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1.
Artigo em Russo | MEDLINE | ID: mdl-26356615

RESUMO

AIM: To compare clinical and morphological results of treatment of ischemic stroke in three groups of patients which differed by the forms and duration of an antioxidant therapy. MATERIAL AND METHODS: A randomized clinical trial was performed in 8 vascular centers of the Russian Federation in 2010-2014. It included 373 patients with ischemic stroke in the carotid territory. Patients were randomized into 3 groups to receive different regimens of antioxidant therapy as an adjunct to standard therapy: control group (ascorbic acid; 132 patients); cytoflavin (20 ml per day for 10 days; 133 patients); cytoflavin (the dose was decreased to 10 ml per day from 11th to 20th day) (108 patients). Patient's condition was assessed in 1, 10 and 21 day by a complex of clinical, laboratory and instrumental methods. RESULTS AND CONCLUSION: The analysis of CT in 1th and 21th day revealed a significant 1,5-1,7- fold decrease in the cerebral ischemic lesion in both groups treated with cytoflavin with no significant morphologic changes in the ascorbic acid group. The percentage of patients with ischemic lesion, increased during days 1-21, was 2-fold higher in the ascorbic acid group compared to cytoflavin groups. Morphologic changes were correlated with clinical variables and outcome. In patients with ≥14 points on NIH scale on admission, prolonged 20 day cytoflavin therapy was associated with a more prominent improvement of neurologic, functional and cognitive status compared to 10-day cytoflavin infusion. No differences in clinical variables were observed in patients with mild symptoms (<14 points on NIH scale on admission) receiving cytoflavin for 10 and 20 days.


Assuntos
Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Infarto Encefálico/tratamento farmacológico , Infarto Encefálico/patologia , Mononucleotídeo de Flavina/uso terapêutico , Inosina Difosfato/uso terapêutico , Niacinamida/uso terapêutico , Succinatos/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antioxidantes/administração & dosagem , Ácido Ascórbico/administração & dosagem , Infarto Encefálico/diagnóstico por imagem , Combinação de Medicamentos , Metabolismo Energético , Feminino , Mononucleotídeo de Flavina/administração & dosagem , Humanos , Infusões Intravenosas , Inosina Difosfato/administração & dosagem , Masculino , Pessoa de Meia-Idade , Niacinamida/administração & dosagem , Federação Russa , Succinatos/administração & dosagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
Antibiot Khimioter ; 60(1-2): 27-34, 2015.
Artigo em Russo | MEDLINE | ID: mdl-26168682

RESUMO

Two hundred twenty one patients aged 32-93 years with brain infarction, admitted to a Vascular Neurology Center in the first 3-48 hours (mean 6 hours) after the onset of the symptoms of stroke with computed tomography (CT) verified diagnosis were enrolled in the study. According to the timing of the CT-verification the patients were divided into 2 groups: "early" visualization (EV 50.2%) and "late" visualization (LV, 49.8%). In the EV group the lesion was visualized by CT on the admission (3-6 hours after the admission), in the LV group it was visualized only when CT was repeated 2-3 days after the admission. The patients in the LV group demonstrated increased severity of the underlying pathology, increased mortality and unfavourable functional outcomes correlating with the stroke lesion volume vs. the EV group. There was observed pathophysiological correlation of the blood enzymatic spectrum and acid-base balance parameters, explaining the late lesion visualization by delayed and more pronounced intracellular energy synthesis stabilization mechanisms failure in the aerobic and anaerobic glycolysis cycles.


Assuntos
Acidente Vascular Cerebral , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Taxa de Sobrevida , Fatores de Tempo
3.
Eksp Klin Farmakol ; 78(1): 21-6, 2015.
Artigo em Russo | MEDLINE | ID: mdl-25826870

RESUMO

The paper reviews the preliminary results of a multicenter randomized clinical research. The aim of the study was to determine the optimal duration of different types of energy-correction therapy. 99 case report forms of patients with cerebral infarction were reviewed with their prior envelope randomization into three groups. Patients in the first group (experimental group), consisting of 32 patients, as part of combined therapy received ascorbic acid (5% solution twice a day in a recommended dosage of 20 ml/day for 20 days); the second group (37 patients) received 10 ml of cytoflavin intravenously by drop infusion twice a day for 10 days; the third group received cytoflavin for 20 days (from day 1 to day 10 - 20 ml a day, from day 11 to day 20 - 10 ml a day). The average NIH scale score on admission was 14.9 ± 2.6. Prescription of cytoflavin came with average 1.7 - 1.8 time regression (p < 0.05) of the volumes of cerebral ischemia in the of cases of the 10- and 20-day courses of treatment, while there were no significant morphologic changes in the ascorbic acid group. These results correlated with the best dynamics and outcomes of the neurological and performance status of patients receiving cytoflavin. Despite the lack of significant general differences in the clinical and morphological data of the second and third groups, the patients with underlying grave medical condition in the 20-day cytoflavin group (with NIH score of 14-20 points on admission) tended to have improved neurologic status parameters in comparison with the experimental group and the 10-day cytoflavin group. These results attest to the advantages of personalized antioxidant energy-correction therapy.


Assuntos
Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Infarto Cerebral/tratamento farmacológico , Mononucleotídeo de Flavina/uso terapêutico , Inosina Difosfato/uso terapêutico , Niacinamida/uso terapêutico , Succinatos/uso terapêutico , Idoso , Infarto Cerebral/patologia , Infarto Cerebral/fisiopatologia , Cognição/efeitos dos fármacos , Esquema de Medicação , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medicina de Precisão , Testes Psicológicos , Federação Russa , Índice de Gravidade de Doença , Resultado do Tratamento
4.
Adv Gerontol ; 27(4): 746-52, 2014.
Artigo em Russo | MEDLINE | ID: mdl-25946854

RESUMO

In the multicenter randomized clinical-instrumental prospective study 185 patients aged 55-75 years (mean age 68 years) with 94 men and 91 women with cerebral infarction were included. All the patients were hospitalized in the period from 6 to 24 hours from the time of the debut of clinical symptoms, 42,2% of patients scored 14 and above on NIH scale on admission. Patients were randomized into 3 groups: 1st group consisted of 64 patients treated as an antioxidant by 5% solution of ascorbic acid 2 times a day the recommended dose (20 ml/day) for 20 days; 2nd group consisted of 72 patients who received energy monitor Cytoflavin in a daily dose of 20 ml (10.0 ml/drip 2 times a day for 10 days); 3rd group consisted of 49 patients with Cytoflavin therapy extended to 20 days, moreover from 11th to 20th day the dose was 10 ml/day. Cytoflavin treatment was more efficient than ascorbic acid, which can be explained by different pharmacologic mechanisms. Treatment with Cytoflavin for 10 days resulted in a significant decrease of ischemia zone volume by 25% in average, treatment with Cytoflavin for 20 days--by 29%, which manifested in better outcomes in neurologic and functional status. Ascorbic acid demonstrated no effect on morphologic parameters. Patients having at the time of admission 18-20 points according to the NIH and treated with Cytoflavin for 20 days demonstrated significant trend towards improvement of the parameters of the neurological status.


Assuntos
Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Metabolismo Energético/efeitos dos fármacos , Mononucleotídeo de Flavina/uso terapêutico , Homeostase/efeitos dos fármacos , Inosina Difosfato/uso terapêutico , Niacinamida/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Succinatos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Ácido Ascórbico/administração & dosagem , Relação Dose-Resposta a Droga , Esquema de Medicação , Combinação de Medicamentos , Feminino , Mononucleotídeo de Flavina/administração & dosagem , Humanos , Inosina Difosfato/administração & dosagem , Masculino , Pessoa de Meia-Idade , Niacinamida/administração & dosagem , Estudos Prospectivos , Índice de Gravidade de Doença , Acidente Vascular Cerebral/metabolismo , Succinatos/administração & dosagem , Resultado do Tratamento
5.
Artigo em Russo | MEDLINE | ID: mdl-25591516

RESUMO

OBJECTIVE: To determine the optimal duration of energy corrective treatment of ischemic stroke (II) with cytoflavin or ascorbic acid. MATERIAL AND METHODS: A multicenter randomized clinical trial included 185 patients, aged 40-75 years. Patients were randomized into 3 groups: the control group (n=64) received ascorbic acid; cytoflavin group 1 (n=72) was treated for 10 days and cytoflavin group 2 (n=49) for 20 days. In all groups, mean NIHSS score was 13, 42.2% of patients scored ≥14 and on admission, 42.2% of patients had consciousness impairment of different severity. RESULTS: Cytoflavin treatment was more efficient than ascorbic acid that can be explained by different pharmacologic mechanisms. Treatment with cytoflavin for 10 days resulted in a significant decrease of ischemia zone volume by 25.2%, treatment with cytoflavin for 20 days - by 29.0%, which was associated with better outcomes in neurologic and functional status. Ascorbic acid demonstrated no effect on morphologic parameters. Prolonged treatment with cytoflavin in critically ill patients led to significant improvement in clinical and morphologic variables compared to the 10-day course. In patients with less severe condition comparable results were obtained. CONCLUSION: Our data justify the need for personalized integrated antioxidant and energy correction therapy.


Assuntos
Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Infarto Encefálico/tratamento farmacológico , Isquemia Encefálica/tratamento farmacológico , Mononucleotídeo de Flavina/uso terapêutico , Inosina Difosfato/uso terapêutico , Niacinamida/uso terapêutico , Succinatos/uso terapêutico , Adulto , Idoso , Antioxidantes/efeitos adversos , Ácido Ascórbico/efeitos adversos , Combinação de Medicamentos , Feminino , Mononucleotídeo de Flavina/efeitos adversos , Humanos , Inosina Difosfato/efeitos adversos , Masculino , Pessoa de Meia-Idade , Niacinamida/efeitos adversos , Succinatos/efeitos adversos , Resultado do Tratamento
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