Vol 24, No 11 (2022)


Analysis of in-hospital mortality among ischemic stroke patients in Veresaev City Clinical Hospital

Murtazalieva D.M., Zakariaeva A.R., Soshina T.D., Shyrokii R.V., Shogenov Z.S.


Background. Ischemic stroke (IS) is one of the most common cause of death in the world. The decline in stroke mortality is an important aim of medicine. The introduction of clinical guidelines for the management of patient with IS and transient ischemic attacks in adults in 2020 has made it possible to improve treatment for stroke patients in the Russian Federation. However, it is not completely understood whether the impact of introduction of clinical guidelines for decrease of stroke mortality.

Aim. To compare and discuss causes of differences between stroke mortality rates in 2019 and 2022 in Veresaev City Clinical Hospital.

Materials аnd methods. We compare the rates of in-hospital mortality among IS, frequency of thrombolytic therapy, mechanical thrombectomy, intermitted pneumatic compression, the incidence of pneumonia, hemorrhagic transformation, pulmonary thromboembolism and early activation in stroke between patients in 2019 and 2022 in Veresaev City Clinical Hospital. The study involved 1609 patients with IS in 2019, and 1429 patients with IS in 2022 in Veresaev City Clinical Hospital. We assessesed NIHSS to objectively rate severity of stroke and the modified Rankin Scale for measuring the degree of disability.

Results. Initial stroke severity on NIHS scale was 9.6 in 2019 and 8.0 in 2022 (p>0.05), stroke severity on NIHS scale at discharge was 7.8 in 2019 and 5.3 in 2022. Modified Rankin Scale at discharge was 1.95 in 2019 and 2.2 in 2022 (p>0.05). Frequency of thrombolytic therapy was 8.6% in 2019 and 14.1% in 2022 (p<0.05); 3.7% of patients undergone of mechanical thrombectomy in 2019 and 6.7% patients in 2022 (p<0.05). In 2019 patients weren’t undergone of mechanical thrombectomy from 6 to 24 hours after stroke; 14 patients in 24-hour therapeutic window undergone of mechanical thrombectomy in 2022 (15.5%). There are no intermitted pneumatic compression in 2019; 18% of patients undergone intermitted pneumatic compression in 2022 (p<0.05). Early activation used in 30% of patients in 2019 and 96% of patients in 2022 (p<0.05). Pulmonary thromboembolism frequency was 26% in 2019 and 1% (p<0.05). In-hospital mortality from IS was 19.9% in 2019 and 5.7% in 2022 (p0.001).

Conclusion. Accurate adherence to clinical guidelines demonstrated decline of in-hospital mortality rate from IS.

Consilium Medicum. 2022;24(11):773-776
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Fortelyzin® in the treatment of ischemic stroke. Case report

Ubushieva S.T., Kazakov D.N., Lebedeva A.Y.


Given the current high incidence of cerebral circulatory disorders and the challenging treatment of such patients, developing therapies and medications for these conditions is urgent. The proportion of patients undergoing various reperfusion techniques is increasing, and so is the medical community's need for novel agents with high efficacy and low complication rate.

Consilium Medicum. 2022;24(11):777-782
pages 777-782 views

B vitamins and diseases of the nervous system: A review

Kamchatnov P.R., Chugunov A.V., Kabanov A.A.


B vitamins (neurotropic vitamins) are involved in numerous reactions in the nervous tissue. Their deficiency is associated with a variety of neurological disorders. The article discusses the effectiveness and safety of the use of neurotropic vitamins in the most common diseases of the central and peripheral nervous system. The results of clinical studies of the drug Neuromultivit are analyzed.

Consilium Medicum. 2022;24(11):783-790
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Personality and psychopathological profile of patients and botulinum therapy for blepharospasm

Tolmacheva V.A., Iuzbashian P.G., Samsonova M.D., Romanov D.V.


Background. Blepharospasm (BS) includes non-motor symptoms manifested by psychopathological disorders. The impact of these disorders on patients' quality of life and therapy of motor symptoms with botulinum toxin is poorly understood.

Aim. To analyze the correlation of different characterological personality abnormalities (CPA) with the BS severity and the response to botulinum toxin therapy (BT).

Materials and methods. Forty-six BS patients (29 females, 17 males) aged 30 to 85 years (61±11.5) with BS were examined. The control group included 46 healthy individuals (39 females and 7 males, with a mean age of 56.4±9.67). Patients were examined before and after BT (after 12 months) using the BS severity scale (BSDI), EQ-5D (EQ-5D-3L) quality of life assessment scales, General Anxiety Disorder (GAD-7) scale, Brief Fear of Negative Evaluation Scale (BFNE-S), and SCID-II-PD structured personality questionnaire.

Results. In the BS group of patients, unemployed and non-married were more common (p<0.05) than in healthy individuals. In the BS patient group, there was an increase in anxiety (15.52±5.6 vs 4.28±3.5 control group by GAD-7 scale) and fear of negative evaluation (42.44±9.2 in the main group vs 21.34±7.3 in the control group). Quality of life was lower in BS patients (65.43, median 62 vs 88.2, median 92, p<0.05). The prevalence of cluster C CPA (anxiety disorders) in patients with BS and, in particular, the obsessive-compulsive disorder was revealed. Patients with different personality profiles showed no differences in the BS severity before BT. The BT efficacy was higher in patients with cluster C CPA.

Conclusion. BS patients often have anxious type CPA; in these patients, BT is more effective than in other CPAs.

Consilium Medicum. 2022;24(11):791-795
pages 791-795 views

Typical practice for managing patients with fibromyalgia

Nasonova T.I., Parfenov V.A., Mukhametzyanova A.K.


Background. Fibromyalgia (FM) is manifested by chronic widespread pain syndrome, sleep disorders, fatigue and subjective cognitive impairment. There is a late diagnosis of FM in different countries; there is no data on the typical medical practice of managing patients with FM in our country.

Aim. To analyse the previous typical practice of managing patients with FM.

Materials and methods. Fifty three patients with FM (47 women and 6 men) were under observation; the average age was 46.8±14.6 years. The duration of FM symptoms (years), the intensity of pain syndrome according to a Numerical Rating Scale (NRS), quality of life using The Revised Fibromyalgia Impact Questionnaire (FIQR), emotional state according to the Hospital Anxiety and Depression Scale (HADS), and treatment were evaluated.

Results. The duration of symptoms before the diagnosis of FM was 7.0 (2.0–15.0) years. The intensity of pain during the initial examination in patients with FM according to NRS – 7.1±1.9 points, the effect on the quality of life of patients with FM according to FIQR – 54.9±18.4 points. The majority of patients (85%) were not diagnosed with FM before hospitalization. There were no statistically significant differences in the intensity of pain (p=0.478), the level of quality of life (p=0.611), the level of anxiety (0.159) and depression (0.347) in the groups of patients who had or did not have a diagnosis of FM.

Conclusion. FM is rarely diagnosed in our country, even in cases of diagnosis, patients in many cases do not receive effective treatment, which reflects the low awareness of doctors about modern methods of diagnosis and treatment of FM.

Consilium Medicum. 2022;24(11):796-799
pages 796-799 views

The use of the drug L-Carnitine Rompharm in patients with Parkinson's disease in the context of rational pharmacotherapy

Yurov I.V.


The basic drug therapy for Parkinson's disease (PD) includes levodopa, dopamine receptor agonists (ADRs), type B monoamine oxidase enzyme inhibitors, catechol-O-methyltransferase inhibitors, and amantadine. In recent years, the efficacy of L-carnitine in neurodegenerative diseases and depression, which is often associated with PD, has been reported.

Aim. To study the efficacy and safety of levocarnitine (L-Carnitine Rompharm) in PD patients of different ages and disease histories combined with ADR and levodopa.

Materials and methods. A total of 142 patients with PD (aged 43 to 82 years) were followed-up from February 2020 to July 2022. All of these patients underwent clinical-neurological and neuropsychological examinations. In all patients, L-Carnitine Rompharm was used in the complex therapy of PD in combination with ADR and levodopa. Therapy efficacy was assessed using the International Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS UPDRS).

Results. After the course of therapy, significant (p<0.05) improvements in non-motor manifestations of PD (MDS UPDRS scale I), motor manifestations of PD (MDS UPDRS scale II), and motor function indices (MDS UPDRS scale III) were observed in all age groups. Improvements in hypokinesia, rigidity, motor fluctuations (depletion of levodopa effect), peak dose dyskinesia, and postural instability were observed; thought processes, behavior, mood, and daily life activity were also improved. L-carnitine showed good tolerability and absence of side effects.

Conclusion. The efficacy and safety of L-Carnitine Rompharm in PD patients of different ages have been demonstrated.

Consilium Medicum. 2022;24(11):800-804
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Epidemiology, clinic and diagnosis of status epilepticus in adults: A review

Gainetdinova G.R., Danilova T.V.


Status epilepticus is one of the causes of impaired consciousness. Status epilepticus can develop both in patients with epilepsy and in patients without an epileptic history. The most difficult diagnostic task is to identify non-convulsive status epilepticus. The most frequently discussed in the literature issues of the clinical picture, diagnosis of different variants of status epilepticus were analyzed. Particular attention was paid to the peculiarities of status epilepticus in patients of older age groups.

Consilium Medicum. 2022;24(11):805-810
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Persistent postural perceptual vertigo and vestibular migraine. Case report

Zastenskaya E.N., Antonenko L.M.


Persistent postural perceptual vertigo (PPPV) and vestibular migraine (VM) are common causes of vertigo. However, despite the typical clinical presentation of PPPV and VM, these diagnoses are rarely made, and dizziness is considered a consequence of other diseases, such as cerebrovascular disorders (chronic cerebral ischemia, vertebrobasilar insufficiency), cervical spine instability, or the manifestation of vegetative dystonia syndrome. This article describes a clinical case of a patient with PPPV and VM. The diagnosis is based on the clinical presentation matched with the diagnostic criteria and an in-depth examination using additional methods to rule out other causes of dizziness. Current evidence on clinical and instrumental diagnostics of the disorders is presented.

Consilium Medicum. 2022;24(11):811-815
pages 811-815 views

The effect of sleep on the normal functioning of the prostate gland: A review

Ershov A.V., Grosheva M.N., Stepanyants S.V., Yakovlev A.V.


The article provides an analysis of current information on the effect of sleep, namely its main element, melatonin, on the functioning of the prostate gland. The direct action of melatonin as a local modulator of the endocrine activity of Sertoli and Leydig cells and its effect on energy metabolism are described. The main biochemical antioxidant properties of melatonin are reflected, as well as the mechanisms of its action on the hormonal system of the body: metabolism, fertility and anticarcinogenicity. The results of studies on the relationship between sleep disorders, the role of the circadian rhythm in fertility disorders and prostate diseases are disclosed. The relationship between the presence of metabolic syndrome and the subsequent risk of developing benign prostatic hyperplasia is presented.

Consilium Medicum. 2022;24(11):816-821
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Clinical characteristics of persistent headaches after the first-ever ischemic stroke (follow-up of 529 patients)

Lebedeva E.R., Ushenin A.V., Gilev D.V., Olesen J.


Background. Although persistent headaches are a common post-stroke pain syndrome, the epidemiology and clinical features of persistent headache after first-ever ischemic stroke have not been considered previously. There is no exact data on how often headache attributed to stroke persists for more than 3 months, i.e. meets the criteria for persistent headache after stroke and what are their distinctive clinical features. The tasks of our study were: to analyze the occurrence/incidence of persistent headaches after the first-ever ischemic stroke; to determine clinical characteristics and types of persistent headaches in comparison with headaches at the onset of stroke.

Materials and methods. The study included 550 patients (mean age 63.1 years, 54% men) with first-ever ischemic stroke, of which 529 patients were followed up for at least three months after the stroke. Standardized semi-structured interview forms were used to assess these headaches during professional face-to-face interviews at the onset of stroke and ≥3 months after the stroke using telephone interview by neurologist.

Results. Among 529 follow up patients 55 (10.4%) had persistent headaches after first-ever ischemic stroke. Among these 55 patients 34 patients had persistent new-type headaches which arose for the first time during the onset of stroke, they included predominated migraine-like headaches (n=20), tension-type-like headaches (n=9) and thunderclap-like headaches (n=5). 21 patients had persistent headaches with altered characteristics: predominated tension-type-like headaches (n=16), and less common migraine-like headaches (n=5). Persistent headaches after stroke had the following characteristics compared to headaches at onset of stroke: severe headache intensity, a gradual decrease of occurrence of accompanying symptoms (photo- and phonophobia; p=0.03), the transition of unilateral headaches in bilateral (p=0.004), the presence of headaches ≥15 days per month in 30.9% of the patients.

Conclusion. Persistent post-stroke headaches represent a persistent pain syndrome with severe intensity and frequency of attacks, which requires their further study and creation of guidelines for their management.

Consilium Medicum. 2022;24(11):823-827
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Osteoarthropathy of the front thorax

Bunchuk N.V.


This article reviews the data on a unique, rare rheumatologic syndrome – osteoarthropathy of the anterior thorax (OAAT), characterized by inflammation of the bone, joint, and ligament structures that form the skeleton of the anterior thorax. OAAT is part of chronic non-bacterial osteomyelitis, which occurs in adults and children and may be due to genetic mutations. The basis of this disorder is osteitis (focal lesion of the sternum, clavicles, and ribs with a tendency to the destruction of mainly articular parts and development of bone proliferation – hyperostosis), arthritis with possible ankylosis development, as well as enthesitis and ligamentitis with ectopic ossification of affected soft tissues. Many patients also show similar dermatological changes: commonly palmar and plantar pustulosis and sometimes acne inversa (purulent hidradenitis and globular acne). The article describes typical radiological, scintigraphic, and MRI changes in the musculoskeletal system. The classification of chronic non-bacterial osteomyelitis is reviewed. Diseases that may mimic OAAT are listed. Treatments for chronic non-bacterial osteomyelitis, including bisphosphonates and biologics, are reported.

Consilium Medicum. 2022;24(11):828-834
pages 828-834 views

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