Vol 21, No 2 (2019)

Aim. To create and test an algorithm for rehabilitation goal setting based on international classification of functioning, disability and health (ICF) for patients with acute cerebral stroke. Materials and methods. The study included 75 patients. Rehabilitation was carried out at the first stage for patients in the acute phase of a stroke involving a multidisciplinary team, which included: neurologist, PRM, speech therapist, occupational therapist, physical therapist, clinical psychologist and nurse. For all patients, a rehabilitation diagnosis was established in the categories of ICF. Results. An algorithm of rehabilitation goal setting is based on the ICF and patient’s rehabilitation potential. Conclusions. The main element in the algorithm for determining the rehabilitation goal for a patient with cerebral stroke in the acute period is the selection of one of the most complex activities formulated by the multidisciplinary rehabilitation team in the categories of ICF activity and participation, and available to the patient by the end of the rehabilitation course. The goal of rehabilitation is established on the basis of a rehabilitation diagnosis at the conclusion of each specialist multidisciplinary team of the patient's recovery potential, and its definition is one of the most important technological components of rehabilitation.

The largest study on neurological disorders in patients with laboratory-confirmed acute thallium poisoning was conducted in State Budgetary Healthcare Institution N.V.Sklifosovsky Research Institute of Emergency Medicine of Moscow Department of Health Care. For the first time affected patients were matched by route of poison exposure, time and severity of poisoning, and age. Neurological disorders as well as other symptoms typical for acute thallium poisoning are presented. Incidence of all symptoms and their severity depending on toxic agent concentration in biological liquids are presented. Thallium poisoning should be suspected if such symptoms as alopecia, myalgia of different localization (predominantly in chest and proximal leg muscles), peripheral paraparesis or tetraparesis, sensory polyneuropathy presenting with paresthesia accompanied by pain and/or hypesthesia transforming to mononeuropathy, coordination impairment presented by static or dynamic ataxia, and postural tremor coexist. Thallium determination in blood and urine is an informative diagnostic test. Pain, motor and coordination disturbances are first to regress, and tremor, sensory, cognitive and emotional disturbances preserve for a longer time. Polyneuropathies transform to mononeuropathies in time. Tremor can get worse despite thallium concentration in biological liquids decrease. Patents have cognitive and severe emotional impairment. Patients affected with thallium poisoning require long-term neurologist follow-up as well as rehabilitation.

Aim. To perform a comparative analysis of clinical and laboratory parameters in groups of young women (pregnant or in early postpartum period) with stroke. Materials and methods. The study included 17 pregnant or in early postpartum period women (group 1) and 17 non-pregnant women (group 2) matched by disease severity with mean age 27.7±14.4 years in acute period of stroke in cerebral hemispheres of medium severity. Results. At the discharge improvement in NIH scale results was observed in women in both groups and there were no significant differences in outcomes. Not statistically significant differences of partial pressure of oxygen in venous blood (VB) from the median cubital vein (MCV) and the jugular vein (JV) in both groups at study period were acquired in comparative time interval. Differences in pH levels in VB from the MCV and the JV were observed during hospital stay. In patients from 2 groups pH levels were more acidic in the JV VB than in the MCV VB. Differences in lactate levels in blood from the MCV and the JV were observed. Lactate levels were lower in the MCV VB than in the JV VB during hospital stay in patients from both groups. In patients from both groups glycemia level in the JV VB was lower than in the MCV VB during the whole study period. At the discharge in patients from both groups a decrease in glucose level in arterial and venous blood from the MCV was observed. Arteriovenous oxygen difference (AVOD) in JV VB in 2 study groups was decreasing over time from admission to discharge. Differences in AVOD of VB from JV and MCV and AVOD in JV VB were higher in both study groups during the follow up period. Conclusion. In the conducted study of neurological status, brain and system metabolism charachteristics in patients with brain infarction in dynamics there were no differences found in 2 grops of women of fertile age. The reported changes suggest macroergic compounds deficit, and oxidative stress reactions products utilization disorders in brain tissue.

Introduction. Ischemic stroke (IS) is a complex multifactorial disorder with heterogeneous congenital component. Polymorphic variants of genes of apolipoprotein В (APOB), apolipoprotein А-V (APOА-V), apolipoprotein С-IV (APOC-IV), apolipoprotein H (APOH), apolipoprotein D (APOD), angiopoietin-related protein 4 (ANGPT4) that regulate lipid metabolism and vascular regeneration, may be regarded as perspective ones. Although until recently they were not studied in complex, in a homogenous group from the perspective of possible association with first IS development. Aim. To study association between polymorphic variants of the following genes: АРОH, APOD, APOE, APOA5, APOC4, ANGPT4 and first IS development. Materials and methods. Frequencies of alleles and genotypes of single nucleotide polymorphic gene variants in 200 patients after first IS and in 115 people without stroke matched by sex, age and place of residence were studied. Blood was taken from all study participants in order to perform genotyping assay using protocol by J.Hixson and D.Vernier. Genomic deoxyribonucleic acid extraction from blood was performed using magnetic beads technology on an automated system for nucleic acid extraction Chemagen Prepito (ABBIS, Germany). For single nucleotide polymorphisms typing alleles identification analysis was performed using polymerase chain reaction with prepared TaqMan probes with Assey ID identification number (Applied Biosystems, USA). Amplification of polymorphic regions of the genes was performed with the use of 7500 Real-Time PCR System (Applied Biosystems, USA). Standard amplification conditions were used that were compatible with those defined by chemical agents supplier for each Assey ID. Genotypes nomenclature is given in accordance with international database db SNP (https://www.ncbi.nlm.nih.gov/SNP/). Results. Significant differences between groups in distribution of minor alleles and genotypes were acquired for АРОD (rs7659) and APOA5 (rs619054) polymorphisms. Conclusion. Significant association of single nucleotide АРОD (rs7659) and APOA-V (rs619054) genes polymorphisms with first IS development was found in study groups.

Spinal disc herniation is a pathological anatomical disorder that is associated with localized disk displacement beyond the intervertebral space. Although in most cases surgical intervention is not necessary for recovery, it still has an important role in this disorder treatment. In most patients a course of conservative treatment results in symptoms improvement and in some patients it allows to eliminate symptoms completely. Nevertheless the underlying mechanisms of this spontaneous improvement are still underexplored, though they may provide therapeutic potential that may speed up the recovery process and prevent development of long-term complications. The article considers in detail the origins of inflammatory response in spinal disc herniation development as well as interrelation between spinal disc herniation resorption and symptomatic improvement. Necessity for conduction of future research on the role of inflammatory response in spinal disc herniation formation and resorption is shown. It is important because understanding the reason why most of the patients recover without surgical intervention can speed up the recovery processes and allow many patients to avoid surgical treatment that will also result in improvement of quality of life in this group.

Aim. To compare the safety and efficacy of using various dosage forms of chondroitin sulfate (CS) and glucose amino sulfate (G) in combination with low-intensity laser radiation (LILR) in patients with back pain and joints with comorbid pathology. Materials and methods. 86 patients (60 women and 20 men) aged 62.6±4.6 years with OA knee, hip joints and spondylosarthrosis. 48 patients were treated injecting forms of CS and G in combination with LILR. 20 patients with the same diagnosis and the same age category have had parenteral introduction of CS and G. 18 similar in pathology of patients took oral forms CS and G. Results and discussion. The significant improvement of subjective and objective condition of patients treated with parenteral CS+G and LILR already on 10-12 day of treatment is shown. The pain in the knee joints, lumbar spine decreased to Visual analogue scale (mm) 32% and amounted to 24.8±0.49 mm, whereas before the treatment of its values were 74.4±0.26 mm (p<0.05). On 25-28 observation day and three months later Intensity of pain syndrome continued to decrease significantly and was 18.8±1.12 (p<0.05). In the group, received parenteral therapy, joint pain has significantly decreased already on 10-12, 25-28 day and after 3 months of observation, but less significant when compared with the group 1, p<0.05. In group 3, treated only with oral forms of CS+G, the positive dynamics of this indicator was noted only after three months (p<0.05) and was accompanied by the development of side effects from the digestive organs. Conclusions. The significant advantage of therapy with parenteral forms of CS and G, caused by faster onset of anti-inflammatory and analgesic effect, absence of complications on the part of gastrointestinal tract is demonstrated. Combination of local influence of LILR with introduction of parenteral forms of CS and G has potentially and accelerated all listed effects of subjects of preparations.

Introduction. Tension headache (TH) is the most frequent type of headache. The overall amounts of patients’ disadaptation and social and economic damage caused by TH are more significant than ones caused by migraine. TH diagnostics and treatment are a challenge in outpatient conditions. Aim. To analyze in detail pathogenic mechanisms and chronification factors, and to generalize therapeutic approaches to TH treatment. Materials and methods. Materials from Russian and foreign publications for the last 20 years (PubMed, eLIBRARY and others) as well as clinical guidelines on TH diagnostics and treatment were systematized. Results. According to the results of a population study conducted in Russia in 2009-2011, TH prevalence rate was 30.8% over one year. TH is subdivided into infrequent, frequent and chronic headache. Apart from that, episodic and chronic TH with and without “tension” of pericranial muscles determined by palpation are distinguished. The studies conducted in recent years confirmed neurobiological genesis of TH. Peripheral as well as central mechanisms are involved in its genesis. The main risk factors of TH development include inability of psychological and muscular relaxation and insufficient nocturnal sleep. Emotional stress and pose strain are the most frequent predisposing factors. We thoroughly analyzed data of randomized controlled studies of rapid relief of TH symptoms and identified the most frequently used medications among which ketoprofen (Ketonal®) occupies an important place. Chronic or frequent episodic TH is indication for TH prevention therapy prescription. Antidepressants such as amitriptyline are considered the first choice medications for chronic TH treatment, mirtazapine and venlafaxine are of lower effectiveness. The third choice therapy includes other tricyclic and tetracyclic antidepressants, clomipramine, maprotiline, and mianserine. Effectiveness of muscle relaxant tizanidine use, dosage and duration of its use in TH treatment, possibilities of monotherapy and combination with antidepressants are discussed. Among non-pharmacological treatment methods biofeedback and cognitive behavior therapy are considered the most effective ones. Conclusion. Combination therapy, including non-pharmacological treatment methods along with pharmacotherapy, remains the most effective method of TH treatment.

Dorsopathy (DP) is a frequent musculoskeletal pain syndrome. The main approach to treatment of patients with DP is the use of non-steroid anti-inflammatory drugs (NSAIDs) with account of their analgesic and anti-inflammatory effects. Considering that many patients with DP have a variety of comorbid conditions and need to use medications systematically, risk of adverse effects development and possible drug interactions should be considered in treatment tactics. The use of transdermal NSAIDs delivery systems, in particular Voltaren® Emulgel® 2% , contributes to maintaimance of the balance of treatment effectiveness and safety. Data from 31 scientific sources published in Russia and abroad during years 2008-2019 that present modern view on the use of such treatment, its advantages and disadvantages confirmed with the results of studies of medications bioavailability, effectiveness and safety are reviewed. The use of transdermal NSAIDs delivery systems (gel, cream, plaster) is considered much safer than the use of other drug delivery methods that makes reasonable to use them in patients with concurrent kidney or liver diseases, and in patients with high cardiovascular and gastrointestinal risks. Voltaren® Emulgel® 2% use in patients with DP allows to reduce treatment duration in patients with moderate pain syndrome and to reduce the need for additional NSAIDs and analgesics use.

Chronic cerebrovascular disorders (CCVD) is a group of syndromes with heterogenic development mechanisms associated with a consistent deficit of brain tissue blood supply, consequences of acute cerebrovascular events and its combination. CCVD development is associated with involvement of vessels, primarily small vessels, in pathologic process and to a great extent with microcirculation and systemic hemodynamics disturbance. The key principles of patients with CCVD treatment include control of cardiovascular risk factors - the use of antiplatelet and antihypertensive therapy, statins and glycemic control in the case of appropriate indications. An important aspect in these patients treatment is the use of medications that improve cerebral blood flow. The most important effect of their use is not vasodilatation itself but the increase of vessel wall sensitivity to natural factors that regulate the inner diameter of the vessel. In this respect it appears to be appropriate to use the term “vasoactive medications”. One of these medications is Vasonit® (pentoxifylline) that is a derivative of methylxanthine. The article reviews its clinical effects, possible mechanisms of action and possibilities of use in patients with CCVD.