[The impact of therapy with Mexidol on neurological deficit and functional outcome in patients with ischemic stroke: a systematic review and meta-analysis]. / Vliyanie terapii preparatom Meksidol na regress nevrologicheskogo defitsita i funktsional'nyi iskhod u patsientov s ishemicheskim insul'tom: sistematizirovannyi obzor i metaanaliz.

OBJECTIVE: To evaluate systematically the published peer-reviewed literature and estimate the effect of therapy with Mexidol on the course and outcomes of ischemic stroke (II) in adult patients. MATERIAL AND METHODS: The meta-analysis included 11 studies reported In Russian (2 randomized controlled studies, 9 non-randomized, unblinded cohort studies). RESULTS: The results obtained indicate a positive effect of Mexidol on the course of II in the treated adult patients: we found statistically significant decrease in NIHSS scores on days 7-10 and 21-24 and in modified Rankin scale scores on days 5-7 and days 10-14 compared with the control group. The cumulative effect of the drug was shown: the between-group difference of the NIHSS scores increases with the course of observation time. The effect of Mexidol on indicators on the NIHSS scale is more significant, the greater the initial severity of the patient's neurological deficit. CONCLUSION: Heterogeneity in study designs and patient characteristics has resulted in significant statistical heterogeneity, and the evidence presented at the time of writing requires further examination as new data become available.

[Epidemiology and features of statistical accounting of in-hospital ischemic stroke (St. Petersburg experience)]. / Epidemiologiya i osobennosti statisticheskogo ucheta vnutrigospital'nogo ishemicheskogo insul'ta (na primere Sankt-Peterburga).

OBJECTIVE: To evaluate the effectiveness of the existing registration system and propose an epidemiological model for statistical accounting of the frequency of development of in-hospital ischemic stroke (IHS) in medical organizations of the Russian Federation on the example of St. Petersburg. MATERIAL AND METHODS: The design of the study, conducted in the period 2014-2021, included two stages. At the first (retrospective) stage (from 01.09.14 to 31.03.16) an initiative analysis of the quality of care for 243 patients (5 medical institutions) was carried out in order to determine the relevance of the issues of IHS for the healthcare of St. Petersburg. At the second (prospective) stage, based on the data of the city stroke registry and sample control of reported cases of IHS during initiative visits and as part of annual audits, an epidemiological analysis of the frequency of occurrence of IHS in city hospitals (11 medical institutions) was performed. At the second stage, 1253 reported cases of IHS were studied: 805 (64.2%) in hospitals providing endovascular care for stroke and 448 (35.8%) in primary stroke centers (PSC). The second stage included 2 chronologically consecutive periods (from 04.01.16 to 31.12.18 and from 01.01.19 to 31.12.21) with testing of 3 different methodological approaches to accounting for the IHS. RESULTS: The share of IHS in the structure of all ischemic strokes (IS) in hospitals with PSC and regional vascular centers (RVC) in St. Petersburg in the period 2016-2021 was 1.4-2.0%. There were no significant differences in the ratio of IHS in the overall structure of IS between typical hospitals with PSC and RVC. In the general structure of IS, initially diagnosed in hospitals, the proportion of IHS is about 1/3 (~30%), the remaining 2/3 (~70%) of cases are cases of late diagnosis of out-of-hospital vascular events (in various periods), other causes of acute cerebral pathology, cases of illegally established in-hospital vascular events. CONCLUSION: The proposed calculation model is able to bring closer to understanding the real number of IHS in a large metropolis, but does not reflect its exact number, because is based on accounting for the work of only a part of the city hospitals included in the city's program of care for patients with stroke.

[Perioperative stroke in heart valve surgery: pathogenesis, clinical findings, diagnosis, prevention, treatment]. / Perioperatsionnyi mozgovoi insul't v khirurgii klapanov serdtsa: patogenez, klinika, diagnostika, lechenie i profilaktika.

AIM: To study risk factors, characteristics of clinical symptoms and diagnosis, and possibilities of prevention of perioperative stroke and other clinical types of cerebral dysfunction in main types of heart valve surgery. MATERIAL AND METHODS: The study included 83 patients, aged 63 (54; 70) years, undergoing heart valve surgery with cardiopulmonary bypass. RESULTS: Postoperative cerebral dysfunction was diagnosed in 37.3% of cases, including perioperative stroke in 3.6% of cases. In cases of aortic stenosis, the frequency of perioperative stroke was 9.5%. The cardioembolic subtype of perioperative ischemic stroke in cardiac valve surgery was most likely. The risk factors of the symptomatic delirium of the early postoperative period are: age over 75 years, preoperative frontal dysfunction, duration of artificial respiratory care more than 20 hours after the surgery. CONCLUSION: The results suggest the efficacy of preventive use of cytoflavin for reducing the frequency and severity of perioperative stroke and symptomatic delirium of the early postoperative period in heart valve surgery with cardiopulmonary bypass.

[Pathogenetic mechanisms of traumatic brain disease and main lines of their treatment].

To assess efficacy and tolerability of axamon (ipidacrine) in the complex therapy of patients with cranial-brain injuries, 40 patients have been studied. Patients of the main group (20 persons) received, along with traditional therapy, axamon in dose 0,02 g 3 times daily during 2 months and patients of the control group (20 persons) received only traditional therapy. Clinical examination and assessment with NIS, Autonomic Symptoms Questionnaire, Hamilton anxiety scale, electrophysiological study (magnetic diagnostics, electroneuromyography with investigation of somatosensory evoked potentials, brain CT (MRI) have been conducted at the beginning of treatment and 1 and 2 months after. Axamon demonstrated the highest efficacy (p<0.05) in stopping anxiety symptoms in patients of the main group in the 1st month of treatment. After 2 months, a significant improvement of patient's state in the main group assessed by NIS and Hamilton anxiety scale (p<0.05) was found. Data of electrophysiological and neuroimaging study revealed significant positive changes reflected in the normalization of intracerebral conductance and resolution of structural changes of brain substances in the injury. Side-effects of the drug were brief and did not lead to stopping treatment.