injury were identified. It is demonstrated that prior to implementation of stream model of medical care provision, the most significant factors determining outcomes of the acute period of craniocerebral injury were characteristics of organization of medical care of these patients. After implementation of stream model the leading predictors became clinical characteristics of patients.

[Therapy of moderate cognitive impairment in the early recovery period of ischemic stroke]. / Terapiya umerennykh kognitivnykh rasstroistv v rannem vosstanovitel'nom periode ishemicheskogo insul'ta.

OBJECTIVE: To assess the efficacy and safety of prospecta in the treatment of moderate cognitive impairment in the early recovery period of ischemic stroke. MATERIAL AND METHODS: The study included 275 patients (mean age 64.0±8.1 years) with a history of single ischemic stroke from 3 to 6 months, with moderate cognitive impairment, and moderate activity in everyday life, who were randomized in two groups. During the screening phase, the severity of cognitive impairment was assessed with the Mini-Mental State Examination and Montreal Cognitive Assessment scales; the level of activity in everyday life was evaluated with the Barthel Scale; and quality of life was assessed with the Stroke Specific Quality of Life Scale. Patients took 2 tablets of prospecta or placebo 2 times a day for 24 weeks. The follow-up period was 4 weeks. The primary endpoint of the study was the proportion of patients with improvement in cognitive function (+1 or more on the MoCA test) after 24 weeks of treatment. The occurrence and type of adverse events (AEs), their severity, relationship to the drug, outcome, changes in vital signs, and the proportion of patients with clinically significant abnormality in laboratory tests were analyzed to assess the safety. RESULTS: A clinically significant improvement in cognitive function was obtained in 91.9% of patients in the prospecta group vs 82.,1% in the placebo group, (p=0.02). There were 57 AEs in 37 (27.4%) Prospecta group patients and 53 AEs in 39 (27.9%) Placebo group participants (p=1.00). No AEs were certainly associated with taking the medication. No clinically significant changes in vital signs or abnormal laboratory results were detected during the study. CONCLUSION: Prospecta is an effective and safe treatment option for patients with moderate cognitive impairment in the early recovery period of ischemic stroke.

[The short-term prognostication of characteristics of course and optimization of tactics of medical care support of patients with epilepsy].

In clinical practice the identification of the dynamics of course of focal epilepsies on the basis of available clinical and neurophysiological indices (prognostication) is of great importance. The purpose of the study is the short-term prognostication of the course of focal frontal and temporal epilepsy. The materials and methods. The control (42 patients) and clinical (70 patients) groups were examined. The complex clinical physiological examination was carried out using electroencephalography, cognitive evoked potential, cardiac rhythm variability and the Schulte test. The cluster analysis was applied to allocate the observable patients into groups according to the dynamics of seizures frequency. The artificial neural networks technology based on physiological characteristics was applied to classify patients into groups with different course of disease. The results. The spectral characteristics of electroencephalographic signal had the greatest value for short-term prognostication of course of disease in the group of patients with focal frontal epilepsy. In patients with focal temporal epilepsy, the most significant predictors were the characteristics of cognitive evoked potential and characteristics of function of coherence of electroencephalogram. The conclusions. The developed algorithm of prognostication of unfavorable course of focal frontal epilepsy has high sensitivity, but lower specificity. Contrariwise, in case of temporal epilepsy, high specificity of the proposed algorithm is demonstrative, but its sensitivity is lower. It is recommended to apply these algorithms and to accentuate attention on characteristics of potential parameters at organization of diagnostic process in case of focal epilepsy.

[The experience of SERVQUAL technique application in measuring satisfaction of patients with medical services quality].

The implementation of system of quality control conforming to requirements of interstate ISO 9001 standards in in the medical organization, the important role is assigned to indicator of satisfaction of patients with quality of medical care as a feedback channel. The study purpose was to investigate satisfaction of patients with quality of medical services in medical organization rendering hospital medical care on the basis of SERVQUAL technique. The analysis of results of survey of 339 patients treated in the twenty-four-hour department of municipal hospital demonstrated rather high rating of perception of quality of rendered medical services that made up to 4.47 points according five-point scale. The application of GAP analysis technique allowed to reveal gaps between expected and real quality of received medical services by means of SQL index quality. The highest points were received for such criteria as "Sympathy" (0.61 points), "Responsiveness" (0.20 points). The satisfactory results were in case of criteria "Materiality" (-0.38 points), "Reliability (-0.43 points). The lowest points were received for criteria "Persuasiveness, confidence" (-0.69 points) that reflects inadequate orientation of hospital personnel to settle problems of patients. The study demonstrated that applying the SERVQUAL technique in assessment of quality of medical services allows to reveal the most significant factors determining satisfaction of patients. The results of survey based on the SERVQUAL technique and processed by GAP analysis are to be considered in management decision making concerning choice of correcting and preventive actions in quality management of rendering medical services at the regional level.

[The comparative analysis of physiological mechanisms of efficiency of purposeful activity in healthy people and patients with epilepsy]. / Sravnitel'nyi analiz fiziologicheskikh mekhanizmov rezul'tativnosti tselenapravlennoi deiatel'nosti u zdorovykh lits i bol'nykh épilepsiei.

AIM: To study the specificity of physiological mechanisms determining the efficiency of modelled purposeful activity in healthy people and patients with epilepsy. MATERIAL AND METHODS: The sample consisted of 235 people, including 72 healthy people (47 men and 25 women) and 163 patients with epilepsy (84 men and 79 women). Emotional and cognitive disorders were scored. Purposeful activity was modelled using the Gorbov-Shulte test. EEG, visual and auditory evoked potentials, P300 wave were recorded. The 'NS-Psychotest' complex was used to record a simple visual-motor reaction, a choice of difference and finger-tapping test. Heart rate variability and external breath functions were studied. An artificial neural network method was used for the prognosis of purposeful activity. RESULTS AND CONCLUSION: The 'resultative' and 'low resultative' groups were selected on the basis of the Gorbov-Shulte test performance. Patients with symptomatic forms of epilepsy, higher frequency of generalized seizures and cognitive disorders were mostly represented in the low resultative group. Artificial neural network classification into groups with different efficiency of activity reveals the greater role of the parameters of afferent and associative mechanisms in healthy people, parameters of cross correlation function of EEG and motor system function in patients with epilepsy.

[THE SPECIFITY OF MOTOR SYSTEMS ORGANISATION AND IT''S INFLUENCES ON RESULTNESS OF ACTIVITY IN HEALTHY PEOPLE AND PATIENTS WITH EPILEPSY].

The specificity of motor systems and its influences on effectiveness of modeling purposeful activity in 46 healthy people and 110 patients with epilepsy was studied. Using cluster analysis the patients with epilepsy were divided in 2 groups: high- and low efficient. The differences of physiological parameters, which characterize the activity of central level of motor systems and visual-motor reaction, were determined. The high level of activation of cortical mechanisms of decision-making and preparedness to motor reaction in the group of healthy people and low effectiveness associated with insufficient activation of these mechanisms in the group of patients with epilepsy was described.

[Physiological mechanisms of simulated purposeful activities in patients with epilepsy].

We examined 102 patients with symptomatic, cryptogenic, and idiopathic forms of epilepsy in order to investigate the physiological mechanisms providing the efficiency of purposeful activity in patients with this disease. Three clusters of patients were formed with the use of the Gorbov-Shulte performance test. The patients of "low efficiency" cluster were characterized by the lack of habituation mechanisms in the activity of afferent systems and mechanism of motor response; the activity rate of stress adaptation systems and the rate of intrasystemic tension during the preparation to purposeful activities were higher than in patients of "intermediate" and "high performance" clusters.

[Clinical and electroencephalographic study of respiratory insufficiency syndrome in patients with chronic bronchitis]. / Kliniko-élektroéntsefalograficheskie paralleli sindroma dykhatelnoi nedostatochnosti u bolnykh khronicheskim bronkhitom.

Standard and computer-assisted resting and exercise electroencephalographic tests performed in 92 patients with chronic bronchitis have found that, if these patients have respiratory distress syndrome, its severity progression proceeds in parallel with aggravation of CNS disorganization. Relevant corrective therapeutic measures are proposed.