Vol 25, No 2 (2023): Неврология и ревматология


Cognitive disorders in patients with atrial fibrillation: A review

Parfenov V.A.


Cognitive disorders (CD) represent one of the leading causes of disability among the elderly. Atrial fibrillation (AF) is an independent and corrected risk factor for CD and dementia. The development of CD with AF is associated with the occurrence of cerebral infarcts, silent infarcts, cerebral micro and macro hemorrhages, a cerebral small vessels disease, cerebral hypoperfusion, and comorbid neurodegenerative disease. The prevention of the first and recurrent ischemic stroke (IS) is the leading importance in preventing the development and progression of the CD in AF, which include the use of the vitamin K antagonists (VKA) and new oral anticoagulants (the NOACs – apixaban, dabigatran, rivaroxaban, edoxaban), control of arterial pressure and other methods of prevention. The use of the NOACs is more effective than using VKA, reduces the risk of CD and dementia. The use of individual NOACs, various methods for the prevention of CD and Alzheimer's disease in patients with AF are discussed.

Consilium Medicum. 2023;25(2):81-85
pages 81-85 views

Combination of cortical-subcortical infarction with lobar microbleeds as a specific MRI pattern in patients with infective endocarditis

Demin D.A., Kulesh A.A., Nikolaeva E.V., Shaposhnikova E.I., Lezhikova M.V., Astanin P.A.


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.

Consilium Medicum. 2023;25(2):86-90
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Impact of stress on hemostasis: A review

Salukhov V.V., Kharitonov M.A., Varavin N.A., Krasovskaya A.S., Santakov A.A.


The article presents an overview of current views of changes in the hemostasis system in response to stress. Stress-induced neurohormonal responses activate the clotting system and inhibit the fibrinolysis system, leading to hypercoagulation. An evolutionary interpretation of such responses is that hypercoagulation under stress protects a healthy body from excessive bleeding in case of trauma in fight-or-flight situations. Acute psychological stress can cause significant hemoconcentration and prothrombotic changes in the blood, which can have potentially “harmful” effects on the cardiovascular system.

Consilium Medicum. 2023;25(2):91-94
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The first cases of using targeted therapy for secondary progressive multiple sclerosis in Russia. Case report

Korobko D.S., Arkhipov I.I., Prokaeva A.I., Tret'iakova E.V.


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.

Consilium Medicum. 2023;25(2):95-100
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Torsion dystonia type 30. Clinical observation. Case report

Latypov A.S., Kotov S.V., Proskurina E.V., Sidorova O.P., Novikova E.S., Vasilenko I.A., Cassina D.V.


A 58-year-old patient with type 30 dystonia (OMIM619291) detected by genome-wide sequencing was described. A variant of rs778751388, not previously described in the literature, has been identified in the heterozygous state in exon 2 of 24 of the VPS16 gene, leading to the amino acid substitution of P.Cys36A4rg. DNA change (HG38)(protein change) – 20:g.2859771T>C ENST00000380445.8:c.106T>C ENSP00000369810.3:p.Cys36Arg. The patient's disease began quite late, in the 4th decade of life, with spastic torticollis. Subsequently, the spread of the pathological process involving the muscles of the neck, the right upper limb, then the right lower limb, myoclonia of the right hand and tremor of the right lower limb was noted. Secondary mitochondrial disorders were revealed in the form of an increase in the level of lactate in the blood before and after loading with carbohydrates. A decrease in the activity of mitochondrial enzymes in peripheral blood lymphocytes was also revealed: succinate dehydrogenase, an enzyme of the mitochondrial respiratory chain complex II; α-glycerophosphate dehydrogenase involved in mitochondrial fat metabolism; glutamate dehydrogenase (amino acid metabolism in mitochondria). The level of lactate dehydrogenase in peripheral blood lymphocytes in the patient was elevated. The identified secondary mitochondrial disorders may be an indication for the appointment of energotropic medicines along with levodopa drugs and dopaminergic receptor agonists. In the presented observation, it can be argued about autosomal dominant inheritance, since the patient has a characteristic clinical picture of the disease and a mutation in the heterozygous state in the VPS16 gene was detected.

Consilium Medicum. 2023;25(2):102-104
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Outcomes of the use of the glycosaminoglycan-peptide complex as monotherapy and in combination with diacerein for the treatment of knee osteoarthritis in real-world practice

Karateev A.E., Polishchuk E.I., Potapova A.S., Matyanova E.V., Filatova E.S., Glukhova S.I., Lila A.M.


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.

Consilium Medicum. 2023;25(2):105-112
pages 105-112 views

New therapeutic opportunities in management of patients with joint hypermobility syndrome and synovitis. Clinical example: A review

Filatova Y.S., Gruzdev A.M., Gauert V.R.


The article describes the issues of diagnosis and treatment of joint hypermobility syndrome. Starting from its historical aspects, ending with the modern possibilities of therapy. The article discusses the risks of developing early osteoarthritis against the background of joint hypermobility syndrome. On a clinical example, the issues of diagnosis according to the Beighton scale and the Brighton criteria are analyzed, and the possibilities of therapy and prevention of early osteoarthritis are presented, according to the clinical recommendations for connective tissue dysplasia, within which this syndrome is considered.

Consilium Medicum. 2023;25(2):113-118
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Baker's cyst: etiopathogenesis, clinical picture, differential diagnosis of complications: A review

Lyalina V.V., Skripnichenko E.A., Borisovskaya S.V., Obyedkov R.N., Lazko F.L., Yudin R.I., Saltykova V.G., Nikitin I.G.


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.

Consilium Medicum. 2023;25(2):119-123
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Impact of COVID-19 on the occurrence and exacerbation of cutaneous forms of lupus erythematosus: A review

Mikheeva E.S., Golubeva I.M., Radionova E.E., Zhukova O.V., Korsunskaya I.M.


The article addresses the impact of the new coronavirus infection on the occurrence of cutaneous forms of lupus erythematosus (LE). Since the beginning of the COVID-19 pandemic, there has been an increase in the incidence of cutaneous LE worldwide, the emergence of new cases, and exacerbation and aggravation of the severity of existing ones. The pathogenesis of cutaneous LE, and the role of viral infections in its occurrence, mainly COVID-19, is reviewed. The need for the SARS-CoV-2 vaccination and its potential as a possible trigger is described. It is necessary to note the importance of clinicians in diagnosing LE since it is essential for the dermatologist to know the features of its course and be able to suspect and diagnose even the rarest forms of this disease. Proper awareness and correct diagnosis determine the optimal drug therapy and patient health in the future.

Consilium Medicum. 2023;25(2):124-127
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Group B vitamins: prospective for multidisciplinary application: A review

Kuzina L.A., Kaishibaeva G.S.


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).

Consilium Medicum. 2023;25(2):128-131
pages 128-131 views

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