[The second stage of rehabilitation of post-infectious myelopathy after a new coronavirus infection]. / Vtoroi etap reabilitatsii postinfektsionnoi mielopatii posle perenesennoi novoi koronavirusnoi infektsii.

After suffering a new coronavirus infection (COVID-19), patients develop damage to various organs and systems, including the central nervous system. One of the rare and little-described complications is spinal cord injury. PURPOSE OF THE STUDY: Description of a clinical case of post-infectious myelopathy in a young patient after a new coronavirus infection. MATERIAL AND METHODS: Patient L., 28 years old, was admitted for rehabilitation treatment at the Regional Medical and Rehabilitation Center with a diagnosis of post-infectious myelopathy, acute period, lower central paraplegia. The patient underwent a comprehensive clinical and instrumental monitoring, including an assessment of the anamnesis, complaints, physical condition, and neurological status. The dynamics of the patient's condition was assessed using the rehabilitation routing scale, as well as the Rivermead mobility index, functional categories of walking, the Hauser walking index, the Berg balance scale, and the Frenchay hand test. RESULTS: After completion of the rehabilitation course, the patient showed positive dynamics in the form of an increase in exercise tolerance up to 40 minutes; increase in strength and volume of active movements in the lower extremities. Positive dynamics was revealed on all scales assessed. CONCLUSION: Due to the fact that the number of complications of COVID-19 is growing, it is necessary to inform doctors about the possibility of such a complication as myelopathy in order to timely diagnosis and effective treatment, which will reduce the incidence associated with spinal cord dysfunction.

[Conceptualization of comorbid anxiety and depressive disorders and approaches to their managing]. / Kontseptualizatsiya komorbidnykh trevozhnykh i depressivnykh rasstroistv i podkhody k ikh vedeniyu.

Anxiety and depressive disorders are characterized with frequent co-occurance. Depression comorbid to anxiety disorder increases severity of main disorder, aggravates it`s clinical course, worsens social functioning of the patients and decreases life quality, results resistance to therapy and increases the probability of suicidal attempts. In patients with depressive disorders onset of anxiety disorder results increased severity of disorder and decrease in quality of remission. There are different opinions on nature and phenomenology of comorbidity of anxiety and depressive disorders. There are biological and psychological factors of risk of comorbidity. Some scientists consider comorbid disorders to be independent and not to effect each other; others pay attention at common anatomic basis of comorbid disorders, which explains manifestation of comorbid disorder. Hierarchical analysis of clinical features of comorbid disorders favors nosological approach to understanding of comorbidity, and implicates the need for inclusion of transdiagnostic elements. Some authors consider comorbid disorders to be separate type of disorder, characterized with special dynamics of syndromes which reveals transformation of one disorder into another. Phenomenon of comorbidity can be described as part of concept of disease spread which estimates important role of bridge psychic states. Considering clinical features of comorbid disorders, difficulties of their therapy based on concepts of phenomenology of comorbid depressive and anxiety disorders recommendations on prevention, early diagnosing and managing of comorbid disorders were elaborated. Psychotherapy (including CBT, which demonstrated high efficiency) is an essential element of treatment of comorbid depressive and anxiety disorders. Psychotherapy is supposed to be correcting personality traits, cognitive mistakes and maladaptive strategies of coping with disorder, which support the comorbidity.

[Higher efficacy of botulinum toxin therapy for hemifacial spasm recurrence after vascular decompression. Case report and literature review]. / Uvelichenie effektivnosti botulinoterapii pri vozvrate simptomov gemifatsial'nogo spazma posle vaskulyarnoi dekompressii. Klinicheskii sluchai i obzor literatury.

Hemifacial spasm (HFS) is an involuntary synchronous tonic and/or clonic contraction of mimic muscles following ipsilateral facial nerve dysfunction. The last one is a result of neurovascular conflict between the facial nerve and vessel. Currently, vascular decompression is a pathogenetic treatment modality for primary HFS. Various authors describe postoperative recurrence of HFS, and botulinum toxin therapy remains the only option for these patients. We aimed to describe the efficacy of botulinum toxin therapy in patients with HFS recurrence after surgical vascular decompression. The article presents a female patient with a long-term history of HFS and botulinum toxin therapy (with different formulations). Efficacy of therapy gradually decreased (progressive reduction of intervals between injections). MRI revealed a close relationship between posterior inferior cerebellar artery and roots of acoustic-facial nerves near the brainstem. The patient underwent vascular decompression of the left facial nerve root under intraoperative monitoring with positive postoperative outcome. However, HFS symptoms recurred in 3 days after surgery. Botulinum toxin type A (BTA) injections were resumed with significant positive effect that can be explained by reduction of one of the factors involved into HFS. Thus, patients with HFS recurrence after vascular decompression may benefit from BTA therapy.

[The efficacy and tolerability of extended release carbamazepine in adult patients with new-onset epilepsy using epileptiform activity index]. / Effektivnost' i perenosimost' terapii prolongirovannym karbamazepinom vpervye vyyavlennoi fokal'noi epilepsii u vzroslykh s uchetom indeksa epileptiformnoi aktivnosti.

OBJECTIVE: To evaluate the efficacy and tolerability of extended release carbamazepine (finlepsin-retard and tegretol CR) in adult patients with new-onset focal epilepsy (FE) with the assessment of epileptiform activity index (EAI). MATERIAL AND METHODS: The study included 62 patients (38 (61.3%) men and 24 (38.7%) women) with new-onset FE aged ≥18 years (mean age 42.9±18.4 years). All patients underwent video-ECG-monitoring with EAI assessment at each visit. Treatment efficacy was assessed using the criteria of seizure absence (medically induced remission), seizure rate decrease by >50% (responders), seizure rate decrease by <50% - insufficient efficacy, retention on treatment and seizure rate increase compared to baseline and/or development of new type of seizures (aggravation). Overall study period was 12 months. RESULTS: By the end of the 12-month follow-up period, there was a 4.3-fold decrease of the total EAI compared to baseline (p<0.001). Retention on carbamazepine treatment during 12 months was achieved in 61.3% (n=38) patients; medically induced remission - in 40.3% (n=25); seizure rate decrease by >50% - in 21.0% (n=13). In 29.1% (n=18) of patients, treatment change was performed; double-drug therapy, including carbamazepine, was prescribed in 9.6% (n=6) of patients. Incidence of adverse events was 29.1% (n=18). CONCLUSIONS: Carbamazepine is an effective and promising drug for initial monotherapy of FE. Its use in the treatment of FE results in a 4.3-fold decrease of EAI (p<0.001), which reflects the efficacy of treatment. EAI is an additional objective measure of treatment efficacy.

[Social, demographic and clinical characteristics of female patients with schizophrenia and HIV]. / Sotsial'no-demograficheskie i klinicheskie osobennosti VICh-infitsirovannykh zhenshchin, bol'nykh shizofreniei.

OBJECTIVE: To evaluate social, demographic and clinical characteristics of women with schizophrenia and HIV. MATERIAL AND METHODS: Medical histories of patients who were in inpatient treatment during 2017 were retrospectively studied. A total of 174 medical histories were analyzed, but the final analysis included 40 HIV-infected patients (main groups) and 48 patients without HIV infection (comparison group). These groups included patients with a diagnosis of schizophrenia or acute polymorphic psychotic disorder. All patients with HIV infection were examined by a specialist and an immunological analysis was performed. Correlation analysis was performed between quantitative clinical indicators (duration of illness, number of hospitalizations, the number and duration of remissions, etc.) and immunological parameters. RESULTS AND CONCLUSION: Patients with schizophrenia and HIV infection are more often hospitalized and stay in the hospital longer than patients with schizophrenia without HIV infection, which may in part be determined by the social problems of this cohort of patients. There is a relationship between individual indicators of the immune status of the patients, the duration and some features of the course of mental illness. Regular treatment of HIV infection correlates with a lower frequency of hospitalizations in a psychiatric hospital due to an exacerbation of the mental state.

[Sleep and wake disorders in epilepsy]. / Narusheniya sna i bodrstvovaniya pri epilepsii.

OBJECTIVE: To summarize published data on the prevalence, characteristics and diagnostic criteria of sleep disorders in epilepsy. MATERIAL AND METHODS: A search of published articles was performed in Medline (Pubmed), Scopus, Web of Science and e-library databases. RESULTS: Epidemiologic, clinical and diagnostic aspects of excessive daytime sleepiness, obstructive sleep apnea and central apnea, restless leg syndrome and parasomnias related to slow-wave and REM-sleep in patients with epilepsy were analyzed. CONCLUSIONS: Further studies are needed to gain an insight into the complex associations of sleep disorders in epilepsy to optimize diagnostic and treatment approaches and to improve the quality of life in that patient population.

[Dynamics of epileptiform activity, efficacy and tolerability of valproic acid in adults and adolescents with newly-diagnosed epilepsy]. / Dinamika epileptiformnoi aktivnosti, effektivnost' i perenosimost' preparatov val'proevoi kisloty pri vpervye vyyavlennoi epilepsii u podrostkov i vzroslykh.

OBJECTIVE: To evaluate the changes of epileptiform activity index (EAI) as a measure of the efficacy and tolerability of treatment with valproic acid (VA) in patients with newly-diagnosed generalized and focal epilepsy. MATERIAL AND METHODS: The study included 93 patients (55 men and 38 women): 27 with focal epilepsy (FE) and 66 with idiopathic generalized epilepsy (IGE). Patients with idiopathic and age-dependent FE were not included in the study. At each visit, video-EEG monitoring with the analysis of focal, diffuse and generalized epileptiform activity during wakefulness before sleep, during sleep, after sleep and during partial awakenings with quantitative EAI assessment at baseline, after 1, 3, 6 and 12 months of therapy was performed. Therapeutic drug monitoring was performed during dose titration 1 month after the start of treatment or in case of treatment change. Treatment efficacy was assessed based on the absence of seizures, decrease of seizure episodes by more than 50% (responders) and <50% (insufficient efficacy). Adverse effects (AE) were assessed using the Assessing SIDe effects in AED treatment scale (SIDAED). RESULTS: Maximal EAI was observed at baseline both in FE and IGE groups. In patients with IGE, the total EAI (52.8±7.8) was significantly higher compared to FE group (27.1±5.5 (p=0,027)). During wakefulness before sleep and during sleep EAI was significantly lower in the IGE group compared to FE patients (3.4±0. vs. 10.5±5.5 (p=0.003) and 4.3±0.8 vs. 8.9±3.7 (p=0.046), respectively). VA demonstrated the high efficacy and good tolerability in IGE and FE patients: after 12 months of treatment remission was achieved in 69 (74.2%) patients, the decrease of seizure frequency by more than 50% was observed in 22 (23,7%) patients, insufficient efficacy only in 2 (2.1%). AEs were registered only sporadically. CONCLUSIONS: VA remains one of the drugs of choice in IGE and FE. EAI may become an additional objective test in cases of difficult differential diagnosis in IGE and FE, using total EAI, EAI before sleep, during sleep, during partial awakenings in the first months of treatment (1-3 months). EAI objectively reflects the dynamics of VA treatment efficacy.

[The efficiency of functioning of regional vascular center in case of acute disorder of cerebral blood circulation].

The acute stroke is one of leading causes of mortality and disability both in Russia Federation and worldwide. The specialized vascular centers and units proved to be effective in improving diagnostics, treatment and functional outcome inpatients in various countries. The purpose of article is to evaluate efficacy of regional vascular center (RVC) in Tyumen. The functioning of RVC in 2011-2017 was assessed using purposefully developed and implemented score card of medical care quality assessment in vascular centers. The epidemiological data for 2007-2017 was obtained from statistical materials of the Department of Health of Tyumen oblast. The epidemiological parameters were calculated both in absolute units by simple summing up of cases of illness and in relative units per number of population. It was established that all diagnostic and treatment procedures in RVC were implemented according actual medical standards. The significant increase of the percentage of patients hospitalized during first three hours after the onset of stroke symptoms was established. The patients receiving thrombolytic therapy was observed, with an improvement of functional status of patients upon discharge. The significant improvement of early diagnosis of cerebrovascular diseases (CVD) in the service area of RVC was demonstrated. The development and implementation of the plan of a regional vascular center placement and stroke patient routing enabled optimization of medical care accessibility to this group of patients and increased identification of CVD.

[Modern aspects of the pathophysiology of walking disorders and their rehabilitation in post-stroke patients]. / Sovremennye aspekty patofiziologii narushenii khod'by u patsientov posle insul'ta i osobennosti ikh reabilitatsii.

The problem of rehabilitation of post-stroke patients with motor deficit remains relevant with growing prevalence of disability and decreasing mortality, despite all measures aimed at stroke prevention and morbidity reduction. One of the most common consequences of stroke is gait impairment as a result of spastic paresis of the lower limb (decreased gait velocity, shortened step, excessive loading of intact limb etc.), which leads to significant maladaptation, increased risk of falls, decrease in quality of life. The article presents a detailed review of motor action in normal and pathologic conditions, analysis of neuronal structures involved into a movement act in healthy individuals and in stroke patients, current aspects of gait pathophysiology, characteristics of post-stroke gait (speed and asymmetry of gain, balance control impairment). A separate paragraph is devoted to gait recovery after stroke with analysis of existing and developing strategies of rehabilitation, aimed at the improvement of vertical posture, balance control and movement, condition, tone and functioning of skeletal muscles. Authors also analyze new research information on the efficacy of botulinum toxin preparations and programs of Guided Self-Rehabilitation Contracts (GSC), present the results of clinical trials demonstrating the efficacy of combination of these two methods.

[The efficacy of botulinum therapy in treatment of delayed facial palsy after resection of vestibular schwannoma]. / Éffektivnost' botulinoterapii v lechenii otsrochennoi neiropatii litsevogo nerva posle udaleniia nevrinomy slukhovogo nerva.

Delayed facial palsy is a complication developing 3 or more days after surgery. The etiology and pathogenesis of this condition has not been fully explored, and there are no treatment standards for it. As in the case of Bell's paralysis, glucocorticosteroids (GCSs) are currently used to treat delayed facial palsy. However, patients with contraindications to GCSs need new therapy modalities. AIM: We aimed to evaluate the efficacy and safety of botulinum therapy in patients with delayed facial palsy after neurosurgical interventions. MATERIAL AND METHODS: We examined 33 patients with delayed facial palsy developed 3 or more days after resection of vestibular schwannoma. The main group included 18 patients with contraindications to GCSs who received injections of botulinum toxin A (BTA) into the facial muscles of the healthy side for muscle relaxation. The comparison group consisted of 15 patients who received a course of prednisolone (1 mg/kg/day) for 5-7 days. The efficacy of treatment was assessed using the House-Brackmann scale and Clinical Global Impression Scale. The follow-up period after therapy was 3 months. RESULTS: Delayed facial palsy was more common in the following cases: the facial nerve was located near the antero-inferior tumor pole; the tumor was adherent to the facial nerve; the tumor extended in the oral direction; the tumor had with unclear borders and was 11 to 30 mm in size. In most patients of both groups, facial muscle palsy developed more than 11 days after surgery. Treatment both in the main and control groups resulted in a significant improvement: complete regression of the facial asymmetry in patients of the main group and comparison groups 3 months after treatment onset was 83.3 and 93.3% (House-Brackmann scale), respectively. CONCLUSION: Botulinum therapy may be recommended for patients with delayed facial palsy developed after vestibular schwannoma resection, who have contraindications to GCSs.

[Expression of genes for neurotransmitter transporters in astrocytes in different brain regions in experiment]. / Ékspressiia genov transporterov neiromediatorov v astrotsitakh raznykh otdelov golovnogo mozga v éksperimente.

AIM: To investigate the expression of transporters of different neurotransmitters (glutamate, aspartate, lactate, choline) in the culture of astrocytes isolated from different regions of the brain (cortex, hippocampus and brainstem) in 3- and 11-day rats. MATERIAL AND METHODS: An experimental study was performed on 24 3- (n=12) and 11-days (n=12) old rats (Rattus norvegicus). The results of high-performance sequencing were analyzed. RESULTS: The expression of glutamate and aspartate transporters in the brainstem of 3-day rats was higher than in other regions, however, an opposite effect was observed in 11-day rats. The expression of lactate transporters with age became identical to those of the cortex. CONCLUSION: The data demonstrate the particular qualities of neuro-astrocytic connections and the important role of astrocytes in signal transmission. Results of the study performed by using genetic methods developed by the authors for the study of neurotransmitter transporters make it possible to recommend these methods to control the neurogenesis and neurohomeostasis, including in cerebrovascular and neurodegenerative diseases.

[Facial nerve injury in neurosurgery: a rehabilitation potential of botulinum therapy]. / Porazhenie litsevogo nerva pri neirokhirurgicheskikh operatsiiakh: reabilitatsionnyi potentsial botulinoterapii.

Surgical treatment of posterior cranial fossa and cerebellopontine angle tumors is associated with a risk of facial nerve dysfunction. The causes for facial muscle paresis include nerve compression by the tumor, destruction of the nerve structure by the tumor growing from nerve fibers, nerve injury during surgical removal of the tumor, etc. The first 3 months after facial nerve injury are a potential therapeutic window for the use of botulinum toxin type A (BTA). During this period, the drug is introduced both in the healthy side to improve the facial symmetry at rest and during mimetic movements and in the affected side to induce drug-induced ptosis. Post-paralytic syndrome develops 4-6 months after facial nerve injury. At this stage, administration of BTA is also an effective procedure; in this case, drug injections are performed on the affected side at small doses and symmetrically on the healthy side at doses doubling those for the affected side. BTA injections are mandatory in complex treatment of facial muscle paralysis.

[A regional experience of the optimization of neurological care for the rural population]. / Regional'nyi opyt optimizatsii nevrologicheskoi pomoshchi sel'skomu naseleniiu.

At present, the problem of disparity of healthcare, including neurological care, in urban and rural settings is highly relevant. Medical care after acute stroke or other chronic disabling diseases (epilepsy, Parkinson's disease) in rural settings is quite challenging due to the lack of access to specialized medical treatment facilities, low level of resources in medical and obstetric centers, low quality of healthcare, personnel turnover in rural healthcare and insufficient coverage of population with outpatient follow-up services. The most promising optimization approaches, which proved to be effective both abroad and in the Russian Federation, including Tyumen district, are the development of multidisciplinary mobile teams and telemedicine. Introduction of these approaches provides an increased access of rural population to specialized medical care, which leads to improvement in overall population health status.

[The efficacy of botulinum toxin therapy in patients with upper limb spasticity due to traumatic brain injury]. / Effektivnost' botulinoterapii v lechenii spastichnosti verkhnei konechnosti u patsientov s cherepno-mozgovoi travmoi.

Spasticity is a type of muscle hyperactivity that occurs in patients after focal lesions of the Central nervous system due to various diseases: stroke, traumatic brain injury or spinal cord injury, neurosurgical intervention, as well as multiple sclerosis and other diseases of the Central nervous system and is the most disability manifestation of the syndrome of upper motor neuron (UMNS). Focal spasticity of the upper limb requires a complex treatment. Botulinum toxin therapy is an effective treatment for focal/multifocal spasticity in reducing muscle tone and improving function with the highest level of evidence according to the latest American and European guidelines for treatment of spasticity. There are many publications devoted to BTA use in post-stroke patients. This article provides a review of the BTA use in patients with the upper limb spasticity due to severe traumatic brain injury. Some local data on the BTA efficacy in the cohort of patients with traumatic brain injury are also presented.

[Electromyographic control of botulinum toxin a injections in the upper extremities in patients with spasticity of various etiology].

AIM: The study was aimed at studying the efficacy of botulinum toxin A injections combined with EMG-control of the injections in patients with upper limb spasticity of various etiology for decreasing muscle tone and improving the passive limb function as well as at assessing the possibility of a botulinum toxin dose reduction under combination of these methods. MATERIAL AND METHODS: 61 patients with upper limb spasticity of different etiology were evaluated. The main group consisted of 29 patients who were injected with abobotulinum, the botulinum toxin A (500 U per vial), under EMG-control. The control group consisted of 32 patients who received BTA injections without EMG-control. A repeated BTA injection was performed on the 4th month of the study. Patients in both groups received standard rehabilitation therapy. The spasticity pattern was determined using the Arm Spasticity Pattern (ASP) scale. Evaluation of the treatment efficacy was performed using the modified Ashworth scale to determine upper limb spasticity and the modified Barthel Index scale to assess the quality of life as well as the Disability Assessment Scale (DAS) and Clinical Global Impression (CGI) scale. RESULTS: The main spasticity patterns were as follows: the type III was in 13 (44.8%) and 17 (53.1%) patients, the type I was in 9 (31.0%) and 9 (28.1%) patients, and the type VI was in 7 (24.2%) and 6 (18.8%) patients of the main and control groups, respectively. One month after BTA treatment, a significant improvement was observed in both groups, but the improvement in the main group was more pronounced compared to that in the control group (р<0.05). This difference persisted for the whole treatment period (р<0.05). The DAS score demonstrated improvement in both groups, but only patients of the main group had a statistically significant improvement in putting the arm through a sleeve (р<0.05). EMG-control enabled a reduction in the BTA dose by 50-300 U. CONCLUSION: BTA injections under EMG-control in upper limb spasticity patients may improve the treatment efficacy.

[Comparative hemodynamic characteristics of patients with the organ of vision subjected to low-intensity laser radiation of the green and red wavelengths].

This comparative study was designed to evaluate effect of low-intensity speckle laser radiation in the green and red wavelengths on intraocular hemodynamics in 202 patients (202 eyes) with retinal vascular problems and without them. Irradiation was performed using "Izumrud" and "Rubin" adapters for an AMO-ATOS unit. Peak systolic velocity and peripheral resistance index in posterior short ciliary arteries and central retinal artery were measured. It was shown for the first time that green speckle laser radiation (wavelength 535 nm) has more pronounced (compared with the red light) effect on intraocular hemodynamics; thereby, it makes a greater contribution to the improvement of the visual function (e.g. in the case of glaucoma) and to the widening of the fields of vision.

[Effect of hirudin-thrombin and phenylmethylsulfonyl-thrombin on various blood clotting indices]. / Vliianie preparatov girudin-trombina i fenilmetilsul'fonil-trombina na nekotorye pokazateli sistemy svertyvaniia krovi.

Some characteristics of the blood coagulation system were analyzed after injection to rats of hirudin-thrombin and phenylmethylsulfonyl-thrombin devoid of clotting and esterase activities because of the blocking of the substrate binding or catalytic site of the active center. Unlike native thrombin, both forms of modified thrombin did not activate the anticoagulation system.

[Activation of plasma Factor XIII by acetylated thrombin]. / Aktivatsiia plazmennogo faktora XIII atsetilirovannym thrombinom

It has been demonstrated that acetylated thrombin (thrombin-esterase), having practically no coagulating activity but possessing high esterase activity, is capable to activate factor XIII. This ability, however, is 2 times lower as compared to that of native thrombin.

[Role of intermediate products of prothrombin proteolysis by thrombin in the stimulation of the anticoagulation system of blood]. / Znachenie promezhutochnykh produktov proteoliza protrombina trombinom v vozbuzhdenii protivosvertyvaiushchei sistemy.

Two components - the intermediate product 1 (P-1) converting under certain conditions into thrombin, and product 2 (P-2) which possesses no such properties were isolated from the products of prothrombin proteolysis by thrombin. The intravenous injection of the P-1 to rats lengthened the blood coagulation time and plasma recalcification. The sum total fibrinolytic activity proved to increase and the fibrinogen concentration - to decrease. A sharp 5-fold rise of the nonfermentative fibrinolysis was observed. It seems that this effect of the anticoagulating and fibrinolytic potential mobilization was stimulated by the response of the second anticoagulating blood system.

[The state of anticoagulant system of animals following injections of purified thrombin and N-acetyl-thrombin]. / Sostoianie protivosvertyvaiushchei sistemy zhivotnykh posle in"ektsii preparatov ochishchennogo trombina i N-atsetil-trombina

I. v. administration of N-acetyl-thrombin, similar to thrombin, increases the fermentative fibrinolytic potency of the plasma, although to a lesser extent. This is also expressed in the increased esterase activity of the plasma and euglobulin fraction. When blocking the forming plasmin, esterase activity is observed in kallekreine. (The inhibitory effect of plasma after N-acetyl-thrombin administration tells also on the nonfermentative fibrinolytic activity of the Fibrinogen-Heparin complex, activity of the latter dropping practically to the zero level. Warming up at 60 degrees C decreases the nonfermentative fibrinolytic activity of the complex N-acetyl-thrombin (thrombin-esterase) does not provoke the activation of the second anticoagulang system, while the native thrombin does it.