[Anxiety in subjects with cardiovascular disease: Current diagnostic strategies and therapeutic options. A review].

Anxiety and anxiety disorders are important modifiable risk factors for cardiovascular and other common chronic non-communicable diseases and complications. Anxiety disorders significantly reduce the motivation and adherence of patients to lifestyle changes and drug therapy, significantly worsen the quality of life, and increase the risk of disability and the costs of the health care system. The issues of diagnosis and therapy of anxiety are relevant for the practice of physicians and cardiologists due to the high incidence of anxiety disorders in patients with cardiovascular diseases, a decrease in the quality of life and an increase in adverse outcomes, and also due to the insufficient awareness of the risks associated with the psycho-emotional state of patients. Therapy of anxiety disorders includes both drug and non-drug methods. The first-line drugs in treating most anxiety disorders are selective serotonin reuptake inhibitors or selective serotonin-norepinephrine reuptake inhibitors. The risk of possible side effects of these agents in patients with cardiovascular diseases should be considered. Sedative and anti-anxiety drugs, including non-benzodiazepine tranquilizers, are more commonly used. The most studied drug from this class in therapeutic and cardiological practice is fabomotizole. The efficacy and safety of fabomotizole, including long-term use, have been studied in numerous studies in patients with cardiovascular diseases and a wide range of anxiety disorders.

[Postcovid cognitive impairment]. / Postkovidnye kognitivnye narusheniya.

This review addresses current issues in post-COVID syndrome with a focus on neurocognitive impairment. The results of studies on complications in patients of different ages and health statuses recovered from mild to severe COVID-19 are discussed. Current data on the pathogenetic mechanisms of the development of various post-COVID disorders are presented, including a detailed discussion of central nervous system damage. The paper summarizes data on the relationship between neurocognitive disorders and accelerated cell aging, chronic nonspecific inflammation, and reduced neuroplasticity in the central nervous system. The main pathogenetic ways to prevent COVID-related complications, including neuronal tissue damage and the prospects for managing such patients are discussed. The choice of pathogenetic therapy in patients with neurocognitive impairment in the post-COVID period is assessed. The main benefits of choline alfoscerate therapy for neurocognitive impairment in patients with post-COVID syndrome are discussed.

[Prospects of use of research results for drugs with anitihypoxic and antioxidative properties in neuroprotective treatment strategies (Opinion of the Council of Experts dated 26 March 2022)]. / Perspektiva ispol'zovaniya rezul'tatov issledovaniya preparatov s anitigipoksantnymi i antioksidantnymi svoistvami v neiroprotektivnoi strategii lecheniya (Zaklyuchenie soveta ekspertov ot 26 marta 2022 g.).

Cerebrovascular diseases are one of the main causes of death and permanent disability. Effective and timely neuroprotective therapy can reduce the burden of cerebrovascular disease. The possibilities of neuroprotection as a method of prevention and medical rehabilitation of acute and chronic cerebrovascular diseases are addressed.

[Correction of psychoemotional disorders and short-term prognosis in patients with COVID-19]. / Korrektsiya psikhoemotsional'nykh narushenii i kratkosrochnyi prognoz u patsientov s COVID-19.

This review discusses the importance of the main psychosocial risk factors in the development of chronic non-communicable diseases. The current data on the prevalence of anxiety and depressive disorders in patients with cardiovascular diseases (CVD) are presented. The article summarizes information about the relationship between the development of psychoemotional disorders and CVD, discusses the prospects for the management of such patients in the framework of interdisciplinary cooperation. The main pathogenetic mechanisms of the development of complications, including damage to the central nervous system during infection with a new coronavirus infection, are considered. The significance of the choice of pathogenetic therapy for patients with comorbid somatic and mental diseases in the conditions of a pandemic of a new coronavirus infection is assessed. The results of multicenter placebo-controlled studies on the use of fluvoxamine in patients with a new coronavirus infection of varying severity are discussed.

Correction of Psychoemotional Disorders and Short-Term Prognosis in Patients with COVID-19.

This review discusses the importance of the main psychoemotional risk factors for the development of chronic noncommunicable diseases. Current data on the prevalence of anxiety and depressive disorders in patients with cardiovascular disease (CVD) are presented. Data on the relationship between the development of psychoemotional disorders and CVD are summarized and the prospects for managing such patients within the framework of interdisciplinary cooperation are discussed. The main pathogenetic mechanisms for the development of complications, including CNS damage in COVID-19, are considered. The significance of the selection of pathogenetic therapy for patients with comorbid somatic and mental diseases in the context of the COVID-19 pandemic is discussed. Results from multicenter placebo-controlled studies of the use of fluvoxamine in patients with COVID-19 of varying severity are addressed.

[Cerebrovascular disease in patients with type 2 diabetes mellitus]. / Tserebrovaskulyarnye zabolevaniya u patsientov s sakharnym diabetom 2-go tipa.

The article discusses the current trends in the spread of carbohydrate disorders, discusses in more detail the problem of type 2 diabetes mellitus and associated cerebrovascular diseases. The spectrum of the therapeutic effect of the drugs neurox and neupilept is considered in relation to this category of patients.

[Prognostic significance of clinical-anthropometric, biochemical, metabolic, vascular-inflammatory and molecular-genetic markers in the development of the first ischemic stroke]. / Prognosticheskaia znachimost' kliniko-antropometricheskikh, biokhimicheskikh, metabolicheskikh, sosudisto-vospalitel'nykh i molekuliarno-geneticheskikh markerov v razvitii pervogo ishemicheskogo insul'ta.

AIM: To study the relationship between clinical-anthropometric, biochemical, metabolic, vascular-inflammatory, molecular-genetic parameters and the development of the first ischemic stroke, and to develop a prognostic model for determining the probability of its occurrence. MATERIAL AND METHODS: The study included 196 first ischemic stroke patients and 119 healthy people matched for age, place of residence and nationality to the group of patients. The main anthropometric, clinical, biochemical, metabolic parameters and markers of vascular inflammation and endothelial dysfunction were assessed. Single nucleotide polymorphisms of IL8, ADIPOQ, ADIROR, APOB, APOC-IV, BDNF, GRM3 genes were genotyped. RESULTS: Weight, BMI, waist circumference, homocysteine, insulin, adiponectin, cystatin C, ApoA1, Apo B, CHOL, HDL, LDL, TG, CRB-sh, glucose, uric acid, IL-1b, IL-4, IL-6, IL-8, TNF-a, VEGF-A were significantly associated with the first ischemic stroke. CONCLUSION: Based on the data obtained in this study, a probability model for the development of the first ischemic stroke was obtained. Of all the parameters studied, diabetes mellitus, adiponectin, Apo A1, IL-4 made the largest contribution to the probability of the first ischemic stroke.

[An assessment of cerebrolysin effect on BDNF level in patients with post stroke aphasia depending on carbohydrate metabolism disorders].

AIM: We carried out an open randomized controlled study to explore the changes in the rate of speech recovery and BDNF concentrations in patients with left-hemisphere stroke and carbohydrate metabolism disorders (diabetes mellitus type2 or prediabetes) who received cerebrolysin. MATERIAL AND METHODS: A study included 60 inpatients of the Center of Speech Pathology and Neurorehabilitation. Neuropsychological examination was performed at baseline and after the treatment was completed. We determined aphasia type and quantitatively assessed speech in scores which reflected the severity of speech impairment. BDNF serum concentrations were measured. RESULTS: Clinical efficacy of cerebrolysin (intravenously in dose 20 ml in 100 ml of physiological solution, 5 days a week, during 4 weeks) used in addition to standard neurorehabilitation measures in patients with post stroke aphasia of different severity was demonstrated. This treatment was most effective in patients with very marked and marked speech impairment that was confirmed by the maximal possible improvement of speech during the first course of neurorehabilitation measures, in particular in a subgroup of patients without carbohydrate metabolism disorders. A significant increase in BDNF concentrations was an additional evidence of this improvement. CONCLUSION: The use of cerebrolysin in the complex treatment of patients with post stroke aphasia of different severity improves the prognosis of their rehabilitation.

[Specific features of neurological complications developing in patients with type 2 diabetes mellitus and metabolic syndrome: possibility for correction and prevention].

The prevalence of type 2 diabetes mellitus (DM) and preceding metabolic disturbances has reached epidemic proportions. Oxidative stress plays a significant role in the development of micro- and macrovascular complications in patients with DM. The accumulation of free radicals is responsible for the development of systemic and vascular inflammation, endothelial dysfunction, and hypercoagulable and ischemic states. Since vascular and nervous system damages do not level off even under adequate glycemic control, there is a need for complex pathogenetic treatment strategies. Antioxidant therapy using mexidol is one of the compulsory components of combination therapy for complications of DM.

[Neuroprotection in hypertensive patients: minimization of poor prognosis].

The paper discusses approaches to optimizing pharmacotherapy in patients with hypertension associated with cerebrovascular diseases. Possible indications for neuroprotectors and a pathogenetic rationale for their mechanism of action in patients with prior cerebral stroke are detailed.

[Cognitive impairments as a universal clinical syndrome in a therapist's practice].

The problem of cognitive dysfunctions in patients with somatic diseases occupies a prominent place now since they are one of the most common manifestations of organic brain lesions. The early detection of potentially cured cognitive impairments is one of the important tasks of a present-day therapist, cardiologist, endocrinologist, and family doctor as the patients with early-stage cognitive impairments constitute the majority of those who have sought medical advice. In the modern world, primary health care physicians' actions are decisive in predicting the development of dementia since the detection of early non-dementia forms of cognitive impairments and neuroprotective therapy with mexidol in particular are frequently quite sufficient to considerably reduce the degree of the impairments and to improve the prognosis of dementia.

[Development of main disturbances of hemostasis in patients with obesity].

According to current views obesity especially with increased amount of visceral fat is characterized by prothrombogenic changes of hemostasis and fibrinolysis. This combined with insulin resistance, compensatory hyperinsulinemia, disturbances of carbohydrate metabolism, atherogenic dyslipidemia and hypertension substantially increases risk of origination and progression of cardiovascular diseases. Results of our study demonstrate high prevalence of various prothrombogenic abnormalities in coagulation and anticoagulation systems in patients with visceral obesity and metabolic syndrome (MS). Disturbances of hemostasis were detected by such screening methods as measurement of APTT, INR and concentration of fibrinogen in blood plasma. We received data on positive association of severity of some abnormalities of hemostasis with anthropometric and biochemical parameters of obesity and MS, parameters of lipid and carbohydrate metabolism. Revealed disturbances of hemostasis create prerequisites for development of thrombophilia and make additional contribution to increase of cardiovascular risk in this category of patients. This dictates necessity of more thorough and deepened examination of patients with visceral obesity and MS with the aim of detection and correction of pathological changes of lipid and carbohydrate metabolism, system of hemostasis and fibrinolysis at earliest stages.

[Clinical significance of the ADVANCE study for a practitioner: Possibility to treat and prevent complications of type 2 diabetes mellitus].

ADVANCE is a multicentre placebo-controlled randomized trial undertaken to investigate effects of intensive decrease of blood pressure and blood glucose level on the development of major micro- and macrovascular complications in patients with type 2 diabetes mellitus. Patients included in the study designed to evaluate results of intense glycemic control were given glyclazide modified release (diabeton MR) as the basic treatment. The main results of ADVANCE indicate that intense hypoglycemic therapy with the use of diabeton MR allows for efficient and safe control of blood glucose level with the reduction of the mean HbA1c level to 6.5% or less. Also, this treatment significantly decreases the risk of severe diabetic complications by 10% including nephropathy and proteinuria (by 21% and 30% respectively).

[Perspectives of the use of antihyperglycemic preparations in patients with metabolic syndrome and prediabetes].

The state of prediabetes comprises two types of impairment of carbohydrate metabolism: impaired fasting glycemia and impaired glucose tolerance. According to International Diabetes Federation at present number of patients with prediabtes is almost 2 times greater than that of patients with diabetes. Risk of development of diabetes and cardiovascular complications in patients with prediabtes is 2 times higher than in persons with normal blood glucose level. Impaired glucose tolerance is also one of main components of metabolic syndrome. For prevention of risk of development of diabetes and cardiovascular complications besides life style changes it is necessary to influence insulin resistance and normalize carbohydrate metabolism. When life style changes are ineffective the use of antihyperglycemic drugs is essential. Antihyperglycemic preparations metformin, acarbose, thiazolidinediones do not affect function of pancreatic beta-cells and do not cause hypoglycaemia. This allows to use these drugs in patients without diabetes but having insulin resistance and prediabetes. Therapeutic effect of metformin and rosiglitazone is related to improvement of sensitivity to insulin in insulin dependent tissues, suppression of glyconeogenesis in the liver, and enhancement of pancreatic beta-cells function. Action of acarbose is based on local inhibition of intestinal enzyme alpha-glycosidase, what leads to diminishment of postprandial hyperglycemia peak. Results of DPP, STOP-NIDDM and DREAM trials have demonstrated high efficacy of antihyperglycemic preparations in prevention of type 2 diabetes.