Vol 26, No 11 (2024): NEUROLOGY AND RHEUMATOLOGY

Aim. To study intravascular changes in hemostasis and changes in electrical, viscoelastic parameters of erythrocytes in COVID-19 convalescents and to evaluate the effectiveness of the pharmacological composition of nicotinamide, cocarboxylase, trifosadenine, cyanocobalamin for intramuscular administration (Cocarnit® drug) and cytidine diphosphocholine (citicoline, Ronocit® drug) to eliminate hemorheological disorders.

Materials and methods. Examined 308 patients (154 men and 154 women), average age 53.1±13.8 years, COVID-19 convalescents, within 2 to 14 months after the disease, 50 people of comparable age and gender who had not suffered COVID-19. 42 patients from the main group who had suffered coronavirus infection received complex therapy (taking the drugs Ronocit® and Cocarnit® (World Medicine Ilac San. Ve Tic. A.S., Turkey), and were re-examined after 8 weeks. The electrical, viscoelastic parameters of erythrocytes were studied by dielectrophoresis using an electro-optical cell detection system; hemostasis parameters were studied by standard methods.

Results. COVID-19 convalescents revealed a marked decrease in the surface charge of erythrocytes with an increased tendency to aggregate formation, a decrease in the ability to deform against the background of high summarized viscosity and rigidity, the predominance of immature cells with reduced polarizability, high readiness for hemolysis, with a significantly altered structure of erythrocyte membranes associated with their thickening and increased ability to conduct electric current (p=0.05–0.00001). Changes in the cellular link, endothelium and leukocytes proved to be dominant in the activation of hemostasis and indicated the course of endotheliitis (p=0.00001). Combined therapy with Ronocit® and Cocarnit® drugs for 8 weeks led to an increase in the diameter of erythrocytes, the proportion of discocytes, a decrease in the proportion of deformed cells and spherocytes (p=0.00007–0.003), an increase in the amplitude of deformation of erythrocytes at high electric field frequencies (10⁶, 5×10⁵ Hz), membrane capacity and a decrease of summarized rigidity and viscosity (p=0.0003–0.04), a decrease in the electrical conductivity of cell membranes, an increase in the speed of movement of red blood cells to the electrodes, the magnitude of the dipole moment; there was a mixing of the crossover frequency into the low frequency range (p=0.0001–0.052). A decrease in the degree of hemolysis was revealed, to a greater extent at low frequencies of the electric field (p=0.0004–0.05), an increase in polarizability at frequencies 5×10⁵, 10⁵, and 5×10⁴ Hz (p=0.005–0.05) and relative polarizability (p=0.001). The normalization of the Willebrand factor level (p=0.0001) was noted, reflecting the restoration of the integrity and function of the endothelium. Intravascular coagulation indices, estimated by the level of soluble fibrin-monomer complexes, decreased (p=0.018). Normalization of bleeding duration (p=0.012), prolongation of clotting time (p=0.001) against the background of complex therapy were established.

Conclusion. The use of complex therapy with Cocarnit® and Ronocit® drugs made it possible to improve the electrical, viscoelastic parameters of erythrocytes, normalize intravascular disorders and eliminate endotheliitis in COVID-19 convalescents, creating the basis for further development of pathogenetic therapy for postcovid syndrome.

The article presents a clinical case of rehabilitation of a patient with moderate cognitive and motor impairment after a COVID-associated stroke. The patient received a complex of rehabilitation measures with daily individualized cognitive training. By the end of the course of medical rehabilitation, the set goals were achieved: the patient learned to make simple decisions on her own, perform separately assigned tasks, independently attend physical therapy classes, physiotherapy, a canteen, walk around the room without the use of aids, climb to the 2nd floor without shortness of breath. The patient showed an improvement in cognitive functions: motor, dynamic and constructive praxis, object gnosis, visual-constructive skills, attention, abstract thinking and speech.

Current approaches to treating multiple sclerosis aim at controlling disease activity. Despite the variety of agents that have proven their effectiveness and were introduced in practice in the last decade, the use of the interferon β group remains relevant. The article presents clinical cases of long-term use of interferons β in treating multiple sclerosis.

Background. Nonsteroidal anti-inflammatory drugs, muscle relaxants, massage, physiotherapy procedures (standard therapy –ST) are widely used in chronic the chest wall pain syndrom (CWPS). Complex therapy (CT) is more effective with CWPS, including additionally personalized kinesiotherapy, psychological treatment methods and the introduction of anesthetics and corticosteroids into the area of identified sources of pain. There are few studies comparing the effectiveness of standard and complex therapy in CWPS, which was the purpose of our study.

Aim. To compare the effectiveness of ST and CT for patients with CWPS.

Materials and methods. One hundred four patients with CWPS were observed, of which 52 patients (19 men and 33 women, 49±14.6 y.o.) received ST, 52 patients (20 men and 32 women, 47±15.8 y.o.) received CT. Pain intensity was assessed using a digital rating scale, the presence of mental disorders – according the Hospital Anxiety and Depression Scale (HADS), functional status – according to the Oswestry questionnaire, quality of life – according to the SF-12 questionnaire.

Results. After 6 months of therapy, the decreases were observed in the intensity of pain from 6.32±0.48 to 3.53±1.9 points in the ST group and from 6.64±0.75 to 2.67±3.2 points in the CT group (p<0.001). A decrease in the severity of depression on the HADS scale from 7.78±0.46 to 6.36±2.6 points in the ST group and from 7.69±3.4 to 5.83±3.4 points in the CT group (p<0.001). A decrease in the severity of anxiety on the HADS scale from 10.47±0.63 to 7.63±2.5 points in the ST group from 10.53±0.58 to 6.42±4.2 points in the CT group (p<0.001). Reduction of functional disorders on the Oswestry scale from 41.14±0.78 to 22.07±14.2% in the ST group and from 40.91±0.56 to 19.1±17.4% in the CT group (p<0.001). Improvement of the quality of life according to the SF-12 questionnaire from 35.01±0.84 to 19.3±21.2 points in the ST group and up to 35.12±0.03 to 13.7±9.8 points in the CT group (p<0.001).

Conclusion. CT in comparison with ST reduces pain more significantly, improves the functional and emotional state of patients, and improves the quality of life. Widespread introduction of CT CWPS into real clinical practice is recommended.

Background. Today it is well known that the structure of sleep disorders and frequency of complaints about sleep disorders depend on the diseases profile. Emotional and behavioral features of patients with different disease profile are important factors affecting the development of sleep disorders.

Aim. To estimate difference of sleep disorders according to the profile of the disease and to assess the emotional and psychological factors that may influence sleep disorders.

Materials and methods. A total of 300 patients participated in the study: 100 from every department (neurological, psychiatric and pulmonological). To assess the quality of sleep Pittsburgh Sleep Quality Index was used; data from the Spielberger anxiety scale, a 5-factor personality questionnaire, and a questionnaire for evaluating coping strategies (coping strategies) were used to assess personal and emotional factors.

Results. Patients from the psychotherapeutic group appeared to be more likely to complain of sleep disorders in general. They also had an average Pittsburgh Sleep Quality Index score higher than patients from neurological and somatic hospitals. In the group of patients with a neurological profile loud snoring is more often reason for sleep disturbing. Awakenings due to difficulties in breathing were more often detected in the group of somatic profile. Situational and personal anxiety influenced the structure of sleep disorders regardless of the disease profile.

Conclusion. The use of various coping strategies has the greatest impact on the presence of sleep disorders in the group of patients with a somatic profile, to a lesser extent – in the group of neurological profile.

Introduction. In rheumatoid arthritis (RA), fractures occur on average 2–3 times more often than in the general population. Data on the incidence of vertebral fractures in RA is controversial and depends on the detection method.

Aim. To determine the incidence of vertebral and peripheral bone fractures in patients with RA during long-term prospective follow-up.

Materials and methods. A prospective multi-year cohort non-interventional study included 120 women with RA (mean age at enrollment 54.3±8.9 years), with a follow-up of 9.5±1.9 years. Initially and then repeatedly, a clinical, laboratory and radiological examination was performed: X-ray morphometry of the spine according to the Genant method, X-ray densitometry of the lumbar spine (L_I-L_IV) and femoral neck.

Results. During the follow-up period, there were 104 low-energy fractures in 64 (53%) patients: 69 (66%) vertebral fractures and 35 (34%) peripheral fractures. Two or more fractures occurred in 25 (39%) subjects. In 30 (25%) patients, 52 fractures occurred repeatedly. Among peripheral fractures, the most frequent localization was fractures of the distal forearm and lower leg bones. Patients with fractures during the follow-up period were also more likely to have fractures before enrollment in the study, had an initially longer duration of RA, a mean daily dose, cumulative dose, and duration of glucocorticoid administration, and a lower bone mineral density in the main parts of the skeleton, determined by densitometry. There was no effect of RA activity on DAS-28, rheumatoid factor positivity, or antibodies to cyclic citrullinated peptide on fractures.

Conclusion. More than half of the patients had low-energy fractures during the observation period, the most common being fractures of the vertebrae, distal forearm, and lower leg bones; a high frequency of repeated fractures was reported. The analysis of risk factors showed that a long duration of RA, a mean daily dose, cumulative dose, and prolonged use of glucocorticoids, a history of low-energy fractures, and low bone mineral density were associated with the occurrence of fractures in patients with RA.