Vol 25, No 11 (2023): Neurology and rheumatology

Background. Asthenia is one of the most common symptoms in the clinical practice of a doctor of any specialty. This is due to the high incidence of this pathology: in patients with chronic somatic diseases from 45% to 90%, with an acute pathological process – about 55%. There are no uniform standards for the treatment of asthenic disorder; however, the basis for the medical correction of this pathology is nootropic drugs.

Aim. To study the clinical efficacy and safety of the nootropic drug Actitropil (fonturacetam) in patients with various types of asthenic disorder.

Materials and methods. The observational clinical program included 50 patients (average age 43.22±14.60) with asthenic symptoms. Patients received Actitropil (fonturacetam) at a dose of 200 mg per day, divided into two doses. The duration of therapy was 30 days, the total duration of follow-up was 60 days. The effectiveness of treatment was evaluated before and after the course of therapy, as well as in the delayed period according to the scales of asthenia MFI-20, well-being, activity, mood SAN, anxiety and depression HADS (part 1), sleep quality Spiegel, quality of life EQoL-5D-3L. Patients' satisfaction with the treatment and tolerability of therapy were also assessed on 5-point scales; adverse events were recorded and the number of patients with good, satisfactory and unsatisfactory treatment results was calculated based on the subjective assessment of the subjects. Blood parameters analysis was used as laboratory assessment methods: erythrocytes, leukocytes, reticulocytes, platelets, hemoglobin, hematocrit, blood sedimentation rate, total protein, glucose, alanine aminotransferase, aspartate aminotransferase, prothrombin and thrombin time, prothrombin, international normalised ratio, activated partial thromboplastin time, fibrinogen.

Results and conclusion. The results of the study showed high efficacy (98%) and safety of the use of Actitropil (absence of adverse events, low adverse events level during the course of treatment, no negative effect on liver function, blood coagulation and carbohydrate metabolism) in the treatment of various types of asthenic syndrome, including those associated with comorbid diseases. There is a significant therapeutic effect of Actitropil on concomitant symptoms of asthenia: anxiety, sleep status and quality of life. The antiasthenic effect of the drug does not differ depending on age and increases in the delayed period.

Background. Degenerative and dystrophic spinal diseases and associated pain syndrome remain a leading problem for practical health. The symptom-modifying and structurally modifying effects of chondrobrotectors suggest that they may be effective in treating patients with lower back pain (LBP).

Aim. Study of the efficacy of Ambene® Bio in complex therapy of patients with acute LBP associated with degenerative dystrophic spinal diseases.

Materials and methods. The article analyzes the results of examination and treatment of 50 patients with dorsopatia and non-specific LBP, who received treatment in hospital in the neurological department of Saratov City Clinical Hospital №9 or outpatient on the basis of the clinic “Artromedcenter” Saratov. Patients are randomly sampled into two groups of 25 people: those who received (core group) and those who did not receive (comparison group) Ambene® Bio therapy. The groups were comparable by sex, age, and clinical manifestations of dorsopathy. Methods of non-parametric analysis have been applied to statistical processing of the study results. The analysis included computing the median (Me) and quartile scale (Q25–Q75 – 25th and 75th percentiles).

Results. All patients participating in the study noted improvement and reduction of pain syndrome during the treatment. The results of a survey using 100-point VAS indicate that on the 20th day of therapy (visit 2) the lower back pain syndrome significantly decreased from 66.1±8.54 to 23.32±6.76 (p<0.05). In the comparison group the VAS dynamics pain was positive, but not so pronounced: before treatment – 70.11±11.43, on the 20th day of therapy – 46.15±9.38. The sum of test points on the Watkins scale in the core group did not exceed 15 points during the study, while in the HS the total scale was close to the value of 24 points.

Conslusion. The use of Ambene® Bio promotes a faster onset of the analgesic effect – on the 7th day of therapy, pain was practically relieved in 56% of patients in the core group. This made it possible to reduce the dose and shorten the duration of the NSAID course.

Sjogren's disease is an immunoinflammatory rheumatic disease that is characterized by damage to the secreting epithelial glands with the development of parenchymal sialadenitis with xerostomia and keratoconjunctivitis sicca with hypolacrymia. Due to the high heterogeneity of clinical manifestations of this disease, diagnosis is difficult. This article presents a clinical case of a patient with a detailed description of the manifestation, course, and treatment of Sjogren's disease with a rare combination of extraglandular complications in the form of polymyositis and secondary polyneuropathy.

Aim. To study changes in the electrical and viscoelastic parameters of erythrocytes using the method of dielectrophoresis in patients with manifestations of the metabolic syndrome who underwent COVID-19, when exposed to the drug citicoline in an in vitro experiment to reduce the severity of microcirculatory disorders.

Materials and methods. 31 men were examined with manifestations of metabolic syndrome (50.6±9.9 years), COVID-19 convalescences, within 8 to 12 months after the disease, the diagnosis was confirmed by PCR, ELISA. The electrical and viscoelastic parameters of erythrocytes were studied by dielectrophoresis twice: the initial levels of indicators were determined and after 30 minutes of exposure with after 30 minutes of exposure to a solution of the drug Ronocyte (oral solution with the active substance citicoline sodium – 104.50 mg., which is equivalent to 100.00 mg citicoline at a concentration of 0.01 µl per 0.3 µl of red blood cell suspension in 0.3M sucrose solution (pH 7.36).

Results. Exposure of erythrocyte suspension of patients with Ronocyte solution led to change in the levels of electrical, viscoelastic parameters: an increase in the average cell diameter (p=0.0003), the proportion of discocytes (p=0.0004), the amplitude of cell deformation at high frequencies of the electric field (p=0.000002), cell capacity (p=0.000007), the velocity of erythrocytes to the electrodes (p=0.003), dipole moment (p=0.002), polarizability at 106 and 0.5×10⁶ Hz (p=0.000019 and p=0.0015, respectively), relative polarizability (p<0.05) and, conversely, to reduce summarized rigidity (p=0.000003), viscosity (p=0.000002), electrical conductivity (p<0.000001), aggregation indices (p=0.00003), destruction at frequencies of 10⁶ Hz (p=0.003), 0.5x10⁶ Hz (p=0.00002), 0.1×10⁶ Hz (p<0.00001), polarizability at low frequencies of the electric field (p=0.02). Under the influence of the drug, the equilibrium frequency of erythrocytes shifted to the low-frequency range compared to the initial values (p<0.0000001). The revealed changes indicate an increase in the surface charge of erythrocytes, their ability to deform, and cell resistance under the action of citicoline.

Conclusion. For the first time, the effect of the drug with the active substance citicoline, improving the rheological properties of erythrocytes, was discovered. Preparations with the active substance - citicoline should be considered promising for conducting a full-fledged clinical study to study the reduction of circulatory disorders at the microcirculatory level in patients with manifestations of metabolic syndrome who have undergone COVID-19 coronavirus infection.

As part of the III All-Russian Scientific and Practical Conference "Musculoskeletal Pain in Rheumatic Diseases," a symposium on multimodal therapy of osteoarthritis (OA) was held on September 22. Leading Russian experts discussed the results of modern fundamental and practical aspects of OA, analyzed the main world trends in pain control in such patients using drug and non-drug approaches, presented new data on the efficacy and safety of various classes of analgesics and chondroprotective agents, discussed the roles of disease-modifying anti-inflammatory therapy and medical rehabilitation. During the symposium, details of a new OA therapy are presented. The symposium was held with the support of OOO Viatris.