No 5 (2018)

The article presents the main chronological milestones, the mechanism of action and the spectrum of pharmacological effects of reference and generic ethylmethylhydroxypyridine succinate-based preparations, the regulatory and legal framework, a review of the effectiveness of clinical use from the perspective of evidence-based medicine and personal author’s experience of their use in practically healthy young people (examined in the Health Center) and elderly patients with comorbid cardiological and neurological disorders.

The development of lower limb spastic paresis is a frequent consequence of a stroke. The presence of motor weakness and increased muscle tone leads to the formation of pathological patterns, disrupts gait and balance, causes falls, disables patients, and significantly reduces their quality of life. Rehabilitation of such patients is a complex and time-consuming process requiring correct assessment of the neurological deficit, development of an individual rehabilitation program involving a multidisciplinary team of specialists. In the last decade, preparations of botulinum toxin type A have been actively used in complex rehabilitation programs to correct focal and multifocal lower limb spasticity in order to reduce muscle tone. However, their effectiveness in improving limb function is not so obvious. The article analyzes the results of several studies conducted in the world over the last 5 years with one of the preparations of botulinum toxin type A - Incobotulinumtoxin A (Inco-BTA), in patients with spasticity of the lower extremity, which showed its efficacy and safety in clinical practice with regard to not only decrease muscle tone, but also improve the function of the lower limb and also discussed methods of rehabilitation with different levels of evidence, used in practical health care in this category of patients.

Background. Cognitive disorders are one of the main consequences of acute cerebrovascular accident. Their formation and dynamics of development are determined by a large number of risk factors. Objective. Evaluation of the dynamics of cognitive impairment in patients with hemispheric ischemic stroke and an assessment of the factors influencing it. Methods. 56 patients in the early recovery period of anterior circulation ischemic stroke were examined. The mean age of patients was 64.67±10.19 years. Evaluation of cognitive functions was carried out according to the Montreal Cognitive Assessment (MoCA) score and the IQCODE questionnaire (for detection of pre-stroke cognitive decline in patients). Separately, the neuropsychological profile was determined. The examination was carried out in acute and early recovery periods (6 months after the onset of the stroke). Results. In the acute and early recovery periods of ischemic stroke, there were no significant differences in the MoCA score (21.71±3.26 and 22.05±3.83 points, respectively). Despite the fact that most patients had cognitive status improvement or lack of its dynamics (76.8%), the proportion of patients with dementia increased from 17.9 to 21.4%. The main risk factors influencing the dynamics of cognitive impairment were employment, disability, the presence of cardiac arrhythmias and chronic heart failure. A special role in the deterioration of cognitive functions was played by the presence of pre-stroke cognitive decline. Conclusion. The results of the study indicate that the dynamics of poststroke cognitive impairment depends on many factors. The most important role is played by the pre-strike cognitive deficiency and disability, as well as the presence of cardiac pathology.

Background. Multidisciplinary expertise of the medical care quality (MEMCQ) is one of the most complex, but also highly sensitive tools in the analysis of multi-stage medical assistance. An example of this type of assistance is the Program of Care for Patients with Acute Cerebrovascular Disorders (ACVDs). The complexity of the program is that, starting from the stage of emergency care, it covers the subsequent rehabilitation stage and follow-up care. The Order of the Ministry of Health of the Russian Federation «On approval of the criteria for assessment of the medical care quality» № 203n dated May 10, 2017 offers dichotomous checklists describing the key technological elements of treatment of patients with ACVDs in primary vascular units (PVUs), but does not determine the criteria for the quality of care in neurological units that are not PVUs, rehabilitation and outpatient units, which is not sufficient for a multidisciplinary expertise. Objective. Development and approbation of a set of local checklists for monitoring the regulations of the organizational and methodological tool for a multidisciplinary examination of the quality of multi-stage treatment systems by the example of patients with ACVDs. Methods. A prospective cohort non-randomized study without a comparison group using formalized checklists to monitor the quality of the implementation of the regulation for medical care for patients with ACVDs in the Sverdlovsk Region. Data collection was carried out in accordance with the inclusion criteria within 3 months. Primary endpoint: obtaining an opinion on the results of the multidisciplinary expertise for each case of multi-stage treatment. Results. Expert control was carried out for 491 cases of medical care to 72 patients with ACVDs in the amount of 11 452 313.47 rubles at all stages of medical care. A total of 299 cases (60.9% of verified cases) with defects in medical care delivery and coding of medical care were identified. Conclusion. MEMCQ is a reproducible effective tool for quality control of medical care both at the level of individual medical organizations and individually in every case of ACVDs.

The article discusses the actual problem of differential diagnosis and treatment of diseases manifested by the syndrome of chronic generalized pain (CGP). International diagnostic criteria for fibromyalgia (FM), the main disease characterized by CGP, are listed. Information on the epidemiology and pathogenesis of CGP and FM is given. It is emphasized that a competent clinical assessment for clarifying the causes of CGP is more important than additional diagnostics. The diagnosis of FM can be established in facilities providing primary health care, based on an assessment of conformity with The American College of Rheumatology criteria (ACR, 2010), on the assumption of normal results of objective examination and routine laboratory tests excluding other diseases. The main groups of diseases that should be borne in mind during the diagnostic search for the detection of CGP are: diseases of the musculoskeletal system and connective tissue, endocrinological, gastroenterological, infectious, oncological diseases, neurological disorders, mental health disorders, and iatrogenic pain. Particular attention is paid to ankylosing spondylitis and myofascial pain syndrome. The problems of treatment of FM are discussed.