Vol 24, No 11 (2022)

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 (p≤0.001).

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

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.

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.

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.

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.

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.