Vol 25, No 2 (2023): Neurology and rheumatology

Background. Ischemic stroke (IS) and cerebral microbleeds (CMB) are the most common types of neurological complications of infective endocarditis (IE), while their combination is poorly understood.

Aim. To evaluate the pattern of combination of cortical-subcortical infarction with lobar CMB or subarachnoid hemorrhage (SAH) in patients with ”left-sided” IE.

Materials and methods. A retrospective case-control study was conducted, including patients with IE who received cardiac surgery at the Federal Center for Cardiovascular Surgery. Inclusion criteria: age of patients ≥18 years; definite or possible (Duke criteria) IE of the left heart (aortic and/or mitral valves). The control group included patients without IE, with non-lacunar (likely embolic) IS. In both groups, the pattern of combination of cortical-subcortical infarction with lobar CMB or SAH was assessed. Differences between groups of patients were assessed using the χ² test, Fisher's exact test and the Mann–Whitney test. Additionally, odds ratios for binary features were calculated. To assess the information content of the studied pattern, classical classification quality metrics were calculated: accuracy, sensitivity, and specificity.

Results. In patients with IS, infarcts corresponded to the main characteristics of cardioembolism: involvement of multiple cerebral arterial territories (84%), multiple infarcts (88%), cortical-subcortical localization (100%), and a high incidence of hemorrhagic transformation (44%). CMB was detected in 64% of cases (in 93.8%, CMB localization was lobar), SAH – in 28% of patients (with CMB in 6 out of 7 cases). The pattern of combination of cortical-subcortical infarction with lobar CMB or SAH was observed in 64% in the IE group (in the control group – in 12%). Odds ratio for the presence of IE was 13.0 (95% confidence interval 3.04–55.9; p<0.001). The accuracy of the sign was 76%, specificity – 71%, sensitivity – 84%.

Conclusion. The combination of cortical-subcortical infarcts with lobar CMB or SAH may be a sign characteristic of IE-associated stroke.

Siponimod (Kajendra) is a sphingosine-1-phosphate receptor modulator type 1 and 5 (S1P1,5), the first targeted agent for the treatment of patients with secondary progressive multiple sclerosis, both with and without exacerbations and/or activity according to magnetic resonance imaging. The drug was approved in Russia at the end of December 2020. The efficacy of siponimod was confirmed in EXPAND study, a large, randomized, double-blind phase III clinical study. This article presents three clinical cases of patients with secondary progressive multiple sclerosis from the practice of specialists of the Novosibirsk Center for Multiple Sclerosis and Other Autoimmune Diseases of the Nervous System with an analysis of patients’ selection for siponimod treatment and an assessment of the therapy effectiveness.

Background. Slow-acting symptomatic agents (chondroprotectors) in osteoarthritis (OA) combined therapy is a promising approach.

Aim. To compare the real-world results of combined therapy with glycosaminoglycan-peptide complex (GPC) and diacerein with GPC monotherapy in treating knee OA.

Materials and methods. Statistical analysis of the data obtained during the observational, non-interventional study was conducted. The study group included 9190 patients with OA, 69.0% females, age 60.9±11.4, with moderate/severe pain (≥4 using a 0–10 numerical rating scale). Of these, 6199 received a combination of GPC (Rumalon®, at least 20 intramuscular injections per course) + diacerein (Diaflex Rompharm) 100 mg/day, and 2991 patients received GPC monotherapy. The following indicators were evaluated: the change of pain during movement, at rest, and at night, the overall health assessment (using a 0–10 numerical rating scale), the number of patients with a pain reduction of ≥50% from the baseline, the patient's assessment of the treatment result using a 0–5 scale, a decrease in the need for non-steroidal anti-inflammatory drugs 2 months after the start of therapy.

Results. The improvement of clinical indicators was more significant in patients who received a combination of GPC + diacerein, compared with GPC monotherapy: the decrease in pain during movement was 3.1±1.5 and 2.6±1.3, at rest – 1 [0; 2] and 1 [0; 1], at night 2 [1; 4] and 2 [1; 3], the overall health assessment was 3.7±1.7 and 3.2±1.8, respectively (for all indicators p<0.001). The percentage of patients with a ≥50% reduction in pain was 66.0 and 60.0% (p<0.001), the assessment of treatment results was "good" or "excellent" in 62.1 and 42.9% (p<0.001), a decrease in the need for non-steroidal anti-inflammatory drugs was reported in 60.9 and 57.1% (p=0.001) of patients, respectively.

Conclusion. The therapeutic effect of the combination of GPC + diacerein in patients with OA is significantly higher than that of GPC monotherapy.

Baker’s cyst (BC) is a common condition and can be caused by both inflammatory and non-inflammatory disorders. Small BCs are usually asymptomatic and accidentally revealed. Large BCs present with pain and discomfort in the posterior knee as well as certain limitations of mobility. Large BCs may rupture resulting the fluid efflux down into the calf, which in turn presents with acute pain and number of potential thrombotic and neural complications. On another note, BC rupture requires differentiation with some urgent conditions such as venosus or arterial thrombosis, soft tissue infections etc. In this article we present some aspects of the etiopathogenesis, clinical signs and course of the BC. We also discuss the problematic issues of assessment and diagnostic work-up in case of BC ruptures.

Group B vitamins are used in various fields of medicine, most commonly in treating diseases of the peripheral and central nervous system, especially in treating pain. Group B vitamins are neurotropic agents; they play an essential role in the functioning of cells, acting as coenzymes in a wide range of catabolic and anabolic enzymatic reactions. They play a role in numerous processes of nervous tissue functioning, including energy production, DNA/RNA synthesis/repair, genomic and non-genomic methylation, and synthesis of many neurochemicals and signaling molecules, which ensures the normal functioning of the central and peripheral nervous system. Among all the B vitamins, these properties are most inherent in thiamine (B₁), pyridoxine (B₆), and cyanocobalamin (B₁₂).