Vol 19, No 9 (2017)


Sleep disordered breathing in stroke patients

Tazartukova A.D., Stakhovskaya L.V.


The purpose of this review is to study existing literature on the epidemiology, pathophysiology and treatment of sleep disordered breathing following stroke. Unrecognized and untreated sleep disordered breathing may influence rehabilitation efforts and functional outcomes following stroke and increase risk for stroke recurrence. Improving screening and treatment for sleep disordered breathing is paramount in the secondary prevention of stroke and in improving stroke outcomes.
Consilium Medicum. 2017;19(9):8-11
pages 8-11 views

Repeated ischemic stroke in a young patient with Fabry disease, with poly-systemic lesion

Kimelfeld E.I., Gudkova V.V., Gutsalyuk A.G., Yushkov A.F., Volkova N.N., Koltsova E.A., Stakhovskaya L.V.


The article presents a clinical observation of the development of repeated ischemic strokes in a young patient, the leading cause of the formation of lacunar infarcts, which was a rare hereditary disease - Fabry's disease. The complexity of clinical diagnosis is reflected. The importance of system analysis with generalization of the results of neurological, general-somatic studies, as well as family and ontogenetic anamnesis was noted. The data of biochemical and molecular-genetic studies of dry blood drop, showing enzymopathy (a significant reduction in the enzyme a-galactosidase) and a unique family mutation in the 7th exon of the GLA gene are given. It was stressed that patients who underwent stroke at a young age (up to 55 years) are subject to selective screening with the mandatory study of a dry drop of blood for the presence of Fabry disease.
Consilium Medicum. 2017;19(9):12-17
pages 12-17 views

The patient after a vascular accident: the principles of rehabilitation and the specifics of treatment

Kovalchuk V.V., Gusev A.O., Barantsevich E.R., Bakirova D.A., Nesterin K.V., Molodovskaia N.V., Agybaeva A.B.


This publication is devoted to the issues of effective rehabilitation of patients with vascular accident. The principles of carrying out, advantages and risks of early rehabilitation, rules of postural correction are considered. Also, the basic rules of physical, neuropsychological and drug rehabilitation are analyzed. In addition, this article presents the results of a study of the efficacy of antiplatelet therapy in the rehabilitation of patients after cerebrovascular catastrophe. The analysis was applied to the results of rehabilitation of 750 patients who were divided into 2 groups: the Curantil® N group (main group) and a group of other antiplatelet agents (control group). After 6 months from the onset of the disease, the degree of recovery of functions was determined using the Barthel, Lindmark and Scandinavian scales, the level of household adaptation - the Merton and Sutton scales, the quality of life - the Sickness Impact Profile. According to the results of the study, the use of Curantil® N in statistically significant degree raises the effectiveness of rehabilitation, which is manifested in increasing the recovery of neurological functions and the level of social adaptation of patients, and in improving the quality of their lives.
Consilium Medicum. 2017;19(9):18-25
pages 18-25 views

Causes of late diagnosis of acute ischemic stroke in children

Shchederkina I.O., Zavadenko N.N., Livshits M.I., Koltunov I.E., Plavunov N.F., Kadyshev V.A., Sidorov A.M., Nesterovskii Y.E., Korneev D.Y.


The presented review of the literature analyzes modern approaches to the diagnosis of ischemic stroke (IS) in childhood, the reasons for the difficulties in the timely formulation of this diagnosis. The spectrum of pathological conditions leading to IS in childhood is very wide, which makes their verification much more difficult. In addition, IS manifests in children a variety of symptoms, which requires a wide differential-diagnostic search. "Masks" of children's IS can be represented by such conditions as migraine with aura, first arising seizures, focal intracranial lesions (swelling, demyelination), Bell's paralysis, conversion disorders. Some reasons for the late diagnosis of IS are unchanged, among them clinical and neuroradiographic features of the disease. Others can be changed by drawing the attention of clinicians and the public to the problem of pediatric stroke, explaining that a timely diagnosis, therapy started as early as possible, fast delivery of the patient to a multi-purpose hospital with a team of specialists trained in the management of pediatric stroke improves the prognosis, reducing disability and mortality.
Consilium Medicum. 2017;19(9):26-30
pages 26-30 views

The efficacy of Phenazepam in the treatment of insomnia in outpatient practice

Kovrov G.V., Posokhov S.I., Shavlovskaia O.A.


The aim of the study was to study the effectiveness of the use of the drug Phenazepam® in patients with sleep disorders. Materials and methods. In an open approbative comparative study, 30 patients with sleep disorders aged 18 to 65 years were selected. Phenazepam® is administered once a day, out of communication with food intake, in the evening at 21.00 (2 hours before bedtime) for 28 days. Some patients received a dose of Phenazepam® 0.5 mg per night, part of the patients - 1 mg per night. Also, the examined patients were divided into 2 subgroups, based on the indices of the evaluation of autonomic disorders. The first subgroup included persons with minor disorders in the autonomic nervous system, the second included patients with severe autonomic disorders. The survey methods included a clinical questionnaire and a questionnaire. The patients' condition was assessed according to questionnaires: Epworth Sleepiness Scale, Hospital Alarm and Depression Scale, Subjective Sleep Characteristics Scale (Ya.I.Levin), questionnaire for evaluating vegetative disorders (A.M.Veyn), scoring subjective sleep characteristics. Results and conclusion. The administration of Phenazepam® significantly reduced anxiety in patients. Decreased the time of falling asleep, the duration of sleep increased, the number of awakenings decreased, the overall assessment of the quality of sleep, the morning feeling improved. Dosage of Phenazepam® 1 mg was more effective both for all subjective characteristics of sleep, and for depressiveness, anxiety and vegetative manifestations. Dosage of Phenazepam® 0.5 mg had a positive effect on sleep quality. Phenazepam® significantly reduced the
Consilium Medicum. 2017;19(9):31-36
pages 31-36 views

Systemic psychoneurology and pain syndromes

Damulin I.V.


In the article review, modern data on the pathogenesis of pain are analyzed. With the help of functional neuroimaging it was shown that in response to nociceptive stimuli, there is a more extensive activation of the cerebral connections than was previously thought. Also, the importance of functional connections ensuring the integration coordination of activation of brain structures was demonstrated. In this process, during the sensation of pain, spontaneous cerebral oscillations and changes in the function of attention play a large role. The process of chronic pain is associated with changes in neural connections, their dynamics. At the same time, the changes in the emotional sphere, and cognitive reactions, also have significance. Changes in the headache of different genesis (migraine, cluster, abusus headache, tension headache), as well as with back pain, are considered in detail. It is concluded that the data obtained open up new opportunities for the development of methods of influence that can reduce or completely get rid of the pain of different genesis.
Consilium Medicum. 2017;19(9):37-43
pages 37-43 views

Facial pain. The private aspects. Treatment

Fokina N.M.


Craniomandibular dysfunction is not independent-term nosology, but rather reflects the different etiology and pathophysiology of the disorder primarily neurological, neurostomatologic, neuroorthopedic, rheumatologic, otorhinolaryngological, ophthalmological and other violations.
Consilium Medicum. 2017;19(9):44-48
pages 44-48 views

Melatonin and its possibilities in the therapy of chronic pain

Kurganova Y.M., Danilov A.B.


The aim of the study was to examine the analgesic effect of melatonin in chronic nonspecific pain in the back. Materials and methods. The study involved 178 patients aged 40 to 65 years with chronic nonspecific pain in the lower back with a duration of pain more than 3 months and an intensity of more than 3 points on a visual analog scale. Patients were divided into 6 groups, which comprised 3 pairs of comparison - the main group and the comparison group. In the 1 st pair, the patients of the main group (n=31) and the comparison group (n = 29) received a combined preparation of glucosamine hydrochloride 500 mg and chondroitin sulfate 500 mg 1 tablet 2 times a day for 1 month, then 1 tablet per day for 2 months, in addition, patients of the main group received melatonin (Melaxen) 3 mg for 30-40 minutes before bedtime. In the 2nd pair, the comparison groups (n=30) took a combined preparation of glucosamine hydrochloride 500 mg and chondroitin sulfate 500 mg 1 tablet 2 times a day and diclofenac 25 mg 2-3 times a day, patients from the main group (n=30) additionally received melatonin (Melaxen) according to the same scheme used in the first pair of comparison. In the third pair, patients of the main group (n=29) received diclofenac 25 mg 3 times a day and melatonin (Melaxen) as described above, patients from the comparison group (n=29) received only diclofenac. The duration of follow-up in the first pair was 3 months, in the 2 nd and 3 rd couples - 1 month. Results and conclusion. Data obtained showed statistically significantly greater reduction in pain intensity during movement and at rest in all major groups than in comparison groups. It is concluded that the addition of melatonin to the standard treatment of back pain increases its effectiveness.
Consilium Medicum. 2017;19(9):49-54
pages 49-54 views

Migraine and cerebrovascular pathology: a review of the literature and experience overview of using candesartan for the prevention of migraine in patients with arterial hypertension

Azimova Y.E., Skorobogatykh K.V., Ishchenko K.A., Klimov E.A.


Relevance. According to modern recommendations, migraine treatment should last at least 12 months. In this regard, adherence to patient therapy is the main condition for its success. Nevertheless, among patients receiving p-adrenoblockers, anticonvulsants, antidepressants, 40% of patients refuse therapy within 1 month, 24-25% remain on treatment after 6 months, 13-16% take drugs for up to 12 months. The main reason for refusing therapy, especially in the first weeks, is the poor tolerance of these drugs (psychotropic effects, sedation, bradycardia). The aim of the study lies in examining the efficacy and safety of the appointment of candesartan (Ordiss) to patients with chronic migraine (according to the criteria of the International Classification of Headache III, 2013) and arterial hypertension (increase in systolic blood pressure - BP of above 140, diastolic - 90 mm Hg). Materials and methods. Treatment was conducted in 72 patients with chronic migraine and hypertension (9 men, 63 women, mean age 46.4±9.7 years). Evaluation of the effectiveness was carried out by analyzing the data of the diary of a headache (indicators of the number of days with a headache, days with migraine). At each of the visits BP was recorded. Evaluation was carried out before the start of treatment, after 1,3 and 6 months. Results. There was a statistically significant decrease in days with headache: from 22.3±6.0 days to 10.4±3.5 days after 1 month, 8.8±3.1 days after 3 months and 6.2±2.7 day after 6 months of therapy (everywhere p<0.01). A statistically significant decrease was also observed in the dynamics of the indicator of days with migraine: from 16.9±5.4 days before treatment to 7.3±2.9 days after 1 month, 6.5±2.7 days -after 3 months, 4.9±1.8 days - after 6 months. Treatment with candesartan (Ordiss) also led to the normalization of BP in 92.8% of patients. 2 patients interrupted treatment due to the development of general weakness and increased fatigue. 5 (6.9%) patients also had general weakness and increased fatigue, but these phenomena were transient. Conclusions. Candesartan (Ordiss) can be recommended for the treatment of patients with chronic migraine and hypertension.
Consilium Medicum. 2017;19(9):55-58
pages 55-58 views

Chondroitin sulfate and glucosamine as an adjuvant therapy for chronic back pain

Vorobyova V.V.


With age, degenerative changes in the articular apparatus of the spine in most patients become the leading cause in the recurrence of back pain. The work focuses on the latest research on the effects of chondroitin sulfate and glucosamine on inflammatory processes associated with degenerative changes in the joint apparatus of the spine. Analysis of clinical trials data on the effectiveness of the combined ARTRA® preparation in chronic back pain allows one to consider it as a promising drug for the relief and prevention of relapses in back pain.
Consilium Medicum. 2017;19(9):59-64
pages 59-64 views

The syndrome of a rigid person with myoclonus and disautonomy: a description of the case

Serdyuk A.V., Kovrazhkina E.A.


The syndrome of a rigid person is a rare autoimmune disease characterized by progressive muscular rigidity, walking disorders and painful spasms in axial muscles and limbs provoked by external stimuli. The syndrome has a different clinical phenomenology, it can be manifested by myoclonus, vegetative and emotional disorders, combined with epilepsy and dystonia, and neuro-ophthalmologic manifestations. The pathogenesis of the syndrome is associated with a violation of GABAergic transmission as a result of the interaction of specific antibodies with glutamate decarboxylase (glutamate decarboxylase), an enzyme involved in the synthesis of y-aminobutyric acid. Taking into account the pathogenesis in the treatment of this disease, GABAergic drugs (diazepam in high doses, etc.) and immunosuppressive therapy are used. We give our own observation of a patient with an atypically occurring syndrome of a rigid person.
Consilium Medicum. 2017;19(9):65-68
pages 65-68 views

Updated international guidelines for the management of patients with osteoarthritis in 2016: focus on chondroitin sulfate, glucosamine and their combination (Theraflex®)

Chichasova N.V.


The article provides updated data on the international recommendations of the European Society in the field of studying the clinical and economic aspects of osteoporosis and osteoarthritis (ESCEO) in 2016, which additionally takes into account the factors of unfavorable tolerability of paracetamol and other fast-acting symptom-modifying drugs. The data of domestic studies showing a reliable analgesic effect of a combination of chondroitin sulfate and glucosamine hydrochloride (Theraflex® preparation), which develops during the first 1-3 months of treatment and persists with prolonged use, are reflected. The data of the latest internationally controlled double-blind studies, which confirmed domestic data, and also showed the structural-modifying possibilities of combined use of these substances are given.
Consilium Medicum. 2017;19(9):69-76
pages 69-76 views

Clinical and neurophysiological dynamics in the patient with spinal cord injury: case report

Kovrazhkina E.A.


Neurophysiological examination is used to assess the topic and severity of nerve conduction disorders in patients with myelopathy, but its use for rehabilitation prognosis is complicated by the absence of a direct correlation between clinical and neurophysiological data. Earlier, we hypothesized that the "myelinopathic" changes in segmental conduct according to electroneuromyography are correlated with the presence of functional dynamics in myelopathy. We give a description of the clinical case that illustrates this hypothesis.
Consilium Medicum. 2017;19(9):77-79
pages 77-79 views

The choice of analgesic for back pain through the prism of drug safety and comorbidity: in the focus of flupirtine

Trukhan D.I.


Back pain (dorsalgia) worries at various periods of life the vast majority of people, occupying the second most common after colds. The most popular class of drugs used as analgesics for degenerative or inflammatory diseases of the musculoskeletal system are nonsteroidal anti-inflammatory drugs (NSAIDs). However, with the intake of NSAIDs, a whole range of different complications is associated. Drug safety and comorbidity are closely intertwined when using NSAIDs. In the presented review, domestic and foreign studies of flupirtine for the treatment of pain syndrome are analyzed. Flupirtine compares favorably with NSAIDs and opioid analgesics with a combination of analgesic and muscle relaxant properties, lack of drug interactions and serious side effects, which makes it possible to use the drug to treat the pain syndrome in patients with comorbid somatic pathology
Consilium Medicum. 2017;19(9):80-87
pages 80-87 views

Data mining of the interactions between the trace element composition of the blood and the state of the patients with the lateral amyotrophic sclerosis shown lowered levels of lithium and selenium

Torshin I.Y., Gromova O.A., Kovrazhkina E.A., Razinskaya O.D., Prokopovich O.A., Stakhovskaya L.V.


The data on patients with amyotrophic lateral sclerosis - ALS (n=25) were analyzed in comparison to the control groups of patients with chronic ischemia (n=45) and similar demographic indicators. In the blood plasma of ALS patients, as compared to the control group, lower levels of lithium (-1.7 mcg/kg, p=2×10-12) and selenium (at -37 mcg/kg, p=0.005) were found. With the help of the data mining techniques, we performed the analysis of the interactions between the trace elements in the plasma and the clinical state of the ALS patients. The results of this study indicated the necessity of the use of the lithium and selenium preparations in patients with ALS
Consilium Medicum. 2017;19(9):88-96
pages 88-96 views

The use of thioctic acid in the polyneuropathic therapy

Pilipovich A.A., Rusaia V.V.


Neuropathy is one of the most frequent and early complications of diabetes and alcoholism. Its clinical manifestations are found in every second of these categories of patients. Often the disease proceeds latently and for a long time remains unnoticed. Treatment of these forms of toxic-metabolic neuropathies should be started as early as possible, even at preclinical stages. Complex therapy is carried out, including the fight against risk factors, correction of hyperglycemia, normalization of nutrition and refusal of alcohol, symptomatic and pathogenetic drug effects. As a pathogenetic therapy for diabetic and alcoholic neuropathies, neurometabolic drugs (thioctic acid and B vitamins) are recommended. Thioctic acid is one of the most powerful natural antioxidants, actively participates in carbohydrate and lipid metabolism, has detoxification and hepatoprotective properties. The effectiveness and safety of its application have been proven in a wide range of clinical studies.
Consilium Medicum. 2017;19(9):97-101
pages 97-101 views

Acute attack of dizziness: differential diagnosis and tactics of patient management

Kunelskaya N.L., Guseva A.L., Baybakova E.V.


The differential diagnostics of acute vestibular syndrome is discussed in the following article. Features of collection of complaints and anamnesis, basic clinical and instrumental methods of research are presented as well. The main approaches to the therapy of such diseases, manifested by acute dizziness, such as vestibular neuronitis, benign paroxysmal positional vertigo, Meniere's disease, vestibular migraine, etc. are presented.
Consilium Medicum. 2017;19(9):102-108
pages 102-108 views

NSAID-associated lesions of the gastrointestinal tract and their complications: ways of preventing

Pakhomova I.G.


Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in clinical practice by a large number of specialists: from traditional rheumatological and neurological practices to gynecological doctors and many other specialists. This fact is explained by the pharmacological properties of NSAIDs, being an effective tool in the therapy of pain and inflammation. At the same time, taking into account the mechanism of action of these drugs, it is necessary to take into account class-specific side effects of NSAIDs, primarily on the part of the gastrointestinal tract. Particular attention should be paid to patients who need long-term use and have risk factors for the development of NSAID-induced gastro-toxic lesions. Therefore, an important task in the appointment of any NSAID is the right choice in favor of an effective and safest drug with a selective mechanism of action. The use of selective inhibitors of cyclooxygenase-2 allows to minimize the incidence of the development of NSAID-induced complications, including bleeding. A popular and widely used in the clinical practice drug from this group of drugs is nimesulide, which has advantages over traditional NSAIDs, is effective and practically safe in the management of acute and chronic pain.
Consilium Medicum. 2017;19(9):109-113
pages 109-113 views

Pleiotropic effects of vitamin D: an essential element of comorbidity therapy

Klimova O.Y., Berdnikova N.G., Kazakov R.E.


Vitamin D plays an important role in the management of calcium metabolism and maintenance of calcium-phosphorus homeostasis. Deficiency of vitamin D due to "extra-skeletal effects" can influence the development of various somatic diseases. This relationship is confirmed by epidemiological studies. However, pathophysiological mechanisms continue to be investigated. One of the mechanisms that bind vitamin D deficiency and obesity, metabolic syndrome, diabetes, chronic obstructive pulmonary disease, cardiovascular disease is systemic inflammation. Calcitriol regulates calcium metabolism and has immunomodulatory properties, which gives a protective effects in systemic inflammation. Alfacalcidol is an activity metabolism of vitamin D, used to prevent and treat D-deficiency conditions.
Consilium Medicum. 2017;19(9):114-121
pages 114-121 views

Nonsteroidal anti-inflammatory drugs in the treatment of osteoarthritis: the problem of choice in terms of safety and impact on cartilage

Chichasova N.V.


The article considers in a comparative aspect the influence of nonsteroidal anti-inflammatory drugs on the synthesis of cartilage prostaglandins, on the metabolism of preglygocans and hyaluronan, and on the course and radiologic progression in osteoarthritis. The data on the conservation effect on articular cartilage of preparations, mainly inhibiting cyclooxygenase-2, are shown on the basis of clinical and experimental data, the positive effect of aceclofenac on the synthesis of hyaluronan and proteoglycans with decreasing their degradation, which, taking into account its effectiveness in relation to the main clinical manifestations of osteoarthrosis and good tolerability allows you to recommend it for the treatment of this pathology.
Consilium Medicum. 2017;19(9):122-128
pages 122-128 views

Violations of purine metabolism and their correction. The urologist's point of view

Borisov V.V.


In the article in the form of clinical lecture, disorders of purine metabolism, their clinical forms, pathogenesis, peculiarities of laboratory diagnostics and medicamentous correction with inhibitors of xanthine oxidase (allopurinolum, febuxostat) are considered. From the position of the urologist, the specifics of citrate litholytic therapy and metaphylactics of urate nephrolithiasis with regard to hyperuricemia, the administration of inhibitors of xanthine oxidase, citrates, and diet therapy are specified. An attempt was made to generalize the role of disorders of purine metabolism from the positions of not only the urologist, but also of internal medicine as a whole.
Consilium Medicum. 2017;19(9):129-133
pages 129-133 views

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