[Predictors of lethal outcome in young patients with hemorrhagic stroke]. / Prediktory letal'nogo iskhoda gemorragicheskogo insul'ta u patsientov molodogo vozrasta.

OBJECTIVE: To evaluate the predictors of the lethal outcome of hemorrhagic stroke in young people. MATERIAL AND METHODS: A retrospective analysis of cases of non-traumatic hemorrhagic stroke was carried out in 60 young patients hospitalized in the neurosurgical department in the Ufa Clinical Emergency Hospital. By gender, the male predominated. The mean age of the patients was 37.4±5.1 years. Lethal outcome was in 18 (30%) patients. RESULTS: Data analysis revealed a relationship between the lethal outcome of hemorrhagic stroke and certain clinical, somatic, laboratory and instrumental factors. As a result, a significant model (p<0.001) of the probability of a lethal outcome in young patients was developed. CONCLUSION: The identified predictors of the probability of death from stroke can serve as the basis for adequate management of young patients with hemorrhagic stroke.

[Ethiopathogenetic features and course of ischemic stroke associated with COVID-19]. / Etiopatogeneticheskie osobennosti i techenie ishemicheskogo insul'ta, assotsiirovannogo s COVID-19.

OBJECTIVE: To analyze etiopathogenetic factors and course of ischemic stroke associated with new coronavirus infection (COVID-19). MATERIAL AND METHODS: A retrospective clinical study of 173 patients with ischemic stroke and COVID-19 (main group) and 86 patients with ischemic stroke without COVID-19 (comparison group) was carried out. There were no statistically significant differences in age and gender. All patients underwent standard clinical-instrumental, laboratory and neuroimaging assessments. RESULTS: Compared with the comparison group, patients with COVID-19 were less likely to have cardiovascular risk factors, the difference being statistically significant. Stroke in the main group was more severe than in the comparison group. According to the TOAST classification, an unknown stroke subtype significantly predominated in the main group. Laboratory data in the main group indicated the significance of an increase in renal-hepatic markers (creatinine, aspartate aminotransferase) and systemic inflammatory response syndrome (C-reactive protein). CONCLUSION: The development of cardiovascular diseases in patients with COVID-19 is an important negative prognostic factor that requires further study to determine the optimal management strategy.

[Dissection of cerebral arteries as a cause of ischemic stroke]. / Dissektsiya tserebral'nykh arterii kak prichina ishemicheskogo insul'ta.

Dissection of cerebral arteries is a rare cause of stroke in the general population. The article describes 5 clinical cases of patients with ischemic stroke after dissection, discusses the issues of etiology, diagnosis and treatment tactics. The possibility of using high-tech methods of treatment for this subtype of stroke is emphasized. The diagnostic method of choice is neuroimaging, including cerebral angiography.

[Therapy of moderate cognitive impairment and asthenia in patients with cerebrovascular pathology: results of a prospective observational study]. / Terapiya umerennykh kognitivnykh narushenii i astenii u patsientov s tserebrovaskulyarnoi patologiei: rezul'taty mnogotsentrovoi otkrytoi prospektivnoi nablyudatel'noi programmy.

OBJECTIVE: Obtaining additional data on the efficacy and safety of the drug Prospekta in the treatment of moderate cognitive impairment (MCI) and asthenia in patients with cerebrovascular disease (CVD). MATERIAL AND METHODS: A prospective observational study in more than 40 Russian cities enrolled 232 patients (mean age 61.5±10.0 years) with mild cognitive impairment (MCI), asthenia on ongoing basic nootropic therapy. The presence of MCI was confirmed by the Montreal Cognitive Assessment Scale (MoCA), asthenia - by 10-point Visual Analog Scale (VAS). All patients were prescribed the nootropic medication Prospekta 2 tablets 2 times a day for 8 weeks in addition to the therapy they received. Ultrasound Doppler sonography of the main arteries of the head and magnetic resonance imaging (MRI) of the brain were also assessed. At the end of treatment, the Clinical Global Impression Efficacy Index (CGI-EI) was assessed and the safety of the treatment was evaluated. RESULTS: The baseline severity of cognitive impairment according to the MoCA scale was 21.6 points, severity of asthenia according to the VAS was 6.3 points. According to Doppler flowmetry findings, hemodynamically significant stenosis was revealed in 105 (49.3%) patients, and narrowing of the main vessels without changes in hemodynamic parameters was revealed in 108 (50.7%) patients. According to MRI results, single vascular lesions in the brain matter were detected in 102 (44.0%) patients. The medications with nootropic effect were administered to 144 (62.1%) patients. A positive therapeutic response as improvement of cognitive functions was seen in 93.3% of patients after 8 weeks of taking Prospekta, including 39.4% of patients who had cognitive functions restored to the normal level. No side effects were registered during the observational study. CONCLUSIONS: The nootropic medication Prospekta is effective and safe in treatment of MCI in patients with asthenia with CVD, and improves cognitive function in patients with asthenia with CVD, both in monotherapy and in combination with other nootropic agents.

[Predictors of unfavorable outcomes of ischemic stroke associated with COVID-19]. / Prediktory neblagopriyatnogo iskhoda ishemicheskogo insul'ta, assotsiirovannogo s COVID-19.

OBJECTIVE: To study predictors of unfavorable outcomes in ischemic stroke associated with COVID-19. MATERIAL AND METHODS: A retrospective analysis of 173 case histories of patients with ischemic stroke and COVID-19 was carried out. The average age was 68.64±11.39 (95% CI 66.93-70.35; median 92, mean 34) years. By gender, women predominated (64.16%). Fatal outcome was observed in 62 (35.84%) patients. Risk factors were studied using binary logistic regression. RESULTS: The risk of a fatal stroke in a univariate analysis was established in the presence of a general severe condition of the patient and a number of other factors, which included the severity of COVID-19, acute coronary syndrome, multiple organ failure, the need for a ventilator, a history of kidney disease, pneumonia, high NIHSS score, oxygen partial pressure level, respiratory rate, number of hospitalizations, complete blood count (erythrocytes, hemoglobin, hematocrit, leukocytes, neutrophils), coagulogram, glucose, liver and kidney markers (bilirubin, aspartate aminotransferase, alanine aminotransferase, creatinine, urea), levels of creatine phosphokinase, lactate dehydrogenase and C-reactive protein. A model based on multivariate analysis was used, which makes it possible to predict the probability of a fatal outcome. A regression function was obtained, which included the content of C-reactive protein, urea and NIHSS score. In patients with a value of 35% and above, there was an increased risk of death, in the case of a value below 35%, a favorable outcome was assumed. The model was statistically significant (p<0.001). The sensitivity and specificity of the model were 88.9% and 97.9%, respectively. CONCLUSION: The revealed predictors of the probability of a fatal stroke outcome can be guidelines for a Coctor in choosing a patient management strategy at different stages of patient care.

[Etiopathogenetic features, course and outcome of hemorrhagic stroke in young people]. / Etiopatogeneticheskie osobennosti, techenie i iskhod gemorragicheskogo insul'ta u lits molodogo vozrasta.

OBJECTIVE: Analysis of etiopathogenetic factors and features of the course of hemorrhagic stroke in young people. MATERIAL AND METHODS: A retrospective analysis of 402 case histories with non-traumatic hemorrhagic stroke was carried out, of which 60 (14.93%) patients were young. The average age was 37.37±5.09 years. There were 19 (31.7%) females and 41 (68.3%) males. Statistical data processing was carried out using Microsoft Office 2010 and SPSS v.26. RESULTS: The main causes of hemorrhagic stroke in young people were changes in cerebral vessels by the type of aneurysmal deformation of the vascular wall, including Moya-Moya disease, and arteriovenous malformations (60%). The second etiological factor of hemorrhagic stroke was arterial hypertension (40%). Intracerebral hematoma was the most common type of hemorrhagic stroke. The functional outcome was influenced by: the severity of the patient's general condition, the severity of the neurological deficit, the degree of consciousness, the presence of concomitant pathology, convulsive, dislocation syndrome, leukocytosis, hyperglycemia, high creatinine levels. CONCLUSION: The problem of hemorrhagic stroke at a young age is complex and relevant, since the etiological factor of the disease at this age differs significantly from that in older age groups, requires adequate diagnostic searches to identify the etiopathogenetic factor and subsequent secondary prevention.

[Factors affecting the effectiveness of rehabilitation in patients in the acute period of cerebral stroke]. / Faktory, vliyayushchie na effektivnost' reabilitatsii bol'nykh v ostrom periode tserebral'nogo insul'ta.

AIM: To study the factors, affecting the effectiveness of acute period rehabilitation in patients after ischemic stroke (IS). MATERIAL AND METHODS: We examined 72 patients (average age 63.8 ± 1.3 years) in the acute period of IS who were treated in the neurological department for patients with acute cerebrovascular accident of the State Budgetary Institution of Healthcare of the Republic of Bashkortostan «Emergency Hospital¼ (Ufa). All patients underwent clinical, instrumental and laboratory examination. The following scales were used: NIHSS, Rankin, Barthel, Rivermead, Montreal Cognitive Assessment, Spielberg - Hanin situational and personal anxiety scale, Beck's Depression Inventory, A.M. Vain questionnaire for assessment of the severity of autonomic dysfunction, T. Ehlers test and A.M. Schubert's method of determination of the state of the motivational sphere and risk preparedness. Assessment of the rehabilitation potential was carried out by analyzing the data of the Rehabilitation List. According to the severity of neurological deficit, the patients were divided into 2 groups: 38 (52.7%) patients with mild IS were included in the Group 1 and 34 (47.2%) patients with moderate IS - in Group 2. RESULTS: By the end of the treatment, significant changes in the number of patients with cognitive and depressive disorders, qualitative changes in the levels of personal and situational anxiety in the direction of their reduction were registered. In the vast majority of patients in both groups at the stages of treatment, one or another degree of autonomic nervous system dysfunction was found. Most patients (82.9%) at the beginning of the treatment had an average and high degree of motivation to achieve success in treatment, along with a low and medium level of risk preparedness, which is characteristic of a person aimed at success. According to the complex of factors, 78% of patients had an average and high level of rehabilitation potential. CONCLUSION: A comprehensive and individual approach to the correction of pathological disorders in patients in the acute period of IS, taking into account the rehabilitation potential, is the key to the effectiveness of rehabilitation treatment at the stages of rehabilitation.

[Vascular remodeling with violations of intracardiac hemodynamics in patients older age category, combined with the clinical-cluster, neurocognitive and biomarker heterogeneity in multifocal atherosclerosis].

AIM: Study of the remodeling of the carotid arteries with violation of intracardiac hemodynamics in patients with MFA, and the estimation of the main parameters of dyslipidemia, apoptosis, and oxidative stress in patients with high vascular risk older age group (6175 years) in a Regional vascular center of Ufa. MATERIALS AND METHODS: Depending on the predominant lesion of the vascular pool, patients were divided into 3 clusters by the method of hierarchical analysis of categorical variables according to the clinical manifestation of atherosclerotic lesions of the heart, brain and lower limb arteries confirmed by coronary angiography, ultrasound Doppler of the main arteries of the head and lower extremities. 96 of them were IPA with a primary lesion of the heart (1st cluster), the 96 IPA with a predominance of lesions of the carotid arteries (2nd cluster), 96 patients with ischemia of lower extremities (3rd cluster). At the hospital stage, electrocardiography, echocardiography, magnetic resonance imaging of the chest and abdomen, ultrasound of the OBP and kidneys, if necessary, ultrasound of the pelvis were performed. Determination of 8-ON-deoxyguanosine, annexin-5 (An-5) and Aan-5 in blood by ELISA was performed in all patients with MFA, as well as standard biochemical screening for lipidogram examination. RESULTS: We have found that most often in different combinations and with different degrees of severity according to our data are observed: Clinical manifestation of atherosclerotic heart disease (cluster 1) mainly due to its history in combination with stage III hypertension with increasing thickness of intima-media complex and stenosis of the right WASP, left ventricular dilatation, as well as a higher concentration of Aan-5IgMand LP-A as a risk factor for coronary heart disease, atherosclerosis, atherothrombosis. 2. Hemodynamically significant violations of the main arteries of the head in patients of the 2nd cluster mainly with acute ischemic cerebral circulation, in which there was a development of left ventricular hypertrophy with an increase in the size of the left atrium and the presence of atherosclerotic plaque of the right and left WASP. The higher prevalence of stroke was combined with a marked cognitive deficit among patients of cluster 2 with the lowest level of An-5, an increase in total cholesterol and low-density lipoprotein cholesterol. 3. The total severity of the condition in patients with hemodynamic ischemia with clinical manifestation of vascular lesions of the lower extremities was accompanied by a predominant increase in stable angina with FC2, lerish syndrome with occlusion of the iliac, superficial femoral arteries, the presence of insulin-independent type 2 diabetes, which in this group was established in 59.4% of cases, combined with a higher concentration of the marker of oxidative stress 8-ON-deoxyguanosine and hypertriglyceridemia. CONCLUSION: The construction of a three-cluster model in patients at high vascular risk of the elderly age category showed the interaction of cardio-carotid comorbid background on the clinical diversity of systemic vascular lesions in MFA with the development of remodeling of the main arteries and disorders of intracardiac hemodynamics associated with laboratory changes in the assessment of the main parameters of dyslipidemia, apoptosis markers, oxidative stress.

[A role of microRNA in the pathogenesis of ischemic stroke]. / Rol' mikroRNK v patogeneze ishemicheskogo insul'ta.

Ischemic stroke (IS) is one of the leading causes of death and disability worldwide. Among all the causes of IS, cardioembolic stroke (CEI) accounts for up to 40%. Based on the literature data, modern ideas about the role and location of cardiac diseases in the pathogenesis of CEI are presented. The leading cause of CEE is non-rheumatic atrial fibrillation. Numerous attempts to study and prove the genetic nature of the development of IS led to the discovery of new markers - micribonucleic acids (microRNAs), the regulators of gene expression, that inhibit mRNA translation and play a key role in the pathogenesis of IS. This review summarizes the current knowledge of microRNAs, their ability to simultaneously regulate several target genes, and their significance as potential diagnostic and prognostic biomarkers in IS.

[Myofascial pain syndrome].

OBJECTIVE: To analyze clinical characteristics of pain syndrome in patients with dorsalgia. MATERIAL AND METHODS: Authors studied 43 patients (mean age 41.9±1.2 years), 34 women and 9 men, with acute and subacute chronic back pain. The study included neurological examination, MRI and/or CT of the spine, measurement of anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), The Brief Pain Inventory (BPI) and the McGill Pain Inventory. RESULTS AND CONCLUSION: Chronic myofascial pain syndrome (MFPS) was frequently associated with anxiety-depressive disorders found in patients with cervical and cervical/pectoral pain, fibromyalgia with minimal neurological symptoms and no signs of neural structure compression according to MRI and CT. The results of the study of chronic MFPS should be taken into account in the choice of tactics of treatment of MFPS patients. The use of amelotex in the combination with compligam B in patients with dorsopathy and MFPS is effective together with correction of emotional disorders and treatment with chondroprotectors.

[The importance of transcranial doppler ultrasound monitoring for prevention of intraoperative cerebral ischemia].

OBJECTIVE: To determine the possibility of using transcranial ultrasound dopplerography (TCDG) in assessment of unfavorable changes in cerebral blood circulation which lead to the development of intraoperative cerebral ischemia. MATERIAL AND METHODS: We studied 55 patients who underwent vascular surgery or neurosurgical interventions. Changes in the systemic hemodynamics of ischemic character were recorded during the surgery in all patients. To assess the state of cerebral blood circulation, we performed TCDG using a special system of monitoring. RESULTS: Intraoperative TCDG monitoring showed the absence of critical changes in cerebral blood circulation (cerebral blood flow). CONCLUSION: Complex preoperative and intraoperative ultrasound diagnosis gives the possibility to prevent intraoperative injuries of the brain.

[Efficacy of cereton in acute ischemic stroke: results of the trial SOLNTSE].

We studied 95 patients with acute (no later than 24h after onset) carotid ischemic stroke. Patients of the main group (50 patients) received cereton in dose 4 ml (1000 mg) intravenously during 10 days in the combination with traditional treatment; 45 patients of the control group received only traditional treatment. Neurological deficit on NIHSS and vigilance on The Glasgow Coma Scale were assessed at baseline and in 5th, 7th and 19-21th days. The Barthel index was used to measure functional independence of the patient at the discharge from a hospital (21th day). The "cost-effectiveness" ratio, the cost of one score on the NIHSS and Barthel scales were calculated. The reduction in neurological deficit (p<0.05) and higher extent of functional independence were seen in the main group compared to the controls. Based on the "cost-effectiveness" analysis, the use of cereton was shown to be more effective for treatment of patients with acute ischemic stroke: the cost of the achievement of positive effect in patients of the control group receiving only traditional treatment was significantly higher (p<0.05).

[Analysis of a disturbance of trace element balance in patients with ischemic stroke with arterial hypertension].

Disturbance of trace element balance increases the risk of cerebrovascular disease and, above all, ischemic stroke (IS). A comparative analysis of clinical and demographic parameters and trace element composition of hair was performed in the group of 30 ischemic stroke patients with arterial hypertension (AH) and 30 stroke patients without hypertension (mean age 55±7 years). The stroke patients with hypertension were characterized by the elevated body mass index (28.5±4.1 kg/m2, AI, 26.0±2.9 kg/m2, p=0.006), higher incidence of coronary heart disease (p=0.04). Alcohol consumption more than 3 drinks a week was associated with a 5-fold increase of the risk of stroke with hypertension (95% CI 1.0-27, p=0.035). The results revealed a number of statistically significant differences in trace element profile in the studied groups of patients: deficits of essential magnesium, manganese, cobalt, copper, zinc, a statistically significant increase in sodium levels, toxic and conditionally toxic trace elements (cadmium, mercury, bismuth, barium, etc.). One of the probable factors that lead to the accumulation of toxic trace elements in stroke patients is the increased consumption of alcohol including that of substandard quality. The data obtained also show the feasibility of implementing screening programs to assess micronutrient status (including trace elements) for early detection of pathological abnormalities in the elemental homeostasis that might lead to an increased risk of ischemic stroke and hypertension.

[The methodological approach to the group formation of pharmacological drugs for the primary prevention of ischemic stroke].

The paper is devoted to the development of a drug list, so called "marker baskets", which can be recommended for the primary prevention of ischemic stroke in patients with high cardio-vascular risk. The authors reviewed various combinations of pharmacological drugs with similar treatment effects and different availability of prices.

[Efficacy of cytoflavin in patients in the acute ischemic stroke].

We present the results of a multicenter study on efficacy of cytoflavin in the treatment of patients with acute ischemic stroke. Seventy patients (41 of the main group and 29 of the control group) were enrolled in the study. All patients received basic therapy aimed at improving systemic hemodynamics, rheological blood properties and at the prevention of stroke complications. Patients of the main group were treated with cytoflavin as follows: days 1-10 - 20 ml (in 400 ml of the 0,9% NaCl solution) twice a day intravenously in drops; days 11-35 - 850 mg twice a day. We assessed the dynamics of restoration of lost functions (NIHSS, the Rankin scale, the Barthel index) and volumes of ischemic lesion (MRI T1-, T2-, diffusion-weighted images). Results of the study on patients of the control group were supplemented with literature data about 306 patients studied using clinical scales and 40 patients studied with MRI. We revealed a trend towards an effect of cytoflavin on the preservation of brain matter in the acute phase of stroke. Cytoflavin reduced the neurological deficit and improved activities of daily living in patients that may be explained by the less brain damage.

[Assessment of berlition effectiveness in ischemic stroke with CT perfusion imaging of the brain].

Berlition, an alpha-lipoic acid preparation, is a natural regulator of the free-radical processes. It was used as an add-on therapy in the management of patients in the acute period of ischemic stroke during 10 days. A main group included 15 patients treated with berlition and a comparison group - 11 patients who received a basic therapy. Patients' age was 30-60 years. A complete clinical study of patients was conducted during 21 days of treatment. CT perfusion imaging of the brain with contrast material was carried out on 1st, 5th and 15th days. The higher therapeutic effectiveness was found in the main group of patients, with complete functional rehabilitation in 33% of cases and significant regress of neurologic symptoms in 67%. These changes were correlated with positive shifts of different hemodynamic parameters to the 15th day of treatment.

[An analysis of association between the apolipoprotein B gene EcoR1 polymorphism and ischemic stroke].

The EcoR1 polymorphism of the apolipoprotein B gene (APOB) is thought to be associated with atherothrombotic type of ischemic stroke (ATTIS) with the APOB*R1/R2 genotype as a marker of increased risk for ATTIS. We estimated odds ratio for this genotype as 2.17 in ethnic Russians and 3.39 in ethnic Tartars. The association between the EcoR1 APOB gene polymorphism and ATTIS confirmed the results of previous studies on relation of the APOB gene to vascular pathology caused by elevated lipid level and atherogenesis.

[Brain functional status in patients suffering from hemorrhagic fever with renal syndrome]. / Funktsional'noe sostoianie mozga u bol'nykh gemorrhagicheskoi likhoradkoi s pochechnym sindromom.

EEG mathematical analysis in 59 patients with hemorrhage fever with renal syndrome (HFRS) revealed significant changes of bioelectrical brain activity, being expressed most distinctly during severe course, in the different stages of the disease. Re-convalescents after HFRS severe type showed lower EEG coherence indices in all frequency bands that argued for consistency of electric process dysfunctions in great brain cortex and might reflect structural brain damage. The data obtained exhibit higher informative ness of the EEG mathematical analysis not only in the context of differential and diagnostic perspectives but also for adequate evaluation of cerebral disturbance expression and their manifestation prognosis in the HFRS patients.